Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report.

PubMed

Weiss, Matthew J; Hornby, Laura; Rochwerg, Bram; van Manen, Michael; Dhanani, Sonny; Sivarajan, V Ben; Appleby, Amber; Bennett, Mary; Buchman, Daniel; Farrell, Catherine; Goldberg, Aviva; Greenberg, Rebecca; Singh, Ram; Nakagawa, Thomas A; Witteman, William; Barter, Jill; Beck, Allon; Coughlin, Kevin; Conradi, Alf; Cupido, Cynthia; Dawson, Rosanne; Dipchand, Anne; Freed, Darren; Hornby, Karen; Langlois, Valerie; Mack, Cheryl; Mahoney, Meagan; Manhas, Deepak; Tomlinson, Christopher; Zavalkoff, Samara; Shemie, Sam D

2017-11-01

Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.

Research recommendations

NASA Technical Reports Server (NTRS)

1979-01-01

The research and development sequences and priorities for CELSS development were established for each of the following areas: nutrition and food processing, food production, waste processing, systems engineering/modeling, and ecology-systems safety.

Allied health clinicians using translational research in action to develop a reliable stroke audit tool.

PubMed

Abery, Philip; Kuys, Suzanne; Lynch, Mary; Low Choy, Nancy

2018-05-23

To design and establish reliability of a local stroke audit tool by engaging allied health clinicians within a privately funded hospital. Design: Two-stage study involving a modified Delphi process to inform stroke audit tool development and inter-tester reliability. Allied health clinicians. A modified Delphi process to select stroke guideline recommendations for inclusion in the audit tool. Reliability study: 1 allied health representative from each discipline audited 10 clinical records with sequential admissions to acute and rehabilitation services. Recommendations were admitted to the audit tool when 70% agreement was reached, with 50% set as the reserve agreement. Inter-tester reliability was determined using intra-class correlation coefficients (ICCs) across 10 clinical records. Twenty-two participants (92% female, 50% physiotherapists, 17% occupational therapists) completed the modified Delphi process. Across 6 voting rounds, 8 recommendations reached 70% agreement and 2 reached 50% agreement. Two recommendations (nutrition/hydration; goal setting) were added to ensure representation for all disciplines. Substantial consistency across raters was established for the audit tool applied in acute stroke (ICC .71; range .48 to .90) and rehabilitation (ICC.78; range .60 to .93) services. Allied health clinicians within a privately funded hospital generally agreed in an audit process to develop a reliable stroke audit tool. Allied health clinicians agreed on stroke guideline recommendations to inform a stroke audit tool. The stroke audit tool demonstrated substantial consistency supporting future use for service development. This process, which engages local clinicians, could be adopted by other facilities to design reliable audit tools to identify local service gaps to inform changes to clinical practice. © 2018 John Wiley & Sons, Ltd.

Using multicriteria decision analysis during drug development to predict reimbursement decisions.

PubMed

Williams, Paul; Mauskopf, Josephine; Lebiecki, Jake; Kilburg, Anne

2014-01-01

Pharmaceutical companies design clinical development programs to generate the data that they believe will support reimbursement for the experimental compound. The objective of the study was to present a process for using multicriteria decision analysis (MCDA) by a pharmaceutical company to estimate the probability of a positive recommendation for reimbursement for a new drug given drug and environmental attributes. The MCDA process included 1) selection of decisions makers who were representative of those making reimbursement decisions in a specific country; 2) two pre-workshop questionnaires to identify the most important attributes and their relative importance for a positive recommendation for a new drug; 3) a 1-day workshop during which participants undertook three tasks: i) they agreed on a final list of decision attributes and their importance weights, ii) they developed level descriptions for these attributes and mapped each attribute level to a value function, and iii) they developed profiles for hypothetical products 'just likely to be reimbursed'; and 4) use of the data from the workshop to develop a prediction algorithm based on a logistic regression analysis. The MCDA process is illustrated using case studies for three countries, the United Kingdom, Germany, and Spain. The extent to which the prediction algorithms for each country captured the decision processes for the workshop participants in our case studies was tested using a post-meeting questionnaire that asked the participants to make recommendations for a set of hypothetical products. The data collected in the case study workshops resulted in a prediction algorithm: 1) for the United Kingdom, the probability of a positive recommendation for different ranges of cost-effectiveness ratios; 2) for Spain, the probability of a positive recommendation at the national and regional levels; and 3) for Germany, the probability of a determination of clinical benefit. The results from the post-meeting questionnaire revealed a high predictive value for the algorithm developed using MCDA. Prediction algorithms developed using MCDA could be used by pharmaceutical companies when designing their clinical development programs to estimate the likelihood of a favourable reimbursement recommendation for different product profiles and for different positions in the treatment pathway.

Using multicriteria decision analysis during drug development to predict reimbursement decisions

PubMed Central

Williams, Paul; Mauskopf, Josephine; Lebiecki, Jake; Kilburg, Anne

2014-01-01

Background Pharmaceutical companies design clinical development programs to generate the data that they believe will support reimbursement for the experimental compound. Objective The objective of the study was to present a process for using multicriteria decision analysis (MCDA) by a pharmaceutical company to estimate the probability of a positive recommendation for reimbursement for a new drug given drug and environmental attributes. Methods The MCDA process included 1) selection of decisions makers who were representative of those making reimbursement decisions in a specific country; 2) two pre-workshop questionnaires to identify the most important attributes and their relative importance for a positive recommendation for a new drug; 3) a 1-day workshop during which participants undertook three tasks: i) they agreed on a final list of decision attributes and their importance weights, ii) they developed level descriptions for these attributes and mapped each attribute level to a value function, and iii) they developed profiles for hypothetical products ‘just likely to be reimbursed’; and 4) use of the data from the workshop to develop a prediction algorithm based on a logistic regression analysis. The MCDA process is illustrated using case studies for three countries, the United Kingdom, Germany, and Spain. The extent to which the prediction algorithms for each country captured the decision processes for the workshop participants in our case studies was tested using a post-meeting questionnaire that asked the participants to make recommendations for a set of hypothetical products. Results The data collected in the case study workshops resulted in a prediction algorithm: 1) for the United Kingdom, the probability of a positive recommendation for different ranges of cost-effectiveness ratios; 2) for Spain, the probability of a positive recommendation at the national and regional levels; and 3) for Germany, the probability of a determination of clinical benefit. The results from the post-meeting questionnaire revealed a high predictive value for the algorithm developed using MCDA. Conclusions Prediction algorithms developed using MCDA could be used by pharmaceutical companies when designing their clinical development programs to estimate the likelihood of a favourable reimbursement recommendation for different product profiles and for different positions in the treatment pathway.

Choosing Wisely: assessment of current US top five list recommendations’ trustworthiness using a pragmatic approach

PubMed Central

Horvath, Karl; Semlitsch, Thomas; Jeitler, Klaus; Abuzahra, Muna E; Posch, Nicole; Domke, Andreas; Siebenhofer, Andrea

2016-01-01

Objectives Identification of sufficiently trustworthy top 5 list recommendations from the US Choosing Wisely campaign. Setting Not applicable. Participants All top 5 list recommendations available from the American Board of Internal Medicine Foundation website. Main outcome measures/interventions Compilation of US top 5 lists and search for current German highly trustworthy (S3) guidelines. Extraction of guideline recommendations, including grade of recommendation (GoR), for suggestions comparable to top 5 list recommendations. For recommendations without guideline equivalents, the methodological quality of the top 5 list development process was assessed using criteria similar to that used to judge guidelines, and relevant meta-literature was identified in cited references. Judgement of sufficient trustworthiness of top 5 list recommendations was based either on an ‘A’ GoR of guideline equivalents or on high methodological quality and citation of relevant meta-literature. Results 412 top 5 list recommendations were identified. For 75 (18%), equivalents were found in current German S3 guidelines. 44 of these recommendations were associated with an ‘A’ GoR, or a strong recommendation based on strong evidence, and 26 had a ‘B’ or a ‘C’ GoR. No GoR was provided for 5 recommendations. 337 recommendations had no equivalent in the German S3 guidelines. The methodological quality of the development process was high and relevant meta-literature was cited for 87 top 5 list recommendations. For a further 36, either the methodological quality was high without any meta-literature citations or meta-literature citations existed but the methodological quality was lacking. For the remaining 214 recommendations, either the methodological quality was lacking and no literature was cited or the methodological quality was generally unsatisfactory. Conclusions 131 of current US top 5 list recommendations were found to be sufficiently trustworthy. For a substantial number of current US top 5 list recommendations, their trustworthiness remains unclear. Methodological requirements for developing top 5 lists are recommended. PMID:27855098

US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis

PubMed Central

Olivier, Kenneth N; Saiman, Lisa; Daley, Charles L; Herrmann, Jean-Louis; Nick, Jerry A; Noone, Peadar G; Bilton, Diana; Corris, Paul; Gibson, Ronald L; Hempstead, Sarah E; Koetz, Karsten; Sabadosa, Kathryn A; Sermet-Gaudelus, Isabelle; Smyth, Alan R; van Ingen, Jakko; Wallace, Richard J; Winthrop, Kevin L; Marshall, Bruce C; Haworth, Charles S

2016-01-01

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with pre-existing inflammatory lung disease such as cystic fibrosis (CF). Pulmonary disease caused by NTM has emerged as a major threat to the health of individuals with CF but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened an expert panel of specialists to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM pulmonary disease in individuals with CF. Nineteen experts were invited to participate in the recommendation development process. Population, Intervention, Comparison, Outcome (PICO) methodology and systematic literature reviews were employed to inform draft recommendations. An anonymous voting process was used by the committee to reach consensus. All committee members were asked to rate each statement on a scale of: 0, completely disagree, to 9, completely agree; with 80% or more of scores between 7 and 9 being considered ‘good’ agreement. Additionally, the committee solicited feedback from the CF communities in the USA and Europe and considered the feedback in the development of the final recommendation statements. Three rounds of voting were conducted to achieve 80% consensus for each recommendation statement. Through this process, we have generated a series of pragmatic, evidence-based recommendations for the screening, investigation, diagnosis and treatment of NTM infection in individuals with CF as an initial step in optimising management for this challenging condition. PMID:26666259

Appendix C: Rapid development approaches for system engineering and design

NASA Technical Reports Server (NTRS)

1993-01-01

Conventional system architectures, development processes, and tool environments often produce systems which exceed cost expectations and are obsolete before they are fielded. This paper explores some of the reasons for this and provides recommendations for how we can do better. These recommendations are based on DoD and NASA system developments and on our exploration and development of system/software engineering tools.

Assessment of DoD Enterprise Resource Planning Business Systems

DTIC Science & Technology

2011-02-01

activities, and processes to the organizational units that execute them • Architecture standards, such as application of the BPMN • Recommended...Recommendation: • Create and use style guides for the development of BPMN based process models. The style guide would probably include specifications such as...o All processes must have ‘entry points’ or ‘triggers’ in the form of BPMN Events o All processes must have ‘outcomes’ also in the form of BPMN

A student-led process to enhance the learning and teaching of teamwork skills in medicine.

PubMed

Balasooriya, Chinthaka; Olupeliyawa, Asela; Iqbal, Maha; Lawley, Claire; Cohn, Amanda; Ma, David; Luu, Queenie

2013-01-01

The development of teamwork skills is a critical aspect of modern medical education. This paper reports on a project that aimed to identify student perceptions of teamwork-focused learning activities and generate student recommendations for the development of effective educational strategies. The project utilized a unique method, which drew on the skills of student research assistants (RAs) to explore the views of their peers. Using structured interview guides, the RAs interviewed their colleagues to clarify their perceptions of the effectiveness of current methods of teamwork teaching and to explore ideas for more effective methods. The RAs shared their deidentified findings with each other, identified preliminary themes, and developed a number of recommendations which were finalized through consultation with faculty. The key themes that emerged focused on the need to clarify the relevance of teamwork skills to clinical practice, reward individual contributions to group process, facilitate feedback and reflection on teamwork skills, and systematically utilize clinical experiences to support experiential learning of teamwork. Based on these findings, a number of recommendations for stage appropriate teamwork learning and assessment activities were developed. Key among these were recommendations to set up a peer-mentoring system for students, suggestions for more authentic teamwork assessment methods, and strategies to utilize the clinical learning environment in developing teamwork skills. The student-led research process enabled identification of issues that may not have been otherwise revealed by students, facilitated a better understanding of teamwork teaching and developed ownership of the curriculum among students. The project enabled the development of recommendations for designing learning, teaching, and assessment methods that were likely to be more effective from a student perspective.

Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an upper-middle income country on the GRADE approach

PubMed Central

Mosquera, Paola; Alzate, Juan Pablo; Pottie, Kevin; Welch, Vivian; Akl, Elie A; Jull, Janet; Lang, Eddy; Katikireddi, Srinivasa Vittal; Morton, Rachel; Thabane, Lehana; Shea, Bev; Stein, Airton T; Singh, Jasvinder; Florez, Ivan D; Guyatt, Gordon; Schünemann, Holger; Tugwell, Peter

2017-01-01

Abstract The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines (‘guidelines’) can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation. PMID:29029068

Total Coliform Rule Distribution System Advisory Committee (TCRDSAC) Document

EPA Pesticide Factsheets

This document provide information about the TCRDSAC, including its charter, processes and recommendations. The Agency used the Advisory Committee recommendations to develop proposed and final rules that revised the Total Coliform Rule.

Implementing AORN recommended practices for medication safety.

PubMed

Hicks, Rodney W; Wanzer, Linda J; Denholm, Bonnie

2012-12-01

Medication errors in the perioperative setting can result in patient morbidity and mortality. The AORN "Recommended practices for medication safety" provide guidance to perioperative nurses in developing, implementing, and evaluating safe medication use practices. These practices include recognizing risk points in the medication use process, collaborating with pharmacy staff members, conducting preoperative assessments and postoperative evaluations (eg, medication reconciliation), and handling hazardous medications and pharmaceutical waste. Strategies for successful implementation of the recommended practices include promoting a basic understanding of the nurse's role in the medication use process and developing a medication management plan as well as policies and procedures that support medication safety and activities to measure compliance with safe practices. Published by Elsevier Inc.

Self-Employment for People with Disabilities in the United States: A Recommended Process for Vocational Rehabilitation Agencies.

ERIC Educational Resources Information Center

Arnold, Nancy; Seekins, Tom; Ipsen, Catherine; Colling, Kyle

2003-01-01

Recommends a research-based process for rehabilitation agencies assisting clients with self-employment. Steps include counselor-client dialog about self-employment, use of assessment tools and resources, education/training, development of a business plan, start-up funding from the agency and other sources, business start-up, and evaluation of…

A novel process for updating recommendations for managing hypertension: rationale and methods.

PubMed

Zarnke, K B; Campbell, N R; McAlister, F A; Levine, M

2000-09-01

There are numerous hypertension consensus recommendations intended for practising physicians. However, recommendations in their current format have limited impact on improving hypertension control. A group of national societies, headed by the Canadian Hypertension Society, the Heart and Stroke Foundation of Canada, the Canadian Coalition for High Blood Pressure Prevention and Control, and Health Canada has developed strategies to maintain annually updated recommendations for hypertension management and to provide greater opportunities for their implementation into clinical practice. The process is overseen by a steering committee. Subcommittees have been formed for each of a list of topics seen as important to the control of hypertension. The subcommittees, with the aid of a central librarian, conduct annual literature reviews in accordance with Cochrane Collaboration strategies. Modified existing and new recommendations are forwarded to a group with expertise in clinical epidemiology. Grades of evidence are assigned to each recommendation. Revised recommendations based on the above process will be presented annually at the conjoint Canadian Hypertension Society/Canadian Cardiovascular Congress meeting. Under the leadership of the Cardiovascular Disease Division of the Laboratory Centre for Disease Control, Health Canada, a committee has been charged with the implementation process. The improvements of the current process over previous national hypertension recommendations are four-fold. First, the recommendations will be updated annually. Second, the methodology has been improved. Third, the grading system can be used in the evaluation of complex study designs. Finally, the implementation process is extended. The authors are optimistic that these changes will contribute to the improvement of hypertension control in the Canadian population.

Building SAWE Capability as an ANSI Accredited Standards Developer

NASA Technical Reports Server (NTRS)

Cerro, Jeffrey A.; Davis, Ed; Peterson, Eric; Griffiths, William T.; Brooks, Andy; Stratton, Bonnie; Attar, Jose

2014-01-01

This paper presents a 2014 status of the Society of Allied Weight Engineers' process towards becoming an Accredited Standards Developer (ASD) under certification by the United States American National Standards Institute (ANSI). Included is material from the committee's 2013 International presentation, current status, and additional general background material. The document strives to serve as a reference point to assist SAWE Recommended Practice and Standards developers in negotiating United States Standards Strategy, international standards strategy, and the association of SAWE standards and recommended practices to those efforts. Required procedures for SAWE to develop and maintain Recommended Practices and ANSI/SAWE Standards are reviewed.

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion.

PubMed

Heffernan, Kayla Joanne; Chang, Shanton; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

2016-02-09

The now ubiquitous catchphrase, "There's an app for that," rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of "do no harm." There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety.

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion

PubMed Central

Heffernan, Kayla Joanne; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

2016-01-01

Background The now ubiquitous catchphrase, “There’s an app for that,” rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of “do no harm.” There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. Objective This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. Methods For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. Results By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). Conclusions This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety. PMID:26860623

The development of clinical practice guidelines and guidance statements of the American College of Physicians: summary of methods.

PubMed

Qaseem, Amir; Snow, Vincenza; Owens, Douglas K; Shekelle, Paul

2010-08-03

The American College of Physicians (ACP) established its evidence-based clinical practice guidelines program in 1981. The ACP's Guidelines Committee and the staff of the Clinical Programs and Quality of Care Department develop the clinical recommendations. The ACP develops 2 different types of clinical recommendations: clinical practice guidelines and clinical guidance statements. The ACP clinical practice guidelines and guidance statements follow a multistep development process that includes a systematic review of the evidence, deliberation of the evidence by the committee, summary recommendations, and evidence and recommendation grading. All ACP clinical practice guidelines and clinical guidance statements, if not updated, are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.

Background to the development process, Automated Residential Energy Standard (ARES) in support of proposed interim energy conservation voluntary performance standards for new non-federal residential buildings: Volume 3

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This report documents the development and testing of a set of recommendations generated to serve as a primary basis for the Congressionally-mandated residential standard. This report treats only the residential building recommendations.

Information Flow Analysis of Level 4 Payload Processing Operations

NASA Technical Reports Server (NTRS)

Danz, Mary E.

1991-01-01

The Level 4 Mission Sequence Test (MST) was studied to develop strategies and recommendations to facilitate information flow. Recommendations developed as a result of this study include revised format of the Test and Assembly Procedure (TAP) document and a conceptualized software based system to assist in the management of information flow during the MST.

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death—Summary Report*

PubMed Central

Hornby, Laura; Rochwerg, Bram; van Manen, Michael; Dhanani, ; Sonny; Sivarajan, V. Ben; Appleby, Amber; Bennett, Mary; Buchman, Daniel; Farrell, Catherine; Goldberg, Aviva; Greenberg, Rebecca; Singh, Ram; Nakagawa, Thomas A.; Witteman, William; Barter, Jill; Beck, Allon; Coughlin, Kevin; Conradi, Alf; Cupido, Cynthia; Dawson, Rosanne; Dipchand, Anne; Freed, Darren; Hornby, Karen; Langlois, Valerie; Mack, Cheryl; Mahoney, Meagan; Manhas, Deepak; Tomlinson, Christopher; Zavalkoff, Samara; Shemie, Sam D.

2017-01-01

Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. Results: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. Conclusions: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation. PMID:28925929

EAES recommendations on methodology of innovation management in endoscopic surgery.

PubMed

Neugebauer, Edmund A M; Becker, Monika; Buess, Gerhard F; Cuschieri, Alfred; Dauben, Hans-Peter; Fingerhut, Abe; Fuchs, Karl H; Habermalz, Brigitte; Lantsberg, Leonid; Morino, Mario; Reiter-Theil, Stella; Soskuty, Gabriela; Wayand, Wolfgang; Welsch, Thilo

2010-07-01

Under the mandate of the European Association for Endoscopic Surgery (EAES) a guideline on methodology of innovation management in endoscopic surgery has been developed. The primary focus of this guideline is patient safety, efficacy, and effectiveness. An international expert panel was invited to develop recommendations for the assessment and introduction of surgical innovations. A consensus development conference (CDC) took place in May 2009 using the method of a nominal group process (NGP). The recommendations were presented at the annual EAES congress in Prague, Czech Republic, on June 18th, 2009 for discussion and further input. After further Delphi processes between the experts, the final recommendations were agreed upon. The development and implementation of innovations in surgery are addressed in five sections: (1) definition of an innovation, (2) preclinical and (3) clinical scientific development, (4) scientific approval, and (5) implementation along with monitoring. Within the present guideline each of the sections and several steps are defined, and several recommendations based on available evidence have been agreed within each category. A comprehensive workflow of the different steps is given in an algorithm. In addition, issues of health technology assessment (HTA) serving to estimate efficiency followed by ethical directives are given. Innovations into clinical practice should be introduced with the highest possible grade of safety for the patient (nil nocere: do no harm). The recommendations can contribute to the attainment of this objective without preventing future promising diagnostic and therapeutic innovations in the field of surgery and allied techniques.

EPICO 4.0. 'Total quality' in the management of invasive candidiasis in critically ill patients by analysing the integrated process.

PubMed

Zaragoza, Rafael; Ferrer, Ricard; Llinares, Pedro; Maseda, Emilio; Rodríguez, Alejandro; Grau, Santiago; Quindós, Guillermo

A high quality integrated process in the clinical setting of non-neutropenic critically ill patients at risk for invasive candidiasis is a necessary tool to improve the management of these patients. To identify the key points on invasive candidiasis in order to develop a set of recommendations with a high level of consensus required for the creation of a total quality integrated process for the management of non-neutropenic critically ill patients at risk of invasive candidiasis. After a thorough review of the literature of the previous five years, a Spanish prospective questionnaire, which measured consensus by the Delphi technique, was anonymously conducted by e-mail, including 31 national multidisciplinary experts with extensive experience in invasive fungal infections, from six national scientific societies. The experts included a specialist in intensive care medicine, anesthetists, microbiologists, pharmacologists, and specialists in infectious diseases that responded 27 questions prepared by the coordination group. The educational objectives considered six processes that included knowledge of the local epidemiology, the creation and development of multidisciplinary teams, the definitions of the process, protocols, and indicators (KPI), an educational phase, hospital implementation, and the measurement of outcomes. The level of agreement among experts in each category to be selected should exceed 70%. In a second phase, after drawing up the recommendations of the selected processes, a face to face meeting with more than 60 specialists was held. The specialists were asked to validate the pre-selected recommendations. Firstly, 20 recommendations from all the sections were pre-selected: Knowledge of local epidemiology (3 recommendations), creation and development of multidisciplinary teams (3), definition of the process, protocols and indicators (1), educational phase (3), hospital implementation (3), and measurement of outcomes (7). After the second phase, 18 recommendations were validated, and it was concluded that the minimum team or core necessary for the development of an efficient program in the use of antifungal drugs in non-neutropenic critically ill patients must consist of a specialist in infectious diseases, a clinical pharmacist, a microbiologist, a specialist in intensive care medicine, a specialist in anesthesia and recovery, and an administrator or member of the medical management team, and, in order to be cost-effective, it should be implemented in hospitals with over 200 beds. In addition, it is recommended to apply a consensual check list for the evaluation of the diagnostic process and treatment of invasive candidiasis in patients that have started an antifungal treatment. The management of external knowledge and individual learning stand out as active educational strategies. The main strategies for measuring patient safety outcomes are the analysis of the results achieved, and learning activities; assess, review and refine the deployment of the processes; quality control; epidemiological surveillance and applied research; benchmarking; and basic research. The results of the integrated process should be annually disseminated outside the hospital. Optimizing the management of invasive candidiasis requires the application of the knowledge and skills detailed in our recommendations. These recommendations, based on the Delphi methodology, facilitate the creation of a total quality integrated process in critically-ill patients at risk for invasive candidiasis. Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT.

PubMed

Schünemann, Holger J; Wiercioch, Wojtek; Brozek, Jan; Etxeandia-Ikobaltzeta, Itziar; Mustafa, Reem A; Manja, Veena; Brignardello-Petersen, Romina; Neumann, Ignacio; Falavigna, Maicon; Alhazzani, Waleed; Santesso, Nancy; Zhang, Yuan; Meerpohl, Jörg J; Morgan, Rebecca L; Rochwerg, Bram; Darzi, Andrea; Rojas, Maria Ximenas; Carrasco-Labra, Alonso; Adi, Yaser; AlRayees, Zulfa; Riva, John; Bollig, Claudia; Moore, Ainsley; Yepes-Nuñez, Juan José; Cuello, Carlos; Waziry, Reem; Akl, Elie A

2017-01-01

Guideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. To describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks. We applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations. We produced a total of 80 EtD frameworks in approximately 4 months and 146 EtDs in approximately 6 months in two waves. Use of the EtD frameworks allowed panel members understand judgments of others about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach. The "GRADE-ADOLOPMENT" approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If developers of guidelines follow EtD criteria more widely and make their work publically available, this approach should prove even more useful. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Development of an evidence-based review with recommendations using an online iterative process.

PubMed

Rudmik, Luke; Smith, Timothy L

2011-01-01

The practice of modern medicine is governed by evidence-based principles. Due to the plethora of medical literature, clinicians often rely on systematic reviews and clinical guidelines to summarize the evidence and provide best practices. Implementation of an evidence-based clinical approach can minimize variation in health care delivery and optimize the quality of patient care. This article reports a method for developing an "Evidence-based Review with Recommendations" using an online iterative process. The manuscript describes the following steps involved in this process: Clinical topic selection, Evidence-hased review assignment, Literature review and initial manuscript preparation, Iterative review process with author selection, and Manuscript finalization. The goal of this article is to improve efficiency and increase the production of evidence-based reviews while maintaining the high quality and transparency associated with the rigorous methodology utilized for clinical guideline development. With the rise of evidence-based medicine, most medical and surgical specialties have an abundance of clinical topics which would benefit from a formal evidence-based review. Although clinical guideline development is an important methodology, the associated challenges limit development to only the absolute highest priority clinical topics. As outlined in this article, the online iterative approach to the development of an Evidence-based Review with Recommendations may improve productivity without compromising the quality associated with formal guideline development methodology. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

The space shuttle payload planning working groups: Volume 9: Materials processing and space manufacturing

NASA Technical Reports Server (NTRS)

1973-01-01

The findings and recommendations of the Materials Processing and Space Manufacturing group of the space shuttle payload planning activity are presented. The effects of weightlessness on the levitation processes, mixture stability, and control over heat and mass transport in fluids are considered for investigation. The research and development projects include: (1) metallurgical processes, (2) electronic materials, (3) biological applications, and (4)nonmetallic materials and processes. Additional recommendations are provided concerning the allocation of payload space, acceptance of experiments for flight, flight qualification, and private use of the space shuttle.

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: screening and diagnosis recommendations.

PubMed

Mehta, S; Guy, S D; Bryce, T N; Craven, B C; Finnerup, N B; Hitzig, S L; Orenczuk, S; Siddall, P J; Widerström-Noga, E; Casalino, A; Côté, I; Harvey, D; Kras-Dupuis, A; Lau, B; Middleton, J W; Moulin, D E; O'Connell, C; Parrent, A G; Potter, P; Short, C; Teasell, R; Townson, A; Truchon, C; Wolfe, D; Bradbury, C L; Loh, E

2016-08-01

Clinical practice guidelines. To develop the first Canadian clinical practice guidelines for screening and diagnosis of neuropathic pain in people with spinal cord injury (SCI). The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. The CanPainSCI Working Group reviewed evidence to address clinical questions regarding screening and diagnosis of neuropathic pain after SCI. A consensus process was followed to achieve agreement on recommendations and clinical considerations. Twelve recommendations, based on expert consensus, were developed for the screening and diagnosis of neuropathic pain after SCI. The recommendations address methods for assessment, documentation tools, team member accountability, frequency of screening and considerations for diagnostic investigation. Important clinical considerations accompany each recommendation. The expert Working Group developed recommendations for the screening and diagnosis of neuropathic pain after SCI that should be used to inform practice.

Developing guidelines in low-income and middle-income countries: lessons from Kenya

PubMed Central

English, Mike; Irimu, Grace; Nyamai, Rachel; Were, Fred; Garner, Paul; Opiyo, Newton

2017-01-01

There are few examples of sustained nationally organised, evidence-informed clinical guidelines development processes in Sub-Saharan Africa. We describe the evolution of efforts from 2005 to 2015 to support evidence-informed decision making to guide admission hospital care practices in Kenya. The approach to conduct reviews, present evidence, and structure and promote transparency of consensus-based procedures for making recommendations improved over four distinct rounds of policy making. Efforts to engage important voices extended from government and academia initially to include multiple professional associations, regulators and practitioners. More than 100 people have been engaged in the decision-making process; an increasing number outside the research team has contributed to the conduct of systematic reviews, and 31 clinical policy recommendations has been developed. Recommendations were incorporated into clinical guideline booklets that have been widely disseminated with a popular knowledge and skills training course. Both helped translate evidence into practice. We contend that these efforts have helped improve the use of evidence to inform policy. The systematic reviews, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches and evidence to decision-making process are well understood by clinicians, and the process has helped create a broad community engaged in evidence translation together with a social or professional norm to use evidence in paediatric care in Kenya. Specific sustained efforts should be made to support capacity and evidence-based decision making in other African settings and clinical disciplines. PMID:28584069

US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis.

PubMed

Floto, R Andres; Olivier, Kenneth N; Saiman, Lisa; Daley, Charles L; Herrmann, Jean-Louis; Nick, Jerry A; Noone, Peadar G; Bilton, Diana; Corris, Paul; Gibson, Ronald L; Hempstead, Sarah E; Koetz, Karsten; Sabadosa, Kathryn A; Sermet-Gaudelus, Isabelle; Smyth, Alan R; van Ingen, Jakko; Wallace, Richard J; Winthrop, Kevin L; Marshall, Bruce C; Haworth, Charles S

2016-01-01

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with pre-existing inflammatory lung disease such as cystic fibrosis (CF). Pulmonary disease caused by NTM has emerged as a major threat to the health of individuals with CF but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened an expert panel of specialists to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM pulmonary disease in individuals with CF. Nineteen experts were invited to participate in the recommendation development process. Population, Intervention, Comparison, Outcome (PICO) methodology and systematic literature reviews were employed to inform draft recommendations. An anonymous voting process was used by the committee to reach consensus. All committee members were asked to rate each statement on a scale of: 0, completely disagree, to 9, completely agree; with 80% or more of scores between 7 and 9 being considered 'good' agreement. Additionally, the committee solicited feedback from the CF communities in the USA and Europe and considered the feedback in the development of the final recommendation statements. Three rounds of voting were conducted to achieve 80% consensus for each recommendation statement. Through this process, we have generated a series of pragmatic, evidence-based recommendations for the screening, investigation, diagnosis and treatment of NTM infection in individuals with CF as an initial step in optimising management for this challenging condition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The 2014 International Pressure Ulcer Guideline: methods and development.

PubMed

Haesler, Emily; Kottner, Jan; Cuddigan, Janet

2017-06-01

A discussion of the methodology used to develop the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. (2014). International experts representing National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance developed the second edition of this clinical guideline. Discussion paper - methodology. A comprehensive search for papers published up to July 2013 was conducted in 11 databases and identified 4286 studies. After critical appraisal, 356 studies were included and assigned a level of evidence. Guideline recommendations provide guidance on best practice in pressure ulcer prevention and treatment. Understanding the development process of a guideline increases the meaningfulness of recommendations to clinicians. Five hundred and seventy five recommendations arose from the research and its interpretation. The body of evidence supporting each recommendation was assigned a strength of evidence. A strength of recommendation was assigned to recommendation statements using the GRADE system. Recommendations are primarily supported by a body of evidence rated as C (87% of recommendations), representing low quality and/or indirect evidence (30%) and expert opinion (57%). Two hundred and forty seven recommendations (43%) received a strong recommendation ('Do it'). Recommendations were developed with consideration to research of the highest methodological quality evidence and studies that add to clinical insight and provide guidance for areas of care where minimal research has been conducted. Recommendations in the guideline reflect best practice and should be implemented with consideration to local context and resources and the individual's preferences and needs. © 2016 John Wiley & Sons Ltd.

Raising the quality of rheumatology management recommendations: lessons from the EULAR process 10 years after provision of standard operating procedures.

PubMed

Colebatch-Bourn, Alexandra N; Conaghan, Philip G; Arden, Nigel K; Cooper, Cyrus; Dougados, Maxime; Edwards, Christopher J

2015-08-01

To increase understanding of how to raise the quality of rheumatology guidelines by reviewing European League Against Rheumatism (EULAR) management recommendations, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 10 years after publication of the EULAR standardized operating procedures (SOP) for the production of recommendations. It was hoped that this work could help inform improvements in guideline development by other societies and organizations. The SOP were published in 2004 to ensure the quality of EULAR-endorsed recommendations. We reviewed 27 published EULAR recommendations for management using the AGREE II tool. This provides a framework to assess the quality of guidelines across six broad domains using 23 specific questions. Overall the EULAR recommendations reviewed have been performed to a high standard. There are particular strengths in the methodology and presentation of the guidelines; however, the results indicate areas for development in future recommendations: in particular, stakeholder involvement and applicability of the recommendations. Improvements in quality were evident in recent years, with patient representation in 9 of 15 (60.0%) recommendations published 2010-14 compared with 4 of 12 (33.3%) published 2000-09. In the last 10 years the overall quality of recommendations was good, with standards improving over the decade following publication of the SOP. However, this review process has identified potential areas for improvement, especially in patient representation and provision of implementation tools. The lessons from this work can be applied to the development of rheumatology guidelines by other societies and organizations. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Recommendations for Selecting Drug-Drug Interactions for Clinical Decision Support

PubMed Central

Tilson, Hugh; Hines, Lisa E.; McEvoy, Gerald; Weinstein, David M.; Hansten, Philip D.; Matuszewski, Karl; le Comte, Marianne; Higby-Baker, Stefanie; Hanlon, Joseph T.; Pezzullo, Lynn; Vieson, Kathleen; Helwig, Amy L.; Huang, Shiew-Mei; Perre, Anthony; Bates, David W.; Poikonen, John; Wittie, Michael A.; Grizzle, Amy J.; Brown, Mary; Malone, Daniel C.

2016-01-01

Purpose To recommend principles for including drug-drug interactions (DDIs) in clinical decision support. Methods A conference series was conducted to improve clinical decision support (CDS) for DDIs. The Content Workgroup met monthly by webinar from January 2013 to February 2014, with two in-person meetings to reach consensus. The workgroup consisted of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information (IT) vendors, and healthcare organizations. Workgroup members addressed four key questions: (1) What process should be used to develop and maintain a standard set of DDIs?; (2) What information should be included in a knowledgebase of standard DDIs?; (3) Can/should a list of contraindicated drug pairs be established?; and (4) How can DDI alerts be more intelligently filtered? Results To develop and maintain a standard set of DDIs for CDS in the United States, we recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated, as only a small set of drug combinations are truly contraindicated. Finally, we recommend more research to identify methods to safely reduce repetitive and less relevant alerts. Conclusion A systematic ongoing process is necessary to select DDIs for alerting clinicians. We anticipate that our recommendations can lead to consistent and clinically relevant content for interruptive DDIs, and thus reduce alert fatigue and improve patient safety. PMID:27045070

Implementing priority setting frameworks: Insights from leading researchers.

PubMed

Angell, Blake; Pares, Jennie; Mooney, Gavin

2016-12-01

In spite of a substantial literature developing frameworks for policymakers to use in resource allocation decisions in healthcare, there remains limited published work reporting on the implementation or evaluation of such frameworks in practice. This paper presents findings of a targeted survey of 18 leading researchers around the implementation and evaluation of priority-setting exercises. Approximately one third of respondents knew of situations where recommendations of priority-setting exercises had been implemented, one third knew that recommendations had not been implemented and the final third responded that they did not know whether recommendations had been adopted. The lack of evidence linking the implementation of priority-setting recommendations to equity and efficiency outcomes was highlighted by all respondents. Features identified as facilitating successful implementation of priority-setting recommendations included having a climate ready to accept priority-setting, good leadership or a 'champion' for the priority-setting process and having a health economist to guide the process. Successful disinvestment was very uncommon in the experience of the researchers surveyed. Recommendations emerging from Program Budgeting and Marginal Analysis exercises appeared to be more widely implemented than those coming from alternative processes. Identifying if the process was repeated following the initial process was suggested as a means to measure success. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evidence-based guidelines for fall prevention in Korea

PubMed Central

Kim, Kwang-Il; Jung, Hye-Kyung; Kim, Chang Oh; Kim, Soo-Kyung; Cho, Hyun-Ho; Kim, Dae Yul; Ha, Yong-Chan; Hwang, Sung-Hee; Won, Chang Won; Lim, Jae-Young; Kim, Hyun Jung; Kim, Jae Gyu

2017-01-01

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people. PMID:28049285

Advance care planning in dementia: recommendations for healthcare professionals.

PubMed

Piers, Ruth; Albers, Gwenda; Gilissen, Joni; De Lepeleire, Jan; Steyaert, Jan; Van Mechelen, Wouter; Steeman, Els; Dillen, Let; Vanden Berghe, Paul; Van den Block, Lieve

2018-06-21

Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual's preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Following the Belgian Centre for Evidence-Based Medicine's procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.

Setting Housing Standards to Improve Global Health

PubMed Central

Howden-Chapman, Philippa; Roebbel, Nathalie

2017-01-01

Developing World Health Organization international guidelines is a highly formal process. Yet the resulting guidelines, which Member States are encouraged, but not required to adopt, are a powerful way of developing rigorous policy and fostering implementation. Using the example of the housing and health guidelines, which are currently being finalised, this paper outlines the process for developing WHO guidelines. This includes: forming a Guidelines Review Group that represents all regions of the world, and ensures gender balance and technical expertise; identifying key health outcomes of interest; commissioning systematic reviews of the evidence; assessing the evidence; and formulating recommendations. The strength of each recommendation is assessed based on the quality of the evidence, along with consideration of issues such as equity, acceptability, and feasibility of the implementation of the recommendation. The proposed housing guidelines will address: cold and hot indoor temperatures, home injuries, household crowding, accessibility and access to active travel infrastructure. PMID:29232827

State of the science on implementation research in early child development and future directions.

PubMed

Aboud, Frances E; Yousafzai, Aisha K; Nores, Milagros

2018-05-01

We summarize the state of the field of implementation research and practice for early child development and propose recommendations. First, conclusions are drawn regarding what is generally known about the implementation of early childhood development programs, based on papers and discussions leading to a published series on the topic. Second, recommendations for short-term activities emphasize the use of newly published guidelines for reporting data collection methods and results for implementation processes; knowledge of the guidelines and a menu of measures allows for planning ahead. Additional recommendations include careful documentation of early-stage implementation, such as adapting a program to a different context and assessing feasibility, as well as the process of sustaining and scaling up a program. Using existing implementation information by building on and improving past programs and translating them into policy are recommended. Longer term goals are to identify implementation characteristics of effective programs and determinants of these characteristics. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.

A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep.

PubMed

Okely, Anthony D; Ghersi, Davina; Hesketh, Kylie D; Santos, Rute; Loughran, Sarah P; Cliff, Dylan P; Shilton, Trevor; Grant, David; Jones, Rachel A; Stanley, Rebecca M; Sherring, Julie; Hinkley, Trina; Trost, Stewart G; McHugh, Clare; Eckermann, Simon; Thorpe, Karen; Waters, Karen; Olds, Timothy S; Mackey, Tracy; Livingstone, Rhonda; Christian, Hayley; Carr, Harriette; Verrender, Adam; Pereira, João R; Zhang, Zhiguang; Downing, Katherine L; Tremblay, Mark S

2017-11-20

In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0-5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework. The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines. Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1-2 years) and preschoolers (3-5 years). To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations.

PubMed

Oddo, Mauro; Poole, Daniele; Helbok, Raimund; Meyfroidt, Geert; Stocchetti, Nino; Bouzat, Pierre; Cecconi, Maurizio; Geeraerts, Thomas; Martin-Loeches, Ignacio; Quintard, Hervé; Taccone, Fabio Silvio; Geocadin, Romergryko G; Hemphill, Claude; Ichai, Carole; Menon, David; Payen, Jean-François; Perner, Anders; Smith, Martin; Suarez, José; Videtta, Walter; Zanier, Elisa R; Citerio, Giuseppe

2018-04-01

To report the ESICM consensus and clinical practice recommendations on fluid therapy in neurointensive care patients. A consensus committee comprising 22 international experts met in October 2016 during ESICM LIVES2016. Teleconferences and electronic-based discussions between the members of the committee subsequently served to discuss and develop the consensus process. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles generated. The consensus focused on three main topics: (1) general fluid resuscitation and maintenance in neurointensive care patients, (2) hyperosmolar fluids for intracranial pressure control, (3) fluid management in delayed cerebral ischemia after subarachnoid haemorrhage. After an extensive literature search, the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were applied to assess the quality of evidence (from high to very low), to formulate treatment recommendations as strong or weak, and to issue best practice statements when applicable. A modified Delphi process based on the integration of evidence provided by the literature and expert opinions-using a sequential approach to avoid biases and misinterpretations-was used to generate the final consensus statement. The final consensus comprises a total of 32 statements, including 13 strong recommendations and 17 weak recommendations. No recommendations were provided for two statements. We present a consensus statement and clinical practice recommendations on fluid therapy for neurointensive care patients.

Research on personalized recommendation algorithm based on spark

NASA Astrophysics Data System (ADS)

Li, Zeng; Liu, Yu

2018-04-01

With the increasing amount of data in the past years, the traditional recommendation algorithm has been unable to meet people's needs. Therefore, how to better recommend their products to users of interest, become the opportunities and challenges of the era of big data development. At present, each platform enterprise has its own recommendation algorithm, but how to make efficient and accurate push information is still an urgent problem for personalized recommendation system. In this paper, a hybrid algorithm based on user collaborative filtering and content-based recommendation algorithm is proposed on Spark to improve the efficiency and accuracy of recommendation by weighted processing. The experiment shows that the recommendation under this scheme is more efficient and accurate.

Intercomparison of U.S. Ballast Water Test Facilities

DTIC Science & Technology

2012-11-01

with many of the requirements of the ETV Protocol, although in some aspects, they employed different approaches and processes . The ETV Protocol calls...and recommendations from the audit process will be reported separately by NSF (in preparation). Both TFs benefited from developing procedures needed...11  4.1.2  Development Process

Characterization of Offgas Generated During Calcination of Incinerator Ash Surrogates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wigent, H.L.; Vienna, J.D.; Darab, J.G.

1999-01-28

The Pacific Northwest National Laboratory (PNNL), in cooperation with the Los Alamos National Laboratory (LANL) and Safe Sites of Colorado (SSOC), developed a recommended flowsheet for the processing of plutonium-bearing incinerator ash stored at the Rocky Flats Environmental Technology Site (RFETS) (Lucy et al. 1998). This flowsheet involves a calcination pretreatment step, the purpose of which is to remove carbonaceous material from the incinerator ash. Removal of this material reduced the probability of process upsets, improved product quality, and increases ash waste loading. As part of the continued development of the recommended flowsheet, PNNL performed a series of tests tomore » characterize the offgas generated during the calcination process.« less

Participatory and evidence-based recommendations for urban redevelopment following natural disasters: older adults as policy advisers.

PubMed

Annear, Michael; Keeling, Sally; Wilkinson, Tim

2014-03-01

To develop community-generated recommendations to inform urban environmental remediation following earthquakes in Christchurch, New Zealand, and share these with local decision-makers during a participatory action research process. This study employed three focus group discussions to critique mixed-methods and multiphase results and develop evidence-based recommendations. Participants included 30 volunteers and 8 knowledgeable advisers aged 65 years and older. Participant recommendations addressed the remediation of earthquake-affected suburbs, access to transportation, age-friendly design, safer communities, resilient support agencies, and restoration of resources for social and cultural activities. Older collaborators identified salient barriers to active ageing and options for post-earthquake redevelopment that had not previously been considered in research or policy. Independently living older adults are well placed to work with researchers to develop recommendations to improve the urban environment following natural disasters as well as in times of relative stability. © 2013 ACOTA.

The advantages and limitations of guideline adaptation frameworks.

PubMed

Wang, Zhicheng; Norris, Susan L; Bero, Lisa

2018-05-29

The implementation of evidence-based guidelines can improve clinical and public health outcomes by helping health professionals practice in the most effective manner, as well as assisting policy-makers in designing optimal programs. Adaptation of a guideline to suit the context in which it is intended to be applied can be a key step in the implementation process. Without taking the local context into account, certain interventions recommended in evidence-based guidelines may be infeasible under local conditions. Guideline adaptation frameworks provide a systematic way of approaching adaptation, and their use may increase transparency, methodological rigor, and the quality of the adapted guideline. This paper presents a number of adaptation frameworks that are currently available. We aim to compare the advantages and limitations of their processes, methods, and resource implications. These insights into adaptation frameworks can inform the future development of guidelines and systematic methods to optimize their adaptation. Recent adaptation frameworks show an evolution from adapting entire existing guidelines, to adapting specific recommendations extracted from an existing guideline, to constructing evidence tables for each recommendation that needs to be adapted. This is a move towards more recommendation-focused, context-specific processes and considerations. There are still many gaps in knowledge about guideline adaptation. Most of the frameworks reviewed lack any evaluation of the adaptation process and outcomes, including user satisfaction and resources expended. The validity, usability, and health impact of guidelines developed via an adaptation process have not been studied. Lastly, adaptation frameworks have not been evaluated for use in low-income countries. Despite the limitations in frameworks, a more systematic approach to adaptation based on a framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs into account. The utilization of frameworks in the guideline implementation process can be optimized by increasing the understanding and upfront estimation of resource and time needed, capacity building in adaptation methods, and increasing the adaptability of the source recommendation document.

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

PubMed Central

Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B.; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

2016-01-01

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations. PMID:27694661

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness.

PubMed

Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

2016-04-11

Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations. © 2016 by Kerman University of Medical Sciences

The process of collecting and evaluating evidences for the development of Guidelines for the management of rheumatoid arthritis, Japan College of Rheumatology 2014: Utilization of GRADE approach.

PubMed

Kojima, Masayo; Nakayama, Takeo; Kawahito, Yutaka; Kaneko, Yuko; Kishimoto, Mitsumasa; Hirata, Shintaro; Seto, Yohei; Endo, Hirahito; Ito, Hiromu; Kojima, Toshihisa; Nishida, Keiichiro; Matsushita, Isao; Tsutani, Kiichiro; Igarashi, Ataru; Kamatani, Naoyuki; Hasegawa, Mieko; Miyasaka, Nobuyuki; Yamanaka, Hisashi

2016-01-01

To describe the process of collecting and evaluating evidence for treating rheumatoid arthritis (RA) for developing clinical practice guidelines (CPGs) for rheumatologists in Japan. The task force comprised rheumatologists, epidemiologists, health economists, and patients. First, the critical outcomes were determined according to a three-round Delphi method, and eight topics with 88 clinical questions (CQs) were formulated. A systematic review of CQs was conducted using the Cochran Database of Systematic Reviews, MEDLINE, and Japana Centra Revvo Medicina (2003-2012). A questionnaire survey and focus group interview were performed to capture the patients' values and preferences. Data from the National Health Insurance drug price list and product information provided by pharmaceutical companies were collected to evaluate drug cost and safety. The GRADE approach was used to describe the evidence quality and determine the strength of recommendations. Recommendations were developed using a modified Delphi method by a multidisciplinary panel including patients. Eight meetings and frequent e-mail communications were conducted to draft a quality assessment of evidence and recommendations. For 88 CQs, recommendation statements were determined. Using the GRADE approach, new CPGs successfully addressed important clinical issues for treating RA patients. Timely updating of recommendations should be routinely considered.

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.

MORECare research methods guidance development: recommendations for ethical issues in palliative and end-of-life care research.

PubMed

Gysels, Marjolein; Evans, Catherine J; Lewis, Penney; Speck, Peter; Benalia, Hamid; Preston, Nancy J; Grande, Gunn E; Short, Vicky; Owen-Jones, Eleanor; Todd, Chris J; Higginson, Irene J

2013-12-01

There is little guidance on the particular ethical concerns that research raises with a palliative care population. To present the process and outcomes of a workshop and consensus exercise on agreed best practice to accommodate ethical issues in research on palliative care. Consultation workshop using the MORECare Transparent Expert Consultation approach. Prior to workshops, participants were sent overviews of ethical issues in palliative care. Following the workshop, nominal group techniques were used to produce candidate recommendations. These were rated online by participating experts. Descriptive statistics were used to analyse agreement and consensus. Narrative comments were collated. Experts in ethical issues and palliative care research were invited to the Cicely Saunders Institute in London. They included senior researchers, service providers, commissioners, researchers, members of ethics committees and policy makers. The workshop comprised 28 participants. A total of 16 recommendations were developed. There was high agreement on the issue of research participation and high to moderate agreement on applications to research ethics committees. The recommendations on obtaining and maintaining consent from patients and families were the most contentious. Nine recommendations were refined on the basis of the comments from the online consultation. The culture surrounding palliative care research needs to change by fostering collaborative approaches between all those involved in the research process. Changes to the legal framework governing the research process are required to enhance the ethical conduct of research in palliative care. The recommendations are relevant to all areas of research involving vulnerable adults.

Learning material recommendation based on case-based reasoning similarity scores

NASA Astrophysics Data System (ADS)

Masood, Mona; Mokmin, Nur Azlina Mohamed

2017-10-01

A personalized learning material recommendation is important in any Intelligent Tutoring System (ITS). Case-based Reasoning (CBR) is an Artificial Intelligent Algorithm that has been widely used in the development of ITS applications. This study has developed an ITS application that applied the CBR algorithm in the development process. The application has the ability to recommend the most suitable learning material to the specific student based on information in the student profile. In order to test the ability of the application in recommending learning material, two versions of the application were created. The first version displayed the most suitable learning material and the second version displayed the least preferable learning material. The results show the application has successfully assigned the students to the most suitable learning material.

Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA

PubMed Central

Levenhagen, Kimberly; Davies, Claire; Perdomo, Marisa; Ryans, Kathryn

2017-01-01

Introduction: The Oncology Section of APTA developed a clinical practice guideline to aid the clinician in diagnosing secondary upper-quadrant cancer-related lymphedema. Methods: Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in their diagnostic process. Overall, clinical practice recommendations were formulated on the basis of the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. Recommendations: In an effort to make these clinically applicable, recommendations were based on the characteristics as to the location and stage of a patient's upper-quadrant lymphedema. PMID:28748128

Including Emotional Intelligence in Pharmacy Curricula to Help Achieve CAPE Outcomes

PubMed Central

Fierke, Kerry K.; Sucher, Brandon J.; Janke, Kristin K.

2015-01-01

The importance of emotional intelligence (EI) for effective teamwork and leadership within the workplace is increasingly apparent. As suggested by the 2013 CAPE Outcomes, we recommend that colleges and schools of pharmacy consider EI-related competencies to build self-awareness and professionalism among students. In this Statement, we provide two examples of the introduction of EI into pharmacy curricula. In addition, we provide a 4-phase process based on recommendations developed by EI experts for structuring and planning EI development. Finally, we make 9 recommendations’ to inform the process of including EI in pharmacy curricula. PMID:26089557

Recommendations in dispatcher-assisted bystander resuscitation from emergency call center.

PubMed

García del Águila, J; López-Messa, J; Rosell-Ortiz, F; de Elías Hernández, R; Martínez del Valle, M; Sánchez-Santos, L; López-Herce, J; Cerdà-Vila, M; Roza-Alonso, C L; Bernardez-Otero, M

2015-01-01

Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Developing a policy guidance for financing dental care in Iran using the RAND Appropriateness Method.

PubMed

Jadidfard, M P; Yazdani, S; Khoshnevisan, M H

2013-12-01

This study aimed to provide recommendations on health care financing with special emphasis on dental care. The RAND Appropriateness Method was employed to obtain the collective opinion of a multidisciplinary panel of experts on a set of recommendation statements regarding Iranian dental care financing. An initial set of recommendations were identified from a literature review. Panel members, selected purposively and by peer nomination, each rated the appropriateness and necessity of the recommendations in a structured process of two rounds. Each recommendation was classified as inappropriate, uncertain, appropriate but not necessary, or appropriate and necessary according to the median rating score and the level of disagreement among the panellists. Of 28 initial recommendations, 25 were agreed on as appropriate, of which 22 were considered as necessary. Altogether, these recommendations provide a holistic picture of an oral health system's financing in three domains: revenue collection, pooling of revenues and purchasing of dental services. The policy guidance recommendations are intended to provide the Iranian oral health authorities with an evidence-base for financing dental care. The recommendations may be transferrable, at least in part, particularly to developing countries with similar hybrid health system structures. Finally, the method used to develop the recommendations can serve as a model for use elsewhere.

[Consensus conference on providing information of adverse events to patients and relatives].

PubMed

Martín-Delgado, M C; Fernández-Maillo, M; Bañeres-Amella, J; Campillo-Artero, C; Cabré-Pericas, L; Anglés-Coll, R; Gutiérrez-Fernández, R; Aranaz-Andrés, J M; Pardo-Hernández, A; Wu, A

2013-01-01

To develop recommendations regarding «Information about adverse events to patients and their families», through the implementation of a consensus conference. A literature review was conducted to identify all relevant articles, the major policies and international guidelines, and the specific legislation developed in some countries on this process. The literature review was the basis for responding to a series of questions posed in a public session. A group of experts presented the best available evidence, interacting with stakeholders. At the end of the session, an interdisciplinary and multi-professional jury established the final recommendations of the consensus conference. The main recommendations advocate the need to develop policies and institutional guidelines in our field, favouring the patient adverse events disclosure process. The recommendations emphasize the need for the training of professionals in communication skills and patient safety, as well as the development of strategies for supporting professionals who are involved in an adverse event. The assessment of the interest and impact of specific legislation that would help the implementation of these policies was also considered. A cultural change is needed at all levels, nuanced and adapted to the specific social and cultural aspects of our social and health spheres, and involves all stakeholders in the system to create a framework of trust and credibility in which the processing of information about adverse events may become effective. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peck, T; Sparkman, D; Storch, N

''The LLNL Site-Specific Advanced Simulation and Computing (ASCI) Software Quality Engineering Recommended Practices VI.I'' document describes a set of recommended software quality engineering (SQE) practices for ASCI code projects at Lawrence Livermore National Laboratory (LLNL). In this context, SQE is defined as the process of building quality into software products by applying the appropriate guiding principles and management practices. Continual code improvement and ongoing process improvement are expected benefits. Certain practices are recommended, although projects may select the specific activities they wish to improve, and the appropriate time lines for such actions. Additionally, projects can rely on the guidance ofmore » this document when generating ASCI Verification and Validation (VSrV) deliverables. ASCI program managers will gather information about their software engineering practices and improvement. This information can be shared to leverage the best SQE practices among development organizations. It will further be used to ensure the currency and vitality of the recommended practices. This Overview is intended to provide basic information to the LLNL ASCI software management and development staff from the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I'' document. Additionally the Overview provides steps to using the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I'' document. For definitions of terminology and acronyms, refer to the Glossary and Acronyms sections in the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I''.« less

How Qualitative Methods Can be Used to Inform Model Development.

PubMed

Husbands, Samantha; Jowett, Susan; Barton, Pelham; Coast, Joanna

2017-06-01

Decision-analytic models play a key role in informing healthcare resource allocation decisions. However, there are ongoing concerns with the credibility of models. Modelling methods guidance can encourage good practice within model development, but its value is dependent on its ability to address the areas that modellers find most challenging. Further, it is important that modelling methods and related guidance are continually updated in light of any new approaches that could potentially enhance model credibility. The objective of this article was to highlight the ways in which qualitative methods have been used and recommended to inform decision-analytic model development and enhance modelling practices. With reference to the literature, the article discusses two key ways in which qualitative methods can be, and have been, applied. The first approach involves using qualitative methods to understand and inform general and future processes of model development, and the second, using qualitative techniques to directly inform the development of individual models. The literature suggests that qualitative methods can improve the validity and credibility of modelling processes by providing a means to understand existing modelling approaches that identifies where problems are occurring and further guidance is needed. It can also be applied within model development to facilitate the input of experts to structural development. We recommend that current and future model development would benefit from the greater integration of qualitative methods, specifically by studying 'real' modelling processes, and by developing recommendations around how qualitative methods can be adopted within everyday modelling practice.

Systems biology of personalized nutrition

PubMed Central

van Ommen, Ben; van den Broek, Tim; de Hoogh, Iris; van Erk, Marjan; van Someren, Eugene; Rouhani-Rankouhi, Tanja; Anthony, Joshua C; Hogenelst, Koen; Pasman, Wilrike; Boorsma, André; Wopereis, Suzan

2017-01-01

Abstract Personalized nutrition is fast becoming a reality due to a number of technological, scientific, and societal developments that complement and extend current public health nutrition recommendations. Personalized nutrition tailors dietary recommendations to specific biological requirements on the basis of a person’s health status and goals. The biology underpinning these recommendations is complex, and thus any recommendations must account for multiple biological processes and subprocesses occurring in various tissues and must be formed with an appreciation for how these processes interact with dietary nutrients and environmental factors. Therefore, a systems biology–based approach that considers the most relevant interacting biological mechanisms is necessary to formulate the best recommendations to help people meet their wellness goals. Here, the concept of “systems flexibility” is introduced to personalized nutrition biology. Systems flexibility allows the real-time evaluation of metabolism and other processes that maintain homeostasis following an environmental challenge, thereby enabling the formulation of personalized recommendations. Examples in the area of macro- and micronutrients are reviewed. Genetic variations and performance goals are integrated into this systems approach to provide a strategy for a balanced evaluation and an introduction to personalized nutrition. Finally, modeling approaches that combine personalized diagnosis and nutritional intervention into practice are reviewed. PMID:28969366

Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines

PubMed Central

Norris, Susan L.; Schulman, Sam; Hirsh, Jack; Eckman, Mark H.; Akl, Elie A.; Crowther, Mark; Vandvik, Per Olav; Eikelboom, John W.; McDonagh, Marian S.; Lewis, Sandra Zelman; Gutterman, David D.; Cook, Deborah J.; Schünemann, Holger J.

2012-01-01

Background: To develop the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Evidence-Based Clinical Practice Guidelines (AT9), the American College of Chest Physicians (ACCP) assembled a panel of clinical experts, information scientists, decision scientists, and systematic review and guideline methodologists. Methods: Clinical areas were designated as articles, and a methodologist without important intellectual or financial conflicts of interest led a panel for each article. Only panel members without significant conflicts of interest participated in making recommendations. Panelists specified the population, intervention and alternative, and outcomes for each clinical question and defined criteria for eligible studies. Panelists and an independent evidence-based practice center executed systematic searches for relevant studies and evaluated the evidence, and where resources and evidence permitted, they created standardized tables that present the quality of the evidence and key results in a transparent fashion. Results: One or more recommendations relate to each specific clinical question, and each recommendation is clearly linked to the underlying body of evidence. Judgments regarding the quality of evidence and strength of recommendations were based on approaches developed by the Grades of Recommendations, Assessment, Development, and Evaluation Working Group. Panel members constructed scenarios describing relevant health states and rated the disutility associated with these states based on an additional systematic review of evidence regarding patient values and preferences for antithrombotic therapy. These ratings guided value and preference decisions underlying the recommendations. Each topic panel identified questions in which resource allocation issues were particularly important and, for these issues, experts in economic analysis provided additional searches and guidance. Conclusions: AT9 methodology reflects the current science of evidence-based clinical practice guideline development, with reliance on high-quality systematic reviews, a standardized process for quality assessment of individual studies and the body of evidence, an explicit process for translating the evidence into recommendations, disclosure of financial as well as intellectual conflicts of interest followed by management of disclosed conflicts, and extensive peer review. PMID:22315256

A systematic review and appraisal of the quality of practice guidelines for the management of Neisseria gonorrhoeae infections.

PubMed

Dickson, Catherine; Arnason, Trevor; Friedman, Dara Spatz; Metz, Gila; Grimshaw, Jeremy M

2017-11-01

Clinical guidelines help ensure consistent care informed by current evidence. As shifts in antimicrobial resistance continue to influence first-line treatment, up-to-date guidelines are important for preventing treatment failure. A guideline's development process will influence its recommendations and users' trust. To assess the quality of current gonorrhoea guidelines' development processes. Multiple databases. Original and current English-language guidelines targeting health professionals and containing treatment recommendations for uncomplicated gonorrhoea in the general adult population. Two appraisers assessed the guidelines independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Scores were combined as per the AGREE II users' manual. We identified 10 guidelines meeting the inclusion criteria. The quality of the gonorrhoea treatment guidelines varied. Most scored poorly on Rigour of Development ; information on the evidence review process and methods for formulating recommendations was often missing. The WHO Guidelines for the Treatment of Neisseria gonorrhoeae and UK National Guideline for the Management of Gonorrhoea in Adults scored the highest on Rigour of Development . Methods to address conflicts of interest were often not described in the materials reviewed. Implementation of recommendations was often not addressed. By limiting our study to English-language guidelines, a small number of guidelines we identified were excluded. Our analysis was limited to either published or online materials that were readily available to users. We could not differentiate between items addressed in the development process but not documented from items that were not addressed. Gonorrhoea treatment guidelines may slow antimicrobial resistance. Many current guidelines are not in line with the current guideline development best practices; this might undermine the perceived trustworthiness of guidelines. By identifying current limitations, this study can help improve the quality of future guidelines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

AAVP Recommendations for Core Competency Standards Relating to Parasitological Knowledge and Skills.

PubMed

Snowden, Karen F; Krecek, Rosina C; Bowman, Dwight D

As part of the accreditation process, the American Veterinary Medical Association Council on Education has defined nine broad areas of core competencies that must be met by graduating students earning a Doctor of Veterinary Medicine degree. To define competencies in veterinary parasitology, the American Association of Veterinary Parasitologists (AAVP) has developed a detailed list of knowledge and skills that are recommended for inclusion in professional curricula. These recommendations were developed by instructors from colleges/schools of veterinary medicine in the US, Canada, and the Caribbean, and were reviewed and endorsed following AAVP guidelines.

Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Recommendations

PubMed Central

Hershey, Christine L.; Bhattarai, Achuyt; Florey, Lia S.; McElroy, Peter D.; Nielsen, Carrie F.; Yé, Yazoume; Eckert, Erin; Franca-Koh, Ana Cláudia; Shargie, Estifanos; Komatsu, Ryuichi; Smithson, Paul; Thwing, Julie; Mihigo, Jules; Herrera, Samantha; Taylor, Cameron; Shah, Jui; Mouzin, Eric; Yoon, Steven S.; Salgado, S. René

2017-01-01

Abstract. As funding for malaria control increased considerably over the past 10 years resulting in the expanded coverage of malaria control interventions, so did the need to measure the impact of these investments on malaria morbidity and mortality. Members of the Roll Back Malaria (RBM) Partnership undertook impact evaluations of malaria control programs at a time when there was little guidance in terms of the process for conducting an impact evaluation of a national-level malaria control program. The President’s Malaria Initiative (PMI), as a member of the RBM Partnership, has provided financial and technical support for impact evaluations in 13 countries to date. On the basis of these experiences, PMI and its partners have developed a streamlined process for conducting the evaluations with a set of lessons learned and recommendations. Chief among these are: to ensure country ownership and involvement in the evaluations; to engage stakeholders throughout the process; to coordinate evaluations among interested partners to avoid duplication of efforts; to tailor the evaluation to the particular country context; to develop a standard methodology for the evaluations and a streamlined process for completion within a reasonable time; and to develop tailored dissemination products on the evaluation for a broad range of stakeholders. These key lessons learned and resulting recommendations will guide future impact evaluations of malaria control programs and other health programs. PMID:28990921

Research and management issues in large-scale fire modeling

Treesearch

David L. Peterson; Daniel L. Schmoldt

2000-01-01

In 1996, a team of North American fire scientists and resource managers convened to assess the effects of fire disturbance on ecosystems and to develop scientific recommendations for future fire research and management activities. These recommendations - elicited with the Analytic Hierarchy Process - include numerically ranked scientific and managerial questions and...

Chapter 10: Management recommendations

Treesearch

Deborah M. Finch; Janie Agyagos; Tracy McCarthey; Robert M. Marshall; Scott H. Stoleson; Mary J. Whitfield

2000-01-01

This chapter was developed over a series of meetings using a group-consensus process. Our recommendations are based on published results, on information compiled in the previous chapters, on expert opinion, and on unpublished data of conservation team members. This chapter is available as temporary guidance until the Recovery Plan for the southwestern willow flycatcher...

Final Report of the NASA Office of Safety and Mission Assurance Agile Benchmarking Team

NASA Technical Reports Server (NTRS)

Wetherholt, Martha

2016-01-01

To ensure that the NASA Safety and Mission Assurance (SMA) community remains in a position to perform reliable Software Assurance (SA) on NASAs critical software (SW) systems with the software industry rapidly transitioning from waterfall to Agile processes, Terry Wilcutt, Chief, Safety and Mission Assurance, Office of Safety and Mission Assurance (OSMA) established the Agile Benchmarking Team (ABT). The Team's tasks were: 1. Research background literature on current Agile processes, 2. Perform benchmark activities with other organizations that are involved in software Agile processes to determine best practices, 3. Collect information on Agile-developed systems to enable improvements to the current NASA standards and processes to enhance their ability to perform reliable software assurance on NASA Agile-developed systems, 4. Suggest additional guidance and recommendations for updates to those standards and processes, as needed. The ABT's findings and recommendations for software management, engineering and software assurance are addressed herein.

A number of factors explain why WHO guideline developers make strong recommendations inconsistent with GRADE guidance.

PubMed

Alexander, Paul E; Gionfriddo, Michael R; Li, Shelly-Anne; Bero, Lisa; Stoltzfus, Rebecca J; Neumann, Ignacio; Brito, Juan P; Djulbegovic, Benjamin; Montori, Victor M; Norris, Susan L; Schünemann, Holger J; Thabane, Lehana; Guyatt, Gordon H

2016-02-01

Many strong recommendations issued by the World Health Organization (WHO) are based on low- or very low-quality (low certainty) evidence (discordant recommendations). Many such discordant recommendations are inconsistent with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. We sought to understand why WHO makes discordant recommendations inconsistent with GRADE guidance. We interviewed panel members involved in guidelines approved by WHO (2007-2012) that included discordant recommendations. Interviews, recorded and transcribed, focused on use of GRADE including the reasoning underlying, and factors contributing to, discordant recommendations. Four themes emerged: strengths of GRADE, challenges and barriers to GRADE, strategies to improve GRADE application, and explanations for discordant recommendations. Reasons for discordant recommendations included skepticism about the value of making conditional recommendations; political considerations; high certainty in benefits (sometimes warranted, sometimes not) despite assessing evidence as low certainty; and concerns that conditional recommendations will be ignored. WHO panelists make discordant recommendations inconsistent with GRADE guidance for reasons that include limitations in their understanding of GRADE. Ensuring optimal application of GRADE at WHO and elsewhere likely requires selecting panelists who have a commitment to GRADE principles, additional training of panelists, and formal processes to maximize adherence to GRADE principles. Copyright © 2016 Elsevier Inc. All rights reserved.

Using IT to improve quality at NewYork-Presybterian Hospital: a requirements-driven strategic planning process.

PubMed

Kuperman, Gilad J; Boyer, Aurelia; Cole, Curt; Forman, Bruce; Stetson, Peter D; Cooper, Mary

2006-01-01

At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goals that would enable demonstrably high quality care: 1) excellence at data warehousing, and 2) optimal use of automated clinical documentation to capture encounter-related quality and safety data. For each high priority goal, a working group was created to develop specific recommendations. The Data Warehousing subgroup has recommended the implementation of an architecture management process and an improved ability for users to get access to aggregate data. The Structured Documentation subgroup is establishing recommendations for a documentation template creation process. The strategic planning process at times is slow, but assures that the organization is focusing on the information technology activities most likely to lead to improved quality.

Using IT to Improve Quality at NewYork-Presybterian Hospital: A Requirements-Driven Strategic Planning Process

PubMed Central

Kuperman, Gilad J.; Boyer, Aurelia; Cole, Curt; Forman, Bruce; Stetson, Peter D.; Cooper, Mary

2006-01-01

At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goals that would enable demonstrably high quality care: 1) excellence at data warehousing, and 2) optimal use of automated clinical documentation to capture encounter-related quality and safety data. For each high priority goal, a working group was created to develop specific recommendations. The Data Warehousing subgroup has recommended the implementation of an architecture management process and an improved ability for users to get access to aggregate data. The Structured Documentation subgroup is establishing recommendations for a documentation template creation process. The strategic planning process at times is slow, but assures that the organization is focusing on the information technology activities most likely to lead to improved quality. PMID:17238381

Best practices in incident investigation in the chemical process industries with examples from the industry sector and specifically from Nova Chemicals.

PubMed

Morrison, Lisa M

2004-07-26

This paper will summarize best practices in incident investigation in the chemical process industries and will provide examples from both the industry sector and specifically from NOVA Chemicals. As a sponsor of the Center for Chemical Process Safety (CCPS), an industry technology alliance of the American Institute of Chemical Engineers, NOVA Chemicals participates in a number of working groups to help develop best practices and tools for the chemical process and associated industries in order to advance chemical process safety. A recent project was to develop an update on guidelines for investigating chemical process incidents. A successful incident investigation management system must ensure that all incidents and near misses are reported, that root causes are identified, that recommendations from incident investigations identify appropriate preventive measures, and that these recommendations are resolved in a timely manner. The key elements of an effective management system for incident investigation will be described. Accepted definitions of such terms as near miss, incident, and root cause will be reviewed. An explanation of the types of incident classification systems in use, along with expected levels of follow-up, will be provided. There are several incident investigation methodologies in use today by members of the CCPS; most of these methodologies incorporate the use of several tools. These tools include: timelines, sequence diagrams, causal factor identification, brainstorming, checklists, pre-defined trees, and team-defined logic trees. Developing appropriate recommendations and then ensuring their resolution is the key to prevention of similar events from recurring, along with the sharing of lessons learned from incidents. There are several sources of information on previous incidents and lessons learned available to companies. In addition, many companies in the chemical process industries use their own internal databases to track recommendations from incidents and to share learnings internally.

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 final recommendations were retained. Recommendations were refined through qualitative comments from stakeholders and blog respondents. Using a consensus building process that included male and female stakeholders from both academic and community EM settings, we developed recommendations for organizations to implement to create a workplace environment supportive of women in EM that were perceived as acceptable and feasible. This process may serve as a model for other medical specialties to establish clear, discrete organization-level practices aimed at supporting women physicians. © 2016 by the Society for Academic Emergency Medicine.

The Ontario Psychosocial Oncology Framework: a quality improvement tool.

PubMed

Li, Madeline; Green, Esther

2013-05-01

To overview the newly developed Psychosocial Health Care for Cancer Patients and Their Families: A Framework to Guide Practice in Ontario and Guideline Recommendations in the context of Canadian psychosocial oncology care and propose strategies for guideline uptake and implementation. Recommendations from the 2008 Institute of Medicine standard Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs were adapted into the Ontario Psychosocial Oncology (PSO) Framework. Existing practice guidelines developed by the Canadian Partnership against Cancer and Cancer Care Ontario and standards developed by the Canadian Association of Psychosocial Oncology are supporting resources for adopting a quality improvement (QI) approach to the implementation of the framework in Ontario. The developed PSO Framework, including 31 specific actionable recommendations, is intended to improve the quality of comprehensive cancer care at both the provider and system levels. Important QI change management processes are described as Educate - raising awareness among medical teams of the significance of psychosocial needs of patients, Evidence - developing a research evidence base for patient care benefits from psychosocial interventions, and Electronics - using technology to collect patient reported outcomes of both physical and emotional symptoms. The Ontario PSO Framework is unique and valuable in providing actionable recommendations that can be implemented through QI processes. Overall, the result will be improved psychosocial health care for the cancer population. Copyright © 2012 John Wiley & Sons, Ltd.

The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty.

PubMed

Dent, Elsa; Lien, Christopher; Lim, Wee Shiong; Wong, Wei Chin; Wong, Chek Hooi; Ng, Tze Pin; Woo, Jean; Dong, Birong; de la Vega, Shelley; Hua Poi, Philip Jun; Kamaruzzaman, Shahrul Bahyah Binti; Won, Chang; Chen, Liang-Kung; Rockwood, Kenneth; Arai, Hidenori; Rodriguez-Mañas, Leocadio; Cao, Li; Cesari, Matteo; Chan, Piu; Leung, Edward; Landi, Francesco; Fried, Linda P; Morley, John E; Vellas, Bruno; Flicker, Leon

2017-07-01

To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Between forwarding and mentoring: a qualitative study of recommending medical doctors for international postdoctoral research positions.

PubMed

Sambunjak, Dario; Marušić, Matko

2011-06-09

Young scientists rarely have extensive international connections that could facilitate their mobility. They often rely on their doctoral supervisors and other senior academics, who use their networks to generate opportunities for young scientists to gain international experience and provide the initial trigger for an outward move. To explore the process of informal recommending of young physicians from a small country for postdoctoral research positions in foreign countries, we conducted in-depth interviews with eight senior academics who acted as recommenders and eight physicians who, based on the recommendations of senior academics, spent at least a year working in a laboratory abroad. Interviews were transcribed and analyzed by using the framework approach. The findings showed that recommending can take four distinct forms: 1) forwarding information, 2) passive recommending, 3) active recommending, and 4) mentor recommending. These forms differ in their level of commitment and mutual trust among actors, and possible control over the success of the process. Two groups of recommendees--'naive' and 'experienced'--can be distinguished based on their previous scientific experience and research collaboration with the recommender. Crucial for the success of the process is an adequate preparation of recommendees' stay abroad, as well as their return and reintegration. The benefits of recommending extend beyond the individual participants to the scientific community and broader society of the sending country. With a sufficient level of commitment by the actors, informal recommending can be a part of or grow into an all-encompassing developmental relationship equal to mentoring. The importance of senior academics' informal contacts and recommendations in promoting junior scientists' mobility should be acknowledged and encouraged by the research institutions and universities, particularly in developing countries.

Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department.

PubMed

Tavender, Emma J; Bosch, Marije; Gruen, Russell L; Green, Sally E; Michie, Susan; Brennan, Sue E; Francis, Jill J; Ponsford, Jennie L; Knott, Jonathan C; Meares, Sue; Smyth, Tracy; O'Connor, Denise A

2015-05-25

Despite the availability of evidence-based guidelines for the management of mild traumatic brain injury in the emergency department (ED), variations in practice exist. Interventions designed to implement recommended behaviours can reduce this variation. Using theory to inform intervention development is advocated; however, there is no consensus on how to select or apply theory. Integrative theoretical frameworks, based on syntheses of theories and theoretical constructs relevant to implementation, have the potential to assist in the intervention development process. This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention. A stepped approach was followed: (i) identification of locally applicable and actionable evidence-based recommendations as targets for change, (ii) selection and use of two theoretical frameworks for identifying barriers to and enablers of change (Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations) and (iii) identification and operationalisation of intervention components (behaviour change techniques and modes of delivery) to address the barriers and enhance the enablers, informed by theory, evidence and feasibility/acceptability considerations. We illustrate this process in relation to one recommendation, prospective assessment of post-traumatic amnesia (PTA) by ED staff using a validated tool. Four recommendations for managing mild traumatic brain injury were targeted with the intervention. The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains. The mode of delivery was informed by six Cochrane reviews. It was delivered via five intervention components : (i) local stakeholder meetings, (ii) identification of local opinion leader teams, (iii) a train-the-trainer workshop for appointed local opinion leaders, (iv) local training workshops for delivery by trained local opinion leaders and (v) provision of tools and materials to prompt recommended behaviours. Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED. The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster randomised trial, part of the Neurotrauma Evidence Translation (NET) program.

Development of the Parkland-UT Southwestern Colonoscopy Reporting System (CoRS) for evidence-based colon cancer surveillance recommendations

PubMed Central

Gupta, Samir; Halm, Ethan A; Wright, Shaun; McCallister, Katharine; Bishop, Wendy; Santini, Noel; Mayorga, Christian; Agrawal, Deepak; Moran, Brett; Sanders, Joanne M; Singal, Amit G

2016-01-01

Objective Through colonoscopy, polyps can be identified and removed to reduce colorectal cancer incidence and mortality. Appropriate use of surveillance colonoscopy, post polypectomy, is a focus of healthcare reform. Materials and Methods The authors developed and implemented the first electronic medical record–based colonoscopy reporting system (CoRS) that matches endoscopic findings with guideline-consistent surveillance recommendations and generates tailored results and recommendation letters for patients and providers. Results In its first year, CoRS was used in 98.6% of indicated cases. Via a survey, colonoscopists agreed/strongly agreed it is easy to use (83%), provides guideline-based recommendations (89%), improves quality of Spanish letters (94%), they would recommend it for other institutions (78%), and it made their work easier (61%), and led to improved practice (56%). Discussion CoRS’ widespread adoption and acceptance likely resulted from stakeholder engagement throughout the development and implementation process. Conclusion CoRS is well-accepted by clinicians and provides guideline-based recommendations and results communications to patients and providers. PMID:26254481

The WHO evidence-informed guideline development process and implications for vitamin and mineral research priorities: symposium rationale and summary.

PubMed

Neufeld, Lynnette M; Jalal, Chowdhury S B; Peña-Rosas, Juan Pablo; Tovey, David; Lutter, Chessa K; Stoltzfus, Rebecca J; Habicht, Jean-Pierre

2013-09-01

The WHO evidence-informed guidelines provide recommendations to Member States and their partners on interventions with vitamins and minerals. Evidence gathered and synthesized through systematic reviews contributes to the development of these guidelines, a process that is dependent on the availability and quality of evidence. Although the guideline development process is stringently governed and supervised to maintain clarity and transparency, the lack of adequacy and specificity of available evidence poses limitations to the formulation of recommendations that can be easily applied for policy and program decision making in diverse contexts. The symposium created a space for dialogue among scientists and public health practitioners to improve the understanding of how evidence fulfills the needs and reflect on mechanisms by which policy and program guidance and priorities for research could be better informed by policy and program needs. Ultimately, programmatic success depends not only on identifying efficacious agents but ensuring effective delivery to those with the potential to respond. To do this, we must understand the rationale for recommending interventions, the biological pathways by which interventions work, delivery systems required to make efficacious interventions work, and other contextual factors that might limit or facilitate successful implementation.

Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis.

PubMed

Kjeken, Ingvild

2011-12-01

The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.

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

PubMed Central

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

2011-01-01

Abstract Objective To appraise the process of development and clinical content of national human immunodeficiency virus (HIV) clinical practice guidelines of countries in the eastern Mediterranean and to formulate recommendations for future guideline development and adaptation. Methods Twenty-three countries in the World Health Organization (WHO) Eastern Mediterranean and United Nations Children’s Fund Middle East and North Africa regions were invited to submit national HIV clinical practice guidelines for review. The guideline development methodology was assessed using an adaptation of the Appraisal of Guidelines Research and Evaluation (AGREE) instrument and guideline content, using a checklist to evaluate concordance with WHO 2006 generic guidelines. Findings Twelve countries submitted 20 guidelines developed between 2004 and 2009. Median scores were poor (i.e. < 0.6) for the methodological quality domains of rigour of development, stakeholder involvement and applicability and flexibility. Scores were better for the domains of scope and purpose (median: 0.82, interquartile range, IQR: 0.58–0.89) and clarity and presentation (median: 0.67, IQR: 0.50–0.78). Concerning guideline content, recommended first-line treatment and eligibility criteria for antiretroviral therapy (ART) in adults were in line with WHO recommendations in most guidelines. However, recommendations on antiretroviral prophylaxis for the prevention of vertical HIV transmission, diagnosis and treatment of HIV infection in infants, monitoring patients on ART, treatment failure and co-morbidities were often lacking. Conclusion The large majority of national HIV clinical practice guidelines had methodological weaknesses and content inaccuracies. Countries require assistance with the adaptation process to ensure that guidelines are valid and up to date and accurately reflect WHO global clinical care recommendations for patients with HIV. PMID:21673860

Recommendations for the development of e-modules for the continuing professional development of European dentists.

PubMed

Kavadella, A; Kossioni, A E; Tsiklakis, K; Cowpe, J; Bullock, A; Barnes, E; Bailey, S; Thomas, H; Thomas, R; Karaharju-Suvanto, T; Suomalainen, K; Kersten, H; Povel, E; Giles, M; Walmsley, D; Soboleva, U; Liepa, A; Akota, I

2013-05-01

To provide evidence-based and peer-reviewed recommendations for the development of dental continuing professional development (CPD) learning e-modules. The present recommendations are consensus recommendations of the DentCPD project team and were informed by a literature research, consultations from e-learning and IT expert, discussions amongst the participants attending a special interest group during the 2012 ADEE meeting, and feedback from the evaluation procedures of the exemplar e-module (as described in a companion paper within this Supplement). The main focus of these recommendations is on the courses and modules organised and offered by dental schools. E-modules for dental CPD, as well as for other health professionals' continuing education, have been implemented and evaluated for a number of years. Research shows that the development of e-modules is a team process, undertaken by academics, subject experts, pedagogists, IT and web designers, learning technologists and librarians. The e-module must have clear learning objectives (outcomes), addressing the learners' individual needs, and must be visually attractive, relevant, interactive, promoting critical thinking and providing feedback. The text, graphics and animations must support the objectives and enable the learning process by creating an attractive, easy to navigate and interactive electronic environment. Technology is usually a concern for learners and tutors; therefore, it must be kept simple and interoperable within different systems and software. The pedagogical and technological proficiency of educators is of paramount importance, yet remains a challenge in many instances. The development of e-courses and modules for dental CPD is an endeavour undertaken by a group of professionals. It must be underpinned by sound pedagogical and e-learning principles and must incorporate elements for effective visual learning and visual design and a simple, consistent technology. © 2013 John Wiley & Sons A/S.

Analysis of procurement processes and development of recommendations for intelligent transportation systems (ITS) procurements : final report.

DOT National Transportation Integrated Search

2007-09-01

Traditional state procurement processes are not well-suited to the procurement of Intelligent Transportation Systems (ITS). The objective of this study was to analyze Kentuckys existing procurement processes, identify strengths and weaknesses of e...

Cloud-radiation interactions and their parameterization in climate models

NASA Technical Reports Server (NTRS)

1994-01-01

This report contains papers from the International Workshop on Cloud-Radiation Interactions and Their Parameterization in Climate Models met on 18-20 October 1993 in Camp Springs, Maryland, USA. It was organized by the Joint Working Group on Clouds and Radiation of the International Association of Meteorology and Atmospheric Sciences. Recommendations were grouped into three broad areas: (1) general circulation models (GCMs), (2) satellite studies, and (3) process studies. Each of the panels developed recommendations on the themes of the workshop. Explicitly or implicitly, each panel independently recommended observations of basic cloud microphysical properties (water content, phase, size) on the scales resolved by GCMs. Such observations are necessary to validate cloud parameterizations in GCMs, to use satellite data to infer radiative forcing in the atmosphere and at the earth's surface, and to refine the process models which are used to develop advanced cloud parameterizations.

National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps

PubMed Central

Murphy, J. Michael; Scholle, Sarah Hudson; Hoagwood, Kimberly Eaton; Sachdeva, Ramesh C.; Mangione-Smith, Rita; Woods, Donna; Kamin, Hayley S.; Jellinek, Michael

2013-01-01

OBJECTIVE: To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. METHODS: Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. RESULTS: Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. CONCLUSIONS: The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace. PMID:23457148

Child neurology practice guidelines: past, present, and future.

PubMed

Hurwitz, Benjamin A; Hurwitz, Kathleen Bretzius; Ashwal, Stephen

2015-03-01

Practice guidelines have been developed in child neurology during the last fifteen years to address important clinical questions and provide evidence-based recommendations for patient care. This review describes the guideline development process and how it has evolved to meet the needs of child neurologists. Several current child neurology guidelines are reviewed and the advantages and disadvantages of guidelines, as well as the legal consequences of using them to determine a standard of care are discussed. The future of guidelines and of their influence on integrated support systems also is considered. Child neurology practice guidelines are a helpful resource for clinicians, families and institutions as they provide evidence-based recommendations concerning the diagnosis and management of common neurological conditions affecting children. Incorporating consensus processes has allowed expansion of clinically relevant recommendations that has increased the utility of guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

[Results and recommendations for vocational rehabilitation from the development project RehaFutur].

PubMed

Riedel, H-P; Schmidt, C; Reinsberg, B; Klügel, T

2012-06-01

The overall project RehaFutur, which has been initiated and funded by the Federal Ministry of Labour and Social Affairs and which involves all the actors of the vocational rehabilitation system, is aimed at advancing the development of the vocational rehabilitation system, so as to prepare it for the challenges ahead. The project started with a group of scientific experts, who formulated 8 fields of action for further developing the vocational rehab system. On this basis, 4 working groups were set up in the framework of a development project to elaborate concrete recommendations on how to implement the necessary changes in vocational rehabilitation. The topics dealt with by the working groups were "self-determination and self-responsibility", "regulation of the overall process", "occupation and working environment" as well as "research". The process was supervised by a steering group, the results were moreover discussed in workshops. Recommendations have been made for 10 subject areas: "consultation and information", "joint service points", "use of the internet", "quality assurance", "individualisation and greater flexibility", "orientation towards the working environment", "participation of the beneficiaries", "research", "legislation", "cooperation of the actors". The next step of the RehaFutur overall project is implementation of those recommendations. This needs to be done in an interdisciplinary manner and conjointly by the agencies and providers involved, including the beneficiaries as experts. As different framework conditions have to be taken into account, the process is a complex one and needs to be supported by systematic research. © Georg Thieme Verlag KG Stuttgart · New York.

Standard development at the Human Variome Project.

PubMed

Smith, Timothy D; Vihinen, Mauno

2015-01-01

The Human Variome Project (HVP) is a world organization working towards facilitating the collection, curation, interpretation and free and open sharing of genetic variation information. A key component of HVP activities is the development of standards and guidelines. HVP Standards are systems, procedures and technologies that the HVP Consortium has determined must be used by HVP-affiliated data sharing infrastructure and should be used by the broader community. HVP guidelines are considered to be beneficial for HVP affiliated data sharing infrastructure and the broader community to adopt. The HVP also maintains a process for assessing systems, processes and tools that implement HVP Standards and Guidelines. Recommended System Status is an accreditation process designed to encourage the adoption of HVP Standards and Guidelines. Here, we describe the HVP standards development process and discuss the accepted standards, guidelines and recommended systems as well as those under acceptance. Certain HVP Standards and Guidelines are already widely adopted by the community and there are committed users for the others. © The Author(s) 2015. Published by Oxford University Press.

Standard development at the Human Variome Project

PubMed Central

Smith, Timothy D.; Vihinen, Mauno

2015-01-01

The Human Variome Project (HVP) is a world organization working towards facilitating the collection, curation, interpretation and free and open sharing of genetic variation information. A key component of HVP activities is the development of standards and guidelines. HVP Standards are systems, procedures and technologies that the HVP Consortium has determined must be used by HVP-affiliated data sharing infrastructure and should be used by the broader community. HVP guidelines are considered to be beneficial for HVP affiliated data sharing infrastructure and the broader community to adopt. The HVP also maintains a process for assessing systems, processes and tools that implement HVP Standards and Guidelines. Recommended System Status is an accreditation process designed to encourage the adoption of HVP Standards and Guidelines. Here, we describe the HVP standards development process and discuss the accepted standards, guidelines and recommended systems as well as those under acceptance. Certain HVP Standards and Guidelines are already widely adopted by the community and there are committed users for the others. PMID:25818894

Usability Guidelines for Product Recommenders Based on Example Critiquing Research

NASA Astrophysics Data System (ADS)

Pu, Pearl; Faltings, Boi; Chen, Li; Zhang, Jiyong; Viappiani, Paolo

Over the past decade, our group has developed a suite of decision tools based on example critiquing to help users find their preferred products in e-commerce environments. In this chapter, we survey important usability research work relative to example critiquing and summarize the major results by deriving a set of usability guidelines. Our survey is focused on three key interaction activities between the user and the system: the initial preference elicitation process, the preference revision process, and the presentation of the systems recommendation results. To provide a basis for the derivation of the guidelines, we developed a multi-objective framework of three interacting criteria: accuracy, confidence, and effort (ACE). We use this framework to analyze our past work and provide a specific context for each guideline: when the system should maximize its ability to increase users' decision accuracy, when to increase user confidence, and when to minimize the interaction effort for the users. Due to the general nature of this multi-criteria model, the set of guidelines that we propose can be used to ease the usability engineering process of other recommender systems, especially those used in e-commerce environments. The ACE framework presented here is also the first in the field to evaluate the performance of preference-based recommenders from a user-centric point of view.

North Dakota Statewide Nursing Study, Phase III. Final Report and Recommendations.

ERIC Educational Resources Information Center

Clark, Neil; Smith, David

The process, outcomes, and recommendations resulting from a project to develop a statewide nursing resource planning system are examined. Phase 1 of the project investigated nursing manpower demands for 1984 and 1986, while phase 2 studied the current scope of nursing practice. In addition to summarizing the findings of these investigations,…

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2012 CFR

2012-10-01

... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Councils or the PDT may develop options for setting ABC, ACL, and OFL for each monkfish stock, as necessary... recommend to the SSC that ABC, ACL, and OFL are specified for each monkfish stock for multiple years as... not limited to, OFLs, ACLs, and management uncertainty. (ii) ACL recommendations. The Councils shall...

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2013 CFR

2013-10-01

... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2014 CFR

2014-10-01

... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

Ligand binding assays in the 21st century laboratory: recommendations for characterization and supply of critical reagents.

PubMed

O'Hara, Denise M; Theobald, Valerie; Egan, Adrienne Clements; Usansky, Joel; Krishna, Murli; TerWee, Julie; Maia, Mauricio; Spriggs, Frank P; Kenney, John; Safavi, Afshin; Keefe, Jeannine

2012-06-01

Critical reagents are essential components of ligand binding assays (LBAs) and are utilized throughout the process of drug discovery, development, and post-marketing monitoring. Successful lifecycle management of LBA critical reagents minimizes assay performance problems caused by declining reagent activity and can mitigate the risk of delays during preclinical and clinical studies. Proactive reagent management assures adequate supply. It also assures that the quality of critical reagents is appropriate and consistent for the intended LBA use throughout all stages of the drug development process. This manuscript summarizes the key considerations for the generation, production, characterization, qualification, documentation, and management of critical reagents in LBAs, with recommendations for antibodies (monoclonal and polyclonal), engineered proteins, peptides, and their conjugates. Recommendations are given for each reagent type on basic and optional characterization profiles, expiration dates and storage temperatures, and investment in a knowledge database system. These recommendations represent a consensus among the authors and should be used to assist bioanalytical laboratories in the implementation of a best practices program for critical reagent life cycle management.

Recommendations for the management of cardiovascular risk in patients with rheumatoid arthritis: scientific evidence and expert opinion.

PubMed

Martín-Martínez, María A; González-Juanatey, Carlos; Castañeda, Santos; Llorca, Javier; Ferraz-Amaro, Iván; Fernández-Gutiérrez, Benjamín; Díaz-González, Federico; González-Gay, Miguel A

2014-08-01

Last recommendations regarding cardiovascular risk (CVR) in rheumatoid arthritis (RA) patients were developed by the EULAR group in 2010. The aim is to update evidence-based recommendations about this worrying health problem. We assembled a multidisciplinary workgroup (rheumatologists, endocrinologist, cardiologist, and epidemiologist) and a panel of 28 expert rheumatologists. The study was carried out in two big phases: identifying key areas in the prevention and management of CVR and developing a set of recommendations based on a review of the available scientific evidence and use of the Delphi consensus technique. All this has been developed according to an updating process of evidence-based recommendations. Overall, 25 recommendations were made addressing three complementary areas: CVR assessment tools, patient eligibility for assessment, and treatment strategies for control of CVR. The grade of the recommendations was not substantially modified compared to the original EULAR recommendations, except in two of them, which were upgraded from C to B. These two recommendations are the ones related to the use of corticosteroids and smoking cessation. The new developed recommendations address these two areas: CVR assessment and treatment strategies for control of CVR. There are substantial gaps in the current knowledge that do not allow classifying properly RA patients based on their actual CVR and to accurately identify those patients who would benefit from CVR assessment. Consequently, studies designed to determine the causal effects of RA disease characteristics on cardiovascular morbidity/mortality and to identify patients at high risk of cardiovascular disease are still needed. Copyright © 2014 Elsevier Inc. All rights reserved.

Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health Administration

PubMed Central

Patterson, Emily S.; Lowry, Svetlana Z.; Ramaiah, Mala; Gibbons, Michael C.; Brick, David; Calco, Robert; Matton, Greg; Miller, Anne; Makar, Ellen; Ferrer, Jorge A.

2015-01-01

Introduction: Human factors workflow analyses in healthcare settings prior to technology implemented are recommended to improve workflow in ambulatory care settings. In this paper we describe how insights from a workflow analysis conducted by NIST were implemented in a software prototype developed for a Veteran’s Health Administration (VHA) VAi2 innovation project and associated lessons learned. Methods: We organize the original recommendations and associated stages and steps visualized in process maps from NIST and the VA’s lessons learned from implementing the recommendations in the VAi2 prototype according to four stages: 1) before the patient visit, 2) during the visit, 3) discharge, and 4) visit documentation. NIST recommendations to improve workflow in ambulatory care (outpatient) settings and process map representations were based on reflective statements collected during one-hour discussions with three physicians. The development of the VAi2 prototype was conducted initially independently from the NIST recommendations, but at a midpoint in the process development, all of the implementation elements were compared with the NIST recommendations and lessons learned were documented. Findings: Story-based displays and templates with default preliminary order sets were used to support scheduling, time-critical notifications, drafting medication orders, and supporting a diagnosis-based workflow. These templates enabled customization to the level of diagnostic uncertainty. Functionality was designed to support cooperative work across interdisciplinary team members, including shared documentation sessions with tracking of text modifications, medication lists, and patient education features. Displays were customized to the role and included access for consultants and site-defined educator teams. Discussion: Workflow, usability, and patient safety can be enhanced through clinician-centered design of electronic health records. The lessons learned from implementing NIST recommendations to improve workflow in ambulatory care using an EHR provide a first step in moving from a billing-centered perspective on how to maintain accurate, comprehensive, and up-to-date information about a group of patients to a clinician-centered perspective. These recommendations point the way towards a “patient visit management system,” which incorporates broader notions of supporting workload management, supporting flexible flow of patients and tasks, enabling accountable distributed work across members of the clinical team, and supporting dynamic tracking of steps in tasks that have longer time distributions. PMID:26290887

Integrating Palliative Care Into Comprehensive Cancer Centers: Consensus-Based Development of Best Practice Recommendations

PubMed Central

Stiel, Stephanie; Simon, Steffen T.; Schmitz, Andrea; van Oorschot, Birgitt; Stachura, Peter; Ostgathe, Christoph

2016-01-01

Background. International associations admit that specialized palliative care (SPC) is an obvious component of excellent cancer care. Nevertheless, gaps in integration at the international level have been identified. Recommendations for integrating SPC in clinical care, research, and education are needed, which are subject of the present study. Materials and Methods. A Delphi study, with three written Delphi rounds, including a face-to-face-meeting with a multiprofessional expert panel (n = 52) working in SPC in 15 German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid was initiated. Initial recommendations are built on evidence-based literature. Consensus was defined in advance with ≥80% agreement based on the question of whether each recommendation was unambiguously formulated, relevant, and realizable for a CCC. Results. A total of 38 experts (73.1%) from 15 CCCs performed all three Delphi rounds. Consensus was achieved for 29 of 30 recommendations. High agreement related to having an organizationally and spatially independent palliative care unit (≥6 beds), a mobile multiprofessional SPC team, and cooperation with community-based SPC. Until round 3, an ongoing discussion was registered on hospice volunteers, a chair of palliative care, education in SPC among staff in emergency departments, and integration of SPC in decision-making processes such as tumor boards or consultation hours. Integration of SPC in decision-making processes was not consented by a low-rated feasibility (76.3%) due to staff shortage. Conclusion. Recommendations should be considered when developing standards for cancer center of excellence in Germany. Definition and implementation of indicators of integration of SPC in CCCs and evaluation of its effectiveness are current and future challenges. Implications for Practice: General and specialized palliative care (SPC) is an integral part of comprehensive cancer care. However, significant diversity concerning the design of SPC in the German Comprehensive Cancer Center (CCC) Network led to the establishment of consensual best practice recommendations for integration of SPC into the clinical structures, processes, research, and education throughout the CCC network. The recommendations contribute to a greater awareness relating to the strategic direction and development of SPC in CCCs. The access to information about SPC and access to offers regarding SPC shall be facilitated by implementing the recommendations in the course of treatment of patients with cancer. PMID:27440065

EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases.

PubMed

Foster, Helen E; Minden, Kirsten; Clemente, Daniel; Leon, Leticia; McDonagh, Janet E; Kamphuis, Sylvia; Berggren, Karin; van Pelt, Philomine; Wouters, Carine; Waite-Jones, Jennifer; Tattersall, Rachel; Wyllie, Ruth; Stones, Simon R; Martini, Alberto; Constantin, Tamas; Schalm, Susanne; Fidanci, Berna; Erer, Burak; Demirkaya, Erkan; Ozen, Seza; Carmona, Loreto

2017-04-01

To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Compendium of GAO’s Views on the Cost Saving Proposals of the Grace Commission. Volume 1. Summary of Findings.

DTIC Science & Technology

1985-02-19

effort to develop a govern- ment-wide integrated financial management structure. Such an effort must have a solid base of fundamental concepts to guide ...initiatives address many PPSSCC debt collection concerns The PPSSCC recommendations basically parallel our prior *- recommendations and ongoing OMB...PPSSCC recommended either selling the PMAs’ facilities or adjusting the PMAs’ user fees, ratemaking process, and pricina structure. In total, the PPSSCC

Process Architecture for Managing Digital Object Identifiers

NASA Astrophysics Data System (ADS)

Wanchoo, L.; James, N.; Stolte, E.

2014-12-01

In 2010, NASA's Earth Science Data and Information System (ESDIS) Project implemented a process for registering Digital Object Identifiers (DOIs) for data products distributed by Earth Observing System Data and Information System (EOSDIS). For the first 3 years, ESDIS evolved the process involving the data provider community in the development of processes for creating and assigning DOIs, and guidelines for the landing page. To accomplish this, ESDIS established two DOI User Working Groups: one for reviewing the DOI process whose recommendations were submitted to ESDIS in February 2014; and the other recently tasked to review and further develop DOI landing page guidelines for ESDIS approval by end of 2014. ESDIS has recently upgraded the DOI system from a manually-driven system to one that largely automates the DOI process. The new automated feature include: a) reviewing the DOI metadata, b) assigning of opaque DOI name if data provider chooses, and c) reserving, registering, and updating the DOIs. The flexibility of reserving the DOI allows data providers to embed and test the DOI in the data product metadata before formally registering with EZID. The DOI update process allows the changing of any DOI metadata except the DOI name unless the name has not been registered. Currently, ESDIS has processed a total of 557 DOIs of which 379 DOIs are registered with EZID and 178 are reserved with ESDIS. The DOI incorporates several metadata elements that effectively identify the data product and the source of availability. Of these elements, the Uniform Resource Locator (URL) attribute has the very important function of identifying the landing page which describes the data product. ESDIS in consultation with data providers in the Earth Science community is currently developing landing page guidelines that specify the key data product descriptive elements to be included on each data product's landing page. This poster will describe in detail the unique automated process and underlying system implemented by ESDIS for registering DOIs, as well as some of the lessons learned from the development of the process. In addition, this paper will summarize the recommendations made by the DOI Process and DOI Landing Page User Working Groups, and the procedures developed for implementing those recommendations.

Evaluating Education and Science at the KSC Visitor Complex

NASA Technical Reports Server (NTRS)

Erickson, Lance K.

2002-01-01

As part of a two-year NASA-ASEE project, a preliminary evaluation and subsequent recommendations were developed to improve the education and science content of the Kennedy Space Center Visitor Complex exhibits. Recommendations for improvements in those exhibits were based on qualitative descriptions of the exhibits, on comparisons to similar exhibit collections, and on available evaluation processes. Because of the subjective nature of measuring content in a broad group of exhibits and displays, emphasis is placed on employing a survey format for a follow-on, more quantitative evaluation. The use of an external organization for this evaluation development is also recommended to reduce bias and increase validity.

Evaluating Education and Science at the KSC Visitor Complex

NASA Technical Reports Server (NTRS)

Erickson, Lance K.

2001-01-01

As part of a two-year NASA-ASEE project, a preliminary evaluation and subsequent recommendations were developed to improve the education and science content of the Kennedy Space Center Visitor Complex exhibits. Recommendations for improvements in those exhibits were based on qualitative descriptions of the exhibits, on comparisons to similar exhibit collections, and on available evaluation processes. Because of the subjective nature of measuring content in a broad group of exhibits and displays, emphasis is placed on employing a survey format for a follow-on, more quantitative evaluation. The use of an external organization for this evaluation development is also recommended to reduce bias and increase validity.

Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy

PubMed Central

Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dubé, Catherine; Enns, Robert; Hollingworth, Roger; MacIntosh, Donald; Borgaonkar, Mark; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Kuipers, Ernst J; Valori, Roland

2012-01-01

BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy. PMID:22308578

Adaptive Signal Processing Testbed: VME-based DSP board market survey

NASA Astrophysics Data System (ADS)

Ingram, Rick E.

1992-04-01

The Adaptive Signal Processing Testbed (ASPT) is a real-time multiprocessor system utilizing digital signal processor technology on VMEbus based printed circuit boards installed on a Sun workstation. The ASPT has specific requirements, particularly as regards to the signal excision application, with respect to interfacing with current and planned data generation equipment, processing of the data, storage to disk of final and intermediate results, and the development tools for applications development and integration into the overall EW/COM computing environment. A prototype ASPT was implemented using three VME-C-30 boards from Applied Silicon. Experience gained during the prototype development led to the conclusions that interprocessor communications capability is the most significant contributor to overall ASPT performance. In addition, the host involvement should be minimized. Boards using different processors were evaluated with respect to the ASPT system requirements, pricing, and availability. Specific recommendations based on various priorities are made as well as recommendations concerning the integration and interaction of various tools developed during the prototype implementation.

Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version.

PubMed

Werner, R N; Stockfleth, E; Connolly, S M; Correia, O; Erdmann, R; Foley, P; Gupta, A K; Jacobs, A; Kerl, H; Lim, H W; Martin, G; Paquet, M; Pariser, D M; Rosumeck, S; Röwert-Huber, H-J; Sahota, A; Sangueza, O P; Shumack, S; Sporbeck, B; Swanson, N A; Torezan, L; Nast, A

2015-11-01

Actinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are missing. The goal of these evidence- and consensus-based guidelines was the development of treatment recommendations appropriate for different subgroups of patients presenting with AK. A secondary aim of these guidelines was the implementation of knowledge relating to the clinical background of AK, including consensus-based recommendations for the histopathological definition, diagnosis and the assessment of patients. The guidelines development followed a pre-defined and structured process. For the underlying systematic literature review of interventions for AK, the methodology suggested by the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was adapted. All recommendations were consented during a consensus conference using a formal consensus methodology. Strength of recommendations was expressed based on the GRADE approach. If expert opinion without external evidence was incorporated into the reasoning for making a certain recommendation, the rationale was provided. The Guidelines underwent open public review and approval by the commissioning societies. Various interventions for the treatment of AK have been assessed for their efficacy. The consenting procedure led to a treatment algorithm as shown in the guidelines document. Based on expert consensus, the present guidelines present recommendations on the classification of patients, diagnosis and histopathological definition of AK. Details on the methods and results of the systematic literature review and guideline development process have been published separately. International guidelines are intended to be adapted to national or regional circumstances (regulatory approval, availability and reimbursement of treatments). © 2015 European Academy of Dermatology and Venereology.

Nuclear education and training: marriages that work

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hanson, H.D.

1985-11-01

Public Service Electric and Gas Company is meeting the education and training needs of its nuclear department operations, support, and services personnel through a variety of activities in association with institutions of higher education. Activities include credit or credit recommendation programs at the associates, undergraduate, and graduate degree level. The paper emphasizes the process of working with a local college in the development of a new degree program for submission through the State Board of Education. The development, review, evaluation, and approval process is detailed as well as lessons learned. Plans for further development of the program toward ABET accreditationmore » are also described. Samples of the surveys conducted to determine employee interest in terms of academic area, academic level, offering strategies, etc. are presented. The process of soliciting program proposals from universities and colleges, the selection process, and implementation of the programs are also discussed. More briefly described is the preparation for credit recommendation process from regionally accredited groups. External degree programs, off-hours course presentations on-site for undergraduate and graduate credit, faculty extern, student intern, and co-op activities are also discussed.« less

Best practice recommendations for the development, implementation, and evaluation of online knowledge translation resources in rehabilitation.

PubMed

Levac, Danielle; Glegg, Stephanie M N; Camden, Chantal; Rivard, Lisa M; Missiuna, Cheryl

2015-04-01

The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, user-centered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion. © 2015 American Physical Therapy Association.

Recommendations for selecting drug-drug interactions for clinical decision support.

PubMed

Tilson, Hugh; Hines, Lisa E; McEvoy, Gerald; Weinstein, David M; Hansten, Philip D; Matuszewski, Karl; le Comte, Marianne; Higby-Baker, Stefanie; Hanlon, Joseph T; Pezzullo, Lynn; Vieson, Kathleen; Helwig, Amy L; Huang, Shiew-Mei; Perre, Anthony; Bates, David W; Poikonen, John; Wittie, Michael A; Grizzle, Amy J; Brown, Mary; Malone, Daniel C

2016-04-15

Recommendations for including drug-drug interactions (DDIs) in clinical decision support (CDS) are presented. A conference series was conducted to improve CDS for DDIs. A work group consisting of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information vendors, and healthcare organizations was convened to address (1) the process to use for developing and maintaining a standard set of DDIs, (2) the information that should be included in a knowledge base of standard DDIs, (3) whether a list of contraindicated drug pairs can or should be established, and (4) how to more intelligently filter DDI alerts. We recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated and more research to identify methods to safely reduce repetitive and less-relevant alerts. An expert panel with a centralized organizer or convener should be established to develop and maintain a standard set of DDIs for CDS in the United States. The process should be evidence driven, transparent, and systematic, with feedback from multiple stakeholders for continuous improvement. The scope of the expert panel's work should be carefully managed to ensure that the process is sustainable. Support for research to improve DDI alerting in the future is also needed. Adoption of these steps may lead to consistent and clinically relevant content for interruptive DDIs, thus reducing alert fatigue and improving patient safety. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Basic Science Process Skills. An Inservice Workshop Kit: Outlines and Activities.

ERIC Educational Resources Information Center

Rowland, Paul; And Others

A science process skill project was developed to help elementary teachers meet competency standards in New Mexico for teaching the process approach in their science classes. An outline of the process skills along with recommended activities are presented in this document. Performance objectives are identified and a sample activity form is…

Is "processed" a four-letter word? The role of processed foods in achieving dietary guidelines and nutrient recommendations.

PubMed

Dwyer, Johanna T; Fulgoni, Victor L; Clemens, Roger A; Schmidt, David B; Freedman, Marjorie R

2012-07-01

This paper, based on the symposium "Is 'Processed' a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations in the U.S." describes ongoing efforts and challenges at the nutrition-food science interface and public health; addresses misinformation about processed foods by showing that processed fruits and vegetables made important dietary contributions (e.g., fiber, folate, potassium, vitamins A and C) to nutrient intake among NHANES 2003-2006 participants, that major sources of vitamins (except vitamin K) were provided by enrichment and fortification and that enrichment and fortification helped decrease the percentage of the population below the Estimated Average Requirement for vitamin A, thiamin, folate, and iron; describes how negative consumer perceptions and consumer confusion about processed foods led to the development of science-based information on food processing and technology that aligns with health objectives; and examines challenges and opportunities faced by food scientists who must balance consumer preferences, federal regulations, and issues surrounding food safety, cost, unintended consequences, and sustainability when developing healthful foods that align with dietary guidelines.

Recommendations for improved and coherent acquisition and processing of backscatter data from seafloor-mapping sonars

NASA Astrophysics Data System (ADS)

Lamarche, Geoffroy; Lurton, Xavier

2018-06-01

Multibeam echosounders are becoming widespread for the purposes of seafloor bathymetry mapping, but the acquisition and the use of seafloor backscatter measurements, acquired simultaneously with the bathymetric data, are still insufficiently understood, controlled and standardized. This presents an obstacle to well-accepted, standardized analysis and application by end users. The Marine Geological and Biological Habitat Mapping group (Geohab.org) has long recognized the need for better coherence and common agreement on acquisition, processing and interpretation of seafloor backscatter data, and established the Backscatter Working Group (BSWG) in May 2013. This paper presents an overview of this initiative, the mandate, structure and program of the working group, and a synopsis of the BSWG Guidelines and Recommendations to date. The paper includes (1) an overview of the current status in sensors and techniques available in seafloor backscatter data from multibeam sonars; (2) the presentation of the BSWG structure and results; (3) recommendations to operators, end-users, sonar manufacturers, and software developers using sonar backscatter for seafloor-mapping applications, for best practice methods and approaches for data acquisition and processing; and (4) a discussion on the development needs for future systems and data processing. We propose for the first time a nomenclature of backscatter processing levels that affords a means to accurately and efficiently describe the data processing status, and to facilitate comparisons of final products from various origins.

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

PubMed

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

2011-01-01

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

Hanford Spent Nuclear Fuel Project recommended path forward

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fulton, J.C.

The Spent Nuclear Fuel Project (the Project), in conjunction with the U.S. Department of Energy-commissioned Independent Technical Assessment (ITA) team, has developed engineered alternatives for expedited removal of spent nuclear fuel, including sludge, from the K Basins at Hanford. These alternatives, along with a foreign processing alternative offered by British Nuclear Fuels Limited (BNFL), were extensively reviewed and evaluated. Based on these evaluations, a Westinghouse Hanford Company (WHC) Recommended Path Forward for K Basins spent nuclear fuel has been developed and is presented in Volume I of this document. The recommendation constitutes an aggressive series of projects to construct andmore » operate systems and facilities to safely retrieve, package, transport, process, and store K Basins fuel and sludge. The overall processing and storage scheme is based on the ITA team`s proposed passivation and vault storage process. A dual purpose staging and vault storage facility provides an innovative feature which allows accelerated removal of fuel and sludge from the basins and minimizes programmatic risks beyond any of the originally proposed alternatives. The projects fit within a regulatory and National Environmental Policy Act (NEPA) overlay which mandates a two-phased approach to construction and operation of the needed facilities. The two-phase strategy packages and moves K Basins fuel and sludge to a newly constructed Staging and Storage Facility by the year 2000 where it is staged for processing. When an adjoining facility is constructed, the fuel is cycled through a stabilization process and returned to the Staging and Storage Facility for dry interim (40-year) storage. The estimated total expenditure for this Recommended Path Forward, including necessary new construction, operations, and deactivation of Project facilities through 2012, is approximately $1,150 million (unescalated).« less

California residential energy standards: problems and recommendations relating to implementation, enforcement, and design. [Thermal insulation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1977-08-01

Documents relevant to the development and implementation of the California energy insulation standards for new residential buildings were evaluated and a survey was conducted to determine problems encountered in the implementation, enforcement, and design aspects of the standards. The impact of the standards on enforcement agencies, designers, builders and developers, manufacturers and suppliers, consumers, and the building process in general is summarized. The impact on construction costs and energy savings varies considerably because of the wide variation in prior insulation practices and climatic conditions in California. The report concludes with a series of recommendations covering all levels of government andmore » the building process. (MCW)« less

Methodology for AACT evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning.

PubMed

Gosselin, Sophie; Morris, Martin; Miller-Nesbitt, Andrea; Hoffman, Robert S; Hayes, Bryan D; Turgeon, Alexis F; Gilfix, Brian M; Grunbaum, Ami M; Bania, Theodore C; Thomas, Simon H L; Morais, José A; Graudins, Andis; Bailey, Benoit; Mégarbane, Bruno; Calello, Diane P; Levine, Michael; Stellpflug, Samuel J; Hoegberg, Lotte C G; Chuang, Ryan; Stork, Christine; Bhalla, Ashish; Rollins, Carol J; Lavergne, Valéry

2015-07-01

Intravenous lipid emulsion (ILE) therapy is a novel treatment that was discovered in the last decade. Despite unclear understanding of its mechanisms of action, numerous and diverse publications attested to its clinical use. However, current evidence supporting its use is unclear and recommendations are inconsistent. To assist clinicians in decision-making, the American Academy of Clinical Toxicology created a workgroup composed of international experts from various clinical specialties, which includes representatives of major clinical toxicology associations. Rigorous methodology using the Appraisal of Guidelines for Research and Evaluation or AGREE II instrument was developed to provide a framework for the systematic reviews for this project and to formulate evidence-based recommendations on the use of ILE in poisoning. Systematic reviews on the efficacy of ILE in local anesthetic toxicity and non-local anesthetic poisonings as well as adverse effects of ILE are planned. A comprehensive review of lipid analytical interferences and a survey of ILE costs will be developed. The evidence will be appraised using the GRADE system. A thorough and transparent process for consensus statements will be performed to provide recommendations, using a modified Delphi method with two rounds of voting. This process will allow for the production of useful practice recommendations for this therapy.

Guide to Considering Children's Health When Developing EPA Actions: Implementing Executive Order 13045 and EPA's Policy on Evaluating Health Risks to Children

EPA Pesticide Factsheets

Recommendations on integrating children's health considerations into EPA's Action Development Process (ADP). Also how to identify economically significant actions, disproportionate risk, and developing the Analytical Blueprint.

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

PubMed Central

2012-01-01

Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors. PMID:22333210

Support Process Development for Assessing Green Infrastructure in Omaha, NE

EPA Pesticide Factsheets

Evaluates Omaha’s current process for assessing green infrastructure projects and recommends improvements for comparing green and gray infrastructure. Compares Omaha’s design criteria to other cities. Reviews other US programs with rights-of-way criteria.

Developing a Cardiac Rehabilitation Education Resource for Rural Health Workers in Queensland: Reviewing the Process and Outcomes.

ERIC Educational Resources Information Center

Parker, Elizabeth; O'Connor-Fleming, M.; Tooth, L.; Humphries, R. J.

2002-01-01

A resource manual on cardiac rehabilitation education was developed for health workers providing patient education in rural and remote Queensland (Australia). A process evaluation of the manual received feedback from 5 key informants and 31 rural health care workers following a 3-month trial. Overall, feedback was positive. Recommended content…

Therapeutic Process and Outcome: The Interplay of Research

ERIC Educational Resources Information Center

Campbel, Holly

2008-01-01

From Freud through to modern times researchers have aimed to develop a clearer understanding of therapeutic processes and outcomes. Despite this continued interest in the field, the representation of psychotherapy processes and the applicability of research findings and recommendations to the therapeutic field continue to prove difficult.…

ISRU: An Overview of NASA'S Current Development Activities and Long-Term Goals

NASA Technical Reports Server (NTRS)

Sanders, Gerald B.; Nicholson, Leonard S. (Technical Monitor)

2000-01-01

The concept of "living off the land" by utilizing the indigenous resources of the Moon, Mars, or other potential sites of robotic and human exploration has been termed In-Situ Resource Utilization (ISRU). It is fundamental to any program of extended human presence and operation on other extraterrestrial bodies that we learn how to utilize the indigenous resources. The chief benefits of ISRU are that it can reduce the mass, cost, and risk of robotic and human exploration while providing capabilities that enable the commercial development of space. In January 1997, the American Institute of Aeronautics and Astronautics (AIAA) Space Processing Technical Committee released a position paper entitled, "Need for A NASA Indigenous Space Resource Utilization (ISRU) Program". Besides outlining some of the potential advantages of incorporating ISRU into Lunar and Mars human mission plans and providing an overview of technologies and processes of interest, the position paper concluded with a list of seven recommendations to NASA. This paper will examine the seven recommendations proposed and provide an overview of NASA's current ISRU development activities and possible long term goals with respect to these recommendations.

Toward a microgravity research strategy

NASA Technical Reports Server (NTRS)

1992-01-01

Recommendations of the Committee on Microgravity Research (CMGR) of the Space Studies Board of the National Research Council are found in the Summary and Recommendations in the front of the report. The CMGR recommends a long-range research strategy. The main rationale for the microgravity research program should be to improve our fundamental scientific and technical knowledge base, particularly in the areas that are likely to lead to improvements in processing and manufacturing on earth. The CMGR recommends research be categorized as Biological science and technology, Combustion, Fluid science, Fundamental phenomena, Materials, and Processing science and technology. The committee also recommends that NASA apply a set of value criteria and measurement indicators to define the research and analysis program more clearly. The CMGR recommends that the funding level for research and analysis in microgravity science be established as a fixed percentage of the total program of NASA's Microgravity Science and Applications Division in order to build a strong scientific base for future experiments. The committee also recommends a cost-effective approach to experiments. Finally the CMGR recommends that a thorough technical review of the centers for commercial development of space be conducted to determine the quality of their activities and to ascertain to what degree their original mission has been accomplished.

78 FR 57450 - State Rail Plan Guidance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-18

... development of State rail plans, as appropriate. A commenter recommended that the FRA Regional Manager be... integration of State rail plan development within the statewide/nonmetropolitan transportation planning... Guidance is to describe the processes for the development, submission, and acceptance of State rail plans...

Evidence synthesis and guideline development in genomic medicine: current status and future prospects.

PubMed

Schully, Sheri D; Lam, Tram Kim; Dotson, W David; Chang, Christine Q; Aronson, Naomi; Birkeland, Marian L; Brewster, Stephanie Jo; Boccia, Stefania; Buchanan, Adam H; Calonge, Ned; Calzone, Kathleen; Djulbegovic, Benjamin; Goddard, Katrina A B; Klein, Roger D; Klein, Teri E; Lau, Joseph; Long, Rochelle; Lyman, Gary H; Morgan, Rebecca L; Palmer, Christina G S; Relling, Mary V; Rubinstein, Wendy S; Swen, Jesse J; Terry, Sharon F; Williams, Marc S; Khoury, Muin J

2015-01-01

With the accelerated implementation of genomic medicine, health-care providers will depend heavily on professional guidelines and recommendations. Because genomics affects many diseases across the life span, no single professional group covers the entirety of this rapidly developing field. To pursue a discussion of the minimal elements needed to develop evidence-based guidelines in genomics, the Centers for Disease Control and Prevention and the National Cancer Institute jointly held a workshop to engage representatives from 35 organizations with interest in genomics (13 of which make recommendations). The workshop explored methods used in evidence synthesis and guideline development and initiated a dialogue to compare these methods and to assess whether they are consistent with the Institute of Medicine report "Clinical Practice Guidelines We Can Trust." The participating organizations that develop guidelines or recommendations all had policies to manage guideline development and group membership, and processes to address conflicts of interests. However, there was wide variation in the reliance on external reviews, regular updating of recommendations, and use of systematic reviews to assess the strength of scientific evidence. Ongoing efforts are required to establish criteria for guideline development in genomic medicine as proposed by the Institute of Medicine.

Using GRADE as a framework to guide research on the sexual and reproductive health and rights (SRHR) of women living with HIV - methodological opportunities and challenges.

PubMed

Siegfried, Nandi; Narasimhan, Manjulaa; Kennedy, Caitlin E; Welbourn, Alice; Yuvraj, Anandi

2017-09-01

In March 2016, WHO reviewed evidence to develop global recommendations on the sexual and reproductive health and rights (SRHR) of women living with HIV. Systematic reviews and a global survey of women living with HIV informed the guideline development decision-making process. New recommendations covered abortion, Caesarean section, safe disclosure, and empowerment and self-efficacy interventions. Identification of key research gaps is part of the WHO guidelines development process, but consistent methods to do so are lacking. Our method aimed to ensure consistency and comprised the systematic application of a framework based on GRADE (Grading of Recommendations, Assessment, Development and Evaluation) to the process. The framework incorporates the strength and quality rating of recommendations and the priorities reported by women in the survey to inform research prioritisation. For each gap, we also articulated: (1) the most appropriate and robust study design to answer the question; (2) alternative pragmatic designs if the ideal design is not feasible; and (3) the methodological challenges facing researchers through identifying potential biases. We found 12 research gaps and identified five appropriate study designs to address the related questions: (1) Cross-sectional surveys; (2) Qualitative interview-driven studies; (3) Registries; (4) Randomised controlled trials; and (5) Medical record audit. Methodological challenges included selection, recruitment, misclassification, measurement and contextual biases, and confounding. In conclusion, a framework based on GRADE can provide a systematic approach to identifying research gaps from a WHO guideline. Incorporation of the priorities of women living with HIV into the framework systematically ensures that women living with HIV can shape future policy decisions affecting their lives. Implementation science and participatory research are appropriate over-arching approaches to enhance uptake of interventions and to ensure inclusion of women living with HIV at all stages of the research process.

Consultancy on Large-Scale Submerged Aerobic Cultivation Process Design - Final Technical Report: February 1, 2016 -- June 30, 2016

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crater, Jason; Galleher, Connor; Lievense, Jeff

NREL is developing an advanced aerobic bubble column model using Aspen Custom Modeler (ACM). The objective of this work is to integrate the new fermentor model with existing techno-economic models in Aspen Plus and Excel to establish a new methodology for guiding process design. To assist this effort, NREL has contracted Genomatica to critique and make recommendations for improving NREL's bioreactor model and large scale aerobic bioreactor design for biologically producing lipids at commercial scale. Genomatica has highlighted a few areas for improving the functionality and effectiveness of the model. Genomatica recommends using a compartment model approach with an integratedmore » black-box kinetic model of the production microbe. We also suggest including calculations for stirred tank reactors to extend the models functionality and adaptability for future process designs. Genomatica also suggests making several modifications to NREL's large-scale lipid production process design. The recommended process modifications are based on Genomatica's internal techno-economic assessment experience and are focused primarily on minimizing capital and operating costs. These recommendations include selecting/engineering a thermotolerant yeast strain with lipid excretion; using bubble column fermentors; increasing the size of production fermentors; reducing the number of vessels; employing semi-continuous operation; and recycling cell mass.« less

ACOEM practice guidelines: elbow disorders.

PubMed

Hegmann, Kurt T; Hoffman, Harold E; Belcourt, Roger M; Byrne, Kevin; Glass, Lee; Melhorn, J Mark; Richman, Jack; Zinni, Phillip; Thiese, Matthew S; Ott, Ulrike; Tokita, Kylee; Passey, Deborah Gwenevere; Effiong, Atim Cecelia; Robbins, Riann Bree; Ording, Julie A

2013-11-01

The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed. Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders. Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations. Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.

An Industrial Engineering Approach to Cost Containment of Pharmacy Education.

PubMed

Duncan, Wendy; Bottenberg, Michelle; Chase, Marilea; Chesnut, Renae; Clarke, Cheryl; Schott, Kathryn; Torry, Ronald; Welty, Tim

2015-11-25

A 2-semester project explored employing teams of fourth-year industrial engineering students to optimize some of our academic management processes. Results included significant cost savings and increases in efficiency, effectiveness, and student and faculty satisfaction. While we did not adopt all of the students' recommendations, we did learn some important lessons. For example, an initial investment of time in developing a mutually clear understanding of the problems, constraints, and goals maximizes the value of industrial engineering analysis and recommendations. Overall, industrial engineering was a valuable tool for optimizing certain academic management processes.

Evaluation and development plan of NRTA measurement methods for the Rokkasho Reprocessing Plant

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, T.K.; Hakkila, E.A.; Flosterbuer, S.F.

Near-real-time accounting (NRTA) has been proposed as a safeguards method at the Rokkasho Reprocessing Plant (RRP), a large-scale commercial boiling water and pressurized water reactors spent-fuel reprocessing facility. NRTA for RRP requires material balance closures every month. To develop a more effective and practical NRTA system for RRP, we have evaluated NRTA measurement techniques and systems that might be implemented in both the main process and the co-denitration process areas at RRP to analyze the concentrations of plutonium in solutions and mixed oxide powder. Based on the comparative evaluation, including performance, reliability, design criteria, operation methods, maintenance requirements, and estimatedmore » costs for each possible measurement method, recommendations for development were formulated. This paper discusses the evaluations and reports on the recommendation of the NRTA development plan for potential implementation at RRP.« less

The Morningside Initiative: Collaborative Development of a Knowledge Repository to Accelerate Adoption of Clinical Decision Support

DTIC Science & Technology

2010-01-01

Comparative Effectiveness Research, or other efforts to determine best practices and to develop guidelines based on meta-analysis and evidence - based medicine . An...authoritative reviews or other evidence - based medicine sources, but they have been made unambiguous and computable – a process which sounds...best practice recommendation created through an evidence - based medicine (EBM) development process. The lifecycle envisions four stages of refinement

Uncovering the information core in recommender systems

NASA Astrophysics Data System (ADS)

Zeng, Wei; Zeng, An; Liu, Hao; Shang, Ming-Sheng; Zhou, Tao

2014-08-01

With the rapid growth of the Internet and overwhelming amount of information that people are confronted with, recommender systems have been developed to effectively support users' decision-making process in online systems. So far, much attention has been paid to designing new recommendation algorithms and improving existent ones. However, few works considered the different contributions from different users to the performance of a recommender system. Such studies can help us improve the recommendation efficiency by excluding irrelevant users. In this paper, we argue that in each online system there exists a group of core users who carry most of the information for recommendation. With them, the recommender systems can already generate satisfactory recommendation. Our core user extraction method enables the recommender systems to achieve 90% of the accuracy of the top-L recommendation by taking only 20% of the users into account. A detailed investigation reveals that these core users are not necessarily the large-degree users. Moreover, they tend to select high quality objects and their selections are well diversified.

The Future of Postgraduate Medical Education in Canada.

PubMed

Busing, Nick; Harris, Ken; MacLellan, Anne-Marie; Moineau, Geneviève; Oandasan, Ivy; Rourke, James; Saxena, Anurag

2015-09-01

The Future of Medical Education in Canada Postgraduate (FMEC PG) Project was launched in 2010 by a consortium of four organizations: the Association of Faculties of Medicine of Canada, the Collège des Médecins du Québec, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada. The FMEC PG study set out to review the state of the Canadian postgraduate medical education (PGME) system and make recommendations for improvements and changes. The extensive process included literature reviews, commissioned papers, stakeholder interviews, international consultations, and dialogue with the public and learners. The resulting key findings and 10 recommendations, published in a report in 2012, represent the collective vision of the consortium partner organizations for PGME in Canada. Implementation of the recommendations began in 2013 and will continue beyond 2016.In this article, the authors describe the complex process of developing the recommendations, highlight several recommendations, consider implementation processes and issues, and share lessons learned to date. They reflect on the ways in which the transformation of a very complex and complicated PGME system has required many stakeholders to work together on multiple interventions simultaneously. Notwithstanding the challenges for the participating organizations, changes have been introduced and sustainability is being forged. Throughout this process, the consortium partners and other stakeholders have continued to address the social accountability role of all physicians with respect to the public they serve.

Canadian sedentary behaviour guidelines for children and youth.

PubMed

Tremblay, Mark S; Leblanc, Allana G; Janssen, Ian; Kho, Michelle E; Hicks, Audrey; Murumets, Kelly; Colley, Rachel C; Duggan, Mary

2011-02-01

The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children's Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5-11 years) and Youth (aged 12-17 years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5-11 years) and youth (aged 12-17 years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2 h per day - lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence.

Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults.

PubMed

Aschner, Pablo M; Muñoz, Oscar Mauricio; Girón, Diana; García, Olga Milena; Fernández-Ávila, Daniel Gerardo; Casas, Luz Ángela; Bohórquez, Luisa Fernanda; Arango T, Clara María; Carvajal, Liliana; Ramírez, Doris Amanda; Sarmiento, Juan Guillermo; Colon, Cristian Alejandro; Correa G, Néstor Fabián; Alarcón R, Pilar; Bustamante S, Álvaro Andrés

2016-06-30

In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes.

Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults

PubMed Central

Muñoz, Oscar Mauricio; Girón, Diana; García, Olga Milena; Fernández-Ávila, Daniel Gerardo; Casas, Luz Ángela; Bohórquez, Luisa Fernanda; Arango T, Clara María; Carvajal, Liliana; Ramírez, Doris Amanda; Sarmiento, Juan Guillermo; Colon, Cristian Alejandro; Correa G, Néstor Fabián; Alarcón R, Pilar; Bustamante S, Álvaro Andrés

2016-01-01

In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes. PMID:27546934

Guideline group composition and group processes: article 3 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Kunz, Regina; Fretheim, Atle; Cluzeau, Françoise; Wilt, Timothy J; Qaseem, Amir; Lelgemann, Monika; Kelson, Marcia; Guyatt, Gordon; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the third of a series of 14 articles that were prepared to advise guideline developers in respiratory and other diseases on considerations for group compositions and group processes in guideline development, and how this can be effectively integrated in the context of respiratory disease guidelines on a national and international level. We updated a review of the literature addressing group composition and group process, focusing on the following questions: 1. How to compose a functioning and representative guideline group; Who should be included in a guideline panel?; How to select organizations, groups, and individuals; What expertise is needed?; Consultation with non-included groups. 2. How to assure a functioning group process; How to make the process constructive; Balancing participation and finding agreement; Administrative support; What constitutes sufficient resources? Our conclusions are based on available evidence from published literature, experience from guideline developers, and workshop discussions. Formal studies addressing optimal processes in developing guidelines are limited, and experience from guideline organizations supplement the formal studies. When resources are available, guideline development groups should aim for multidisciplinary groups, including patients. Prerequisites for a multidisciplinary group include: a strong chair experienced in group facilitation with broad acceptance in the group, training the group in guideline methodology, and professional technical support. Formal consensus developing methods have proved effective in reaching agreement on the final recommendations.

STS/Spacelab payload utilization planning study: Executive summary

NASA Technical Reports Server (NTRS)

1976-01-01

The planning process recommended to meet the orbital flight requirements for the Space Transportation System and payload development, procurement, operations, and support leading to authorization and funding of STS and payload project activities is described. The rationale and rp primary products of STS utilization planning are summarized along with the implementation of the system. Major recommendations of the study are included.

[Dietary supplements from ground fish meat with DNA for treatment and prophylaxis].

PubMed

Boiarkina, L G; Kas'ianenko, Iu I; Epshteĭn, L M; Iakush, E V

1998-01-01

It has been developed a receipt of a new treatment-and-prophylactic products based on fish farce with treatment-and-prophylactic additive--DNA. It is recommended to be produced. As biological active additive keeps its initial pharmacological characteristics under technological processing this product is recommended for rendering general effect and increasing of physical and mental activity of organism.

Indicators of climate impacts for forests: recommendations for the US National Climate Assessment indicators system

Treesearch

Linda S. Heath; Sarah M. Anderson; Marla R. Emery; Jeffrey A. Hicke; Jeremy Littell; Alan Lucier; Jeffrey G. Masek; David L. Peterson; Richard Pouyat; Kevin M. Potter; Guy Robertson; Jinelle Sperry; Andrzej Bytnerowicz; Sarah Jovan; Miranda H. Mockrin; Robert Musselman; Bethany K. Schulz; Robert J. Smith; Susan I. Stewart

2015-01-01

The Third National Climate Assessment (NCA) process for the United States focused in part on developing a system of indicators to communicate key aspects of the physical climate, climate impacts, vulnerabilities, and preparedness to inform decisionmakers and the public. Initially, 13 active teams were formed to recommend indicators in a range of categories, including...

How to Develop a Better Guidance Program.

ERIC Educational Resources Information Center

Lawrence, William W.

Designed for school board members, superintendents, administrators, counselors, and teachers, the paper outlines steps toward the systematic development of a guidance program. Following a rationale and introduction, the paper recommends a specific process for program development: (1) the identification of student needs through formal needs…

Community College Older Adult Program Development Guidelines.

ERIC Educational Resources Information Center

Getskow, Veronica

This guide provides information and suggestions for developing programs that meet the needs of older adults at community colleges. Recommended procedures are presented for the following stages of program development: (1) leadership influences, highlighting the process of hiring effective leaders, key leadership skills, and leaders'…

Evaluation of coal feed systems being developed by the Energy Research and Development administration

NASA Technical Reports Server (NTRS)

Phen, R. L.; Luckow, W. K.; Mattson, L.; Otth, D.; Tsou, P.

1977-01-01

Development criteria and recommendations for coal feed system selections that include supporting data are presented. Considered are the areas of coal feed coasts, coal feed system reliability, and the interaction of the feed system with the conversion process.

[Global immunization policies and recommendations: objectives and process].

PubMed

Duclos, Philippe; Okwo-Bele, Jean-Marie

2007-04-01

The World Health Organization (WHO) has a dual mandate of providing global policies, standards and norms as well as support for member countries in applying such policies and standards to national programmes with the aim to improve health. The vaccine world is changing and with it the demands and expectations of the global and national policy makers, donors, and other interested parties. Changes pertain to : new vaccines and technologies developments, vaccine safety issues, regulation and approval of vaccines, and increased funding flowing through new financing mechanisms. This places a special responsibility on WHO to respond effectively. WHO has recently reviewed and optimized its policy making structure for vaccines and immunization and adjusted it to the new Global Immunization Vision and Strategy, which broadens the scope of immunization efforts to all age groups and vaccines with emphasis on integration of immunization delivery with other health interventions. This includes an extended consultation process to promptly generate evidence base recommendations, ensuring transparency of the decision making process and added communication efforts. This article presents the objectives and impact of the process set to develop global immunization policies, norms, standards and recommendations. The key advisory committees landscape contributing to this process is described. This includes the Strategic Advisory Group of Experts, the Global Advisory Committee on Vaccine Safety and the Expert Committee on Biological Standardization. The elaboration of WHO vaccine position papers is also described.

The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support.

PubMed

Dew, Mary Amanda; DiMartini, Andrea F; Dobbels, Fabienne; Grady, Kathleen L; Jowsey-Gregoire, Sheila G; Kaan, Annemarie; Kendall, Kay; Young, Quincy-Robyn; Abbey, Susan E; Butt, Zeeshan; Crone, Catherine C; De Geest, Sabina; Doligalski, Christina T; Kugler, Christiane; McDonald, Laurie; Ohler, Linda; Painter, Liz; Petty, Michael G; Robson, Desiree; Schlöglhofer, Thomas; Schneekloth, Terry D; Singer, Jonathan P; Smith, Patrick J; Spaderna, Heike; Teuteberg, Jeffrey J; Yusen, Roger D; Zimbrean, Paula C

2018-04-27

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals. Copyright © 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative

PubMed Central

Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S R; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J; Landewé, Robert B; Bijlsma, Johannes W; Branco, Jaime C; Burgos-Vargas, Rubén; Catrina, Anca I; Elewaut, Dirk; Ferrari, Antonio J L; Kiely, Patrick; Leeb, Burkhard F; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Østergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M

2014-01-01

We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010–2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1–10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice. PMID:23868909

Communications Contingency Plan: Planning for Crises and Controversy. Phase 1

NASA Technical Reports Server (NTRS)

Treise, Deborah; Bernstein, Arla G.; Yates, Brad

1998-01-01

Interviews were conducted with a variety of Marshall Space Flight Center personnel and local media representatives in Huntsville, Alabama, in order to identify the current perceptions of these individuals regarding communication effectiveness between MSFC and the media. The purposes of the Phase One report are to (1) assess the need for a contingency plan for communicating in situations of crisis and controversy; (2) identify goals and objectives for the planning process; and (3) provide recommendations for future planning activities to achieve the goals and objectives outlined in Phase One. It is strongly recommended that MSFC personnel who are involved in communications with the media participate in a facilitated, strategic communications planning process in order to develop Phase Two of the Communications Contingency Plan (CCP). Phase Two will address (1) the categorizing, ranking and prioritizing of crises and controversies; (2) the development of action steps and implementation strategies for the CCP; and (3) the development of a monitoring and evaluation process for ongoing plan effectiveness.

Development of a set of process and structure indicators for palliative care: the Europall project

PubMed Central

2012-01-01

Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs. PMID:23122255

The process of developing evidence-based guidance in medicine and public health: a qualitative study of views from the inside

PubMed Central

2013-01-01

Background There has been significant investment in developing guidelines to improve clinical and public health practice. Though much is known about the processes of evidence synthesis and evidence-based guidelines implementation, we know little about how evidence presented to advisory groups is interpreted and used to form practice recommendations or what happens where evidence is lacking. This study investigates how members of advisory groups of NICE (National Institute of Health and Clinical Excellence) conceptualize evidence and experience the process. Methods Members of three advisory groups for acute physical, mental and public health were interviewed at the beginning and end of the life of the group. Seventeen were interviewed at both time points; five were interviewed just once at time one; and 17 were interviewed only once after guidance completion. Using thematic and content analysis, interview transcripts were analysed to identify the main themes. Results Three themes were identified: 1. What is the task? Different members conceptualized the task differently; some emphasized the importance of evidence at the top of the quality hierarchy while others emphasized the importance of personal experience. 2. Who gets heard? Managing the diversity of opinion and vested interests was a challenge for the groups; service users were valued and as was the importance of fostering good working relationships between group members. 3. What is the process? Group members valued debate and recognized the need to marshal discussion; most members were satisfied with the process and output. Conclusions Evidence doesn’t form recommendations on its own, but requires human judgement. Diversity of opinion within advisory groups was seen as key to making well-informed judgments relevant to forming recommendations. However, that diversity can bring tensions in the evaluation of evidence and its translation into practice recommendations. PMID:24006933

The Canadian Rheumatology Association/ Spondyloarthritis Research Consortium of Canada treatment recommendations for the management of spondyloarthritis: a national multidisciplinary stakeholder project.

PubMed

Maksymowych, Walter P; Gladman, Dafna; Rahman, Proton; Boonen, Annelies; Bykerk, Vivien; Choquette, Denis; Dimond, Sherry; Fortin, Paul; Karsh, Jacob; Klinkhoff, Alice V; Mosher, Dianne; Mulholland, Ken; Olszynski, Wojciech P; Russell, Anthony S; Savage, Laurie; Shanner, Laura; Shojania, Kam; Starr, Michael; Thomson, Glen; Zummer, Michel; Inman, Robert

2007-11-01

Development of treatment recommendations for arthritis has traditionally relied on the compilation of evidence-based data by experts in the field despite recommendations by various bodies for broad stakeholder input. Our objectives were: (1) To develop evidence-based treatment recommendations for the management of spondyloarthritis (SpA) in Canada that also incorporate the perspective of multiple stakeholders. (2) To generate a procedural template for the multidisciplinary development of treatment recommendations. The process was directed by a steering committee comprising the SPARCC Executive, rheumatologists from academic and community-based practice, patient consumers, and a representative from the John Dossetor Health Ethics Centre. Guidelines established by EULAR and stipulated in the AGREE instrument were followed. First, a working document was drafted that included a referenced summary of the evidence-based data and the 12 national arthritis care standards developed by the Alliance for the Canadian Arthritis Program. Second, a Web-based survey was conducted among patient consumers to address the relevance to patients of 2 primary outcome instruments that assess the effectiveness of treatment. Third, a list of questions was generated for drafting propositions by the ethics consultant. A Delphi consensus exercise was then conducted. Consensus was generated on a final list of 38 treatment recommendations categorized under the subject headings of general management principles, ethical considerations, target groups, definition of target disease, disease monitoring, and specific management recommendations. Using broad stakeholder input, we provide treatment recommendations to guide clinical practice and access to care for patients with SpA in Canada.

Implementing Family-Centered Care Through Facilitated Sensemaking.

PubMed

Davidson, Judy E; Zisook, Sidney

2017-01-01

The Society of Critical Care Medicine has released updated recommendations for care of the family in neonatal, pediatric, and adult intensive care units. Translation of the recommendations into practice may benefit from a supporting theoretical framework. Facilitated sensemaking is a mid-range theory built from the same literature that formed the basis for recommendations within the guidelines. The process of facilitated sensemaking may be used to help nurses adopt the SCCM recommendations into practice through the development of caring relationships, promoting family presence, teaching family engagement strategies, and supporting families with communication, information gathering, and participation in decision-making. ©2017 American Association of Critical-Care Nurses.

Report on the RCDS-CDHSRU workshop on developing clinical guidelines/standards of practice.

PubMed

Leake, J L; Main, P A; Woodward, G L

1996-07-01

Investigators from the Community Dental Health Services Research Unit (CDHSRU) held a workshop to test a model for developing clinical guidelines/standards of practice, which are required under the Regulated Health Professions Legislation. Forty-two individuals from Ontario and Canada, including dentists, representatives of the public, and professionals, participated in the three-day workshop, held under the auspices of the quality assurance committee of the Royal College of Dental Surgeons of Ontario (RCDS). Through direct experience, workshop participants sought to learn each of the steps, as defined by the literature, involved in clinical guideline development. Ultimately, they hoped to recommend steps for RCDS to follow in developing standards of practice. To ensure that a realistic and valid model emerged from the workshop, a real topic, namely the management of smooth surface enamel lesions in permanent teeth, was used to develop and test clinical guidelines. Prior to the workshop, participants were sent literature on one of five aspects of the topic, as well as papers describing the methodology of critically appraising the literature, and partially-completed templates outlining the basic steps to be followed. During the first evening and first morning of the workshop, participants listened to presentations on the development of clinical guidelines, the prevalence of smooth surface lesions, the role of economics in guideline development, and the necessary considerations in writing clinical guidelines. Under the leadership of trained facilitators, they then worked in small groups to write evidence-based recommendations and report them to the other workshop participants for feedback. Using this feedback, they returned to their groups to revise their recommendations and work on the workshop's overall recommendations to the RCDS. The day concluded in the evening, when the workshop facilitators and coordinators met to edit the groups' recommendations into a consistent format for presentation to all participants. On the second morning, the participants attended a plenary session to review the evidence-based recommendations developed by the groups, as well as their overall recommendations on the steps to be followed by the RCDS. Ultimately, workshop participants partially completed the templates and developed preliminary evidence-based recommendations on the management of enamel smooth-surface caries. Based on their experiences, they recommended a seven-step process for the future development of clinical practice guidelines/standards of practice in Ontario. These steps are recommendations only, and are not RCDS policy.

Human-Centered Development of an Online Social Network for Metabolic Syndrome Management.

PubMed

Núñez-Nava, Jefersson; Orozco-Sánchez, Paola A; López, Diego M; Ceron, Jesus D; Alvarez-Rosero, Rosa E

2016-01-01

According to the International Diabetes Federation (IDF), a quarter of the world's population has Metabolic Syndrome (MS). To develop (and assess the users' degree of satisfaction of) an online social network for patients who suffer from Metabolic Syndrome, based on the recommendations and requirements of the Human-Centered Design. Following the recommendations of the ISO 9241-210 for Human-Centered Design (HCD), an online social network was designed to promote physical activity and healthy nutrition. In order to guarantee the active participation of the users during the development of the social network, a survey, an in-depth interview, a focal group, and usability tests were carried out with people suffering from MS. The study demonstrated how the different activities, recommendations, and requirements of the ISO 9241-210 are integrated into a traditional software development process. Early usability tests demonstrated that the user's acceptance and the effectiveness and efficiency of the social network are satisfactory.

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

PubMed

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

Energy Efficiency Opportunities in Highway Lodging Buildings: Development of 50% Energy Savings Design Technology Packages

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jiang, Wei; Gowri, Krishnan; Thornton, Brian A.

2010-06-30

This paper presents the process, methodology, and assumptions for development of the 50% Energy Savings Design Technology Packages for Highway Lodging Buildings, a design guidance document that provides specific recommendations for achieving 50% energy savings in roadside motels (highway lodging) above the requirements of ANSI/ASHRAE/IESNA Standard 90.1-2004. This 50% solution represents a further step toward realization of the U.S. Department of Energy’s net-zero energy building goal, and go beyond the 30% savings in the Advanced Energy Design Guide series (upon which this work was built). This work can serve as the technical feasibility study for the development of a 50%more » saving Advanced Energy Design Guide for highway lodging, and thus should greatly expedite the development process. The purpose of this design package is to provide user-friendly design assistance to designers, developers, and owners of highway lodging properties. It is intended to encourage energy-efficient design by providing prescriptive energy-efficiency recommendations for each climate zone that attains the 50% the energy savings target. This paper describes the steps that were taken to demonstrate the technical feasibility of achieving a 50% reduction in whole-building energy use with practical and commercially available technologies. The energy analysis results are presented, indicating the recommended energy-efficient measures achieved a national-weighted average energy savings of 55%, relative to Standard 90.1-2004. The cost-effectiveness of the recommended technology package is evaluated and the result shows an average simple payback of 11.3 years.« less

Senior GRADE methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis.

PubMed

Alexander, Paul E; Li, Shelly-Anne; Gionfriddo, Michael R; Stoltzfus, Rebecca J; Neumann, Ignacio; Brito, Juan P; Djulbegovic, Benjamin; Montori, Victor M; Schünemann, Holger J; Guyatt, Gordon H

2016-02-01

The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly regarding discordant recommendations. Senior active GRADE methodologists who had served on at least two WHO panels and were an author on at least one peer-reviewed published article on GRADE methodology. Five eligible methodologists participated in detailed semistructured interviews. Respondents answered questions regarding how they were viewed by other panelists and WHO leadership, and how they handled situations when panelists made discordant recommendations they felt were inappropriate. They also provided information on how the process can be improved. Interviews were recorded and transcribed, and inductive content analysis was used to derive codes, categories, and emergent themes. Three themes emerged from the interviews of five methodologists: (1) The perceived role of methodologists in the process, (2) Contributors to discordant recommendations, and (3) Strategies for improvement. Salient findings included (1) a perceived tension between methodologists and WHO panels as a result of panel members' resistance to adhering to GRADE guidance; (2) both financial and nonfinancial conflicts of interest among panel members as an explanation for discordant recommendations; and (3) the need for greater clarity of, and support for, the role of methodologists as co-chairs of panels. These findings suggest that the role of the GRADE methodologist as a co-chair needs to be clarified by the WHO leadership. They further suggest the need for additional training for panelists, quality monitoring, and feedback to ensure optimal use of GRADE in guideline development at WHO. Copyright © 2016 Elsevier Inc. All rights reserved.

Multibeam Sonar Backscatter Data Acquisition and Processing: Guidelines and Recommendations from the GEOHAB Backscatter Working Group

NASA Astrophysics Data System (ADS)

Heffron, E.; Lurton, X.; Lamarche, G.; Brown, C.; Lucieer, V.; Rice, G.; Schimel, A.; Weber, T.

2015-12-01

Backscatter data acquired with multibeam sonars are now commonly used for the remote geological interpretation of the seabed. The systems hardware, software, and processing methods and tools have grown in numbers and improved over the years, yet many issues linger: there are no standard procedures for acquisition, poor or absent calibration, limited understanding and documentation of processing methods, etc. A workshop organized at the GeoHab (a community of geoscientists and biologists around the topic of marine habitat mapping) annual meeting in 2013 was dedicated to seafloor backscatter data from multibeam sonars and concluded that there was an overwhelming need for better coherence and agreement on the topics of acquisition, processing and interpretation of data. The GeoHab Backscatter Working Group (BSWG) was subsequently created with the purpose of documenting and synthetizing the state-of-the-art in sensors and techniques available today and proposing methods for best practice in the acquisition and processing of backscatter data. Two years later, the resulting document "Backscatter measurements by seafloor-mapping sonars: Guidelines and Recommendations" was completed1. The document provides: An introduction to backscatter measurements by seafloor-mapping sonars; A background on the physical principles of sonar backscatter; A discussion on users' needs from a wide spectrum of community end-users; A review on backscatter measurement; An analysis of best practices in data acquisition; A review of data processing principles with details on present software implementation; and finally A synthesis and key recommendations. This presentation reviews the BSWG mandate, structure, and development of this document. It details the various chapter contents, its recommendations to sonar manufacturers, operators, data processing software developers and end-users and its implication for the marine geology community. 1: Downloadable at https://www.niwa.co.nz/coasts-and-oceans/research-projects/backscatter-measurement-guidelines

Elaboration and formalization of current scientific knowledge of risks and preventive measures illustrated by colorectal cancer.

PubMed

Giorgi, R; Gouvernet, J; Dufour, J; Degoulet, P; Laugier, R; Quilichini, F; Fieschi, M

2001-01-01

Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures. The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines. The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach. Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.

National Study of Word Processing Installations in Selected Business Organizations. A Report on the National Word Processing Research Study of Delta Pi Epsilon.

ERIC Educational Resources Information Center

Scriven, Jolene D.; And Others

A study was conducted (1) to determine current practices in word processing installations in selected organizations throughout the United States, and (2) to ascertain anticipated future developments in word processing as well as to provide recommendations for educational institutions that prepare workers for business offices. Seven interview…

Optimising adherence to childhood pneumonia treatment: the design and development of patient instructions and a job aid for amoxicillin dispersible tablets.

PubMed

Ebels, Kelly; Faulx, Dunia; Gerth-Guyette, Emily; Murunga, Peninah; Mahapatro, Samarendra; Das, Manoja Kumar; Ginsburg, Amy Sarah

2016-01-01

Pneumonia is the leading cause of death from infection in children worldwide. Despite global treatment recommendations that call for children with pneumonia to receive amoxicillin dispersible tablets, only one-third of children with pneumonia receive any antibiotics and many do not complete the full course of treatment. Poor adherence to antibiotics may be driven in part by a lack of user-friendly treatment instructions. In order to optimise childhood pneumonia treatment adherence at the community level, we developed a user-friendly product presentation for caregivers and a job aid for healthcare providers (HCPs). This paper aims to document the development process and offers a model for future health communication tools. We employed an iterative design process that included document review, key stakeholder interviews, engagement with a graphic designer and pre-testing design concepts among target users in India and Kenya. The consolidated criteria for reporting qualitative research were used in the description of results. Though resources for pneumonia treatment are available in some countries, their content is incomplete and inconsistent with global recommendations. Document review and stakeholder interviews provided the information necessary to convey to caregivers and recommendations for how to present this information. Target users in India and Kenya confirmed the need to support better treatment adherence, recommended specific modifications to design concepts and suggested the development of a companion job aid. There was a consensus among caregivers and HCPs that these tools would be helpful and improve adherence behaviours. The development of user-friendly instructions for medications for use in low-resource settings is a critically important but time-intensive and resource-intensive process that should involve engagement with target audiences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association

PubMed Central

Levenhagen, Kimberly; Davies, Claire; Perdomo, Marisa; Ryans, Kathryn

2017-01-01

Abstract The Oncology Section of the American Physical Therapy Association (APTA) developed a clinical practice guideline to aid the clinician in diagnosing secondary upper quadrant cancer-related lymphedema. Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in the diagnostic process. Overall clinical practice recommendations were formulated based on the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. In an effort to maximize clinical applicability, recommendations were based on the characteristics as to the location and stage of a patient's upper quadrant lymphedema. PMID:28838217

Moving from evidence to developing recommendations in guidelines: article 11 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Schünemann, Holger J; Oxman, Andy D; Akl, Elie A; Brozek, Jan L; Montori, Victor M; Heffner, John; Hill, Suzanne; Woodhead, Mark; Campos-Outcalt, Doug; Alderson, Phil; Woitalla, Thomas; Puhan, Milo A; Falck-Ytter, Yngve; Bousquet, Jean; Guyatt, Gordon

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence. This is the 11th of a series of 14 articles that methodologists and researchers from around the world prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. For this article, we developed five key questions and updated a review of the literature on moving from evidence to recommendations. We addressed the following specific questions.What is the strength of a recommendation and what determines the strength? What are the implications of strong and weak recommendations for patients, clinicians, and policy makers? Should guideline panels make recommendations in the face of very low-quality evidence? Under which circumstances should guideline panels make research recommendations? How should recommendations be formulated and presented? We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on available evidence, consideration of what guideline developers are doing, and pre- and postworkshop discussions. The strength of a recommendation reflects the extent to which guideline developers can, across the range of patients for whom the recommendations are intended, be confident that the desirable effects of following the recommendation outweigh the undesirable effects. Four factors influence the strength of a recommendation: the quality of evidence supporting the recommendation, the balance between desirable and undesirable effects, the uncertainty or variability of patient values and preferences, and costs. Strong and weak (also called "conditional") recommendations have distinct implications for patients, clinicians, and policy makers. Adherence to strong recommendations or, in the case of weak (conditional) recommendations, documentation of discussion or shared decision making with a patient, might be used as quality measures or performance indicators. Clinicians desire guidance regardless of the quality of the underlying evidence. Very low-quality evidence should ideally result in either appropriately labeled recommendations (i.e., as based on very low-quality evidence) or a statement that the guideline panel did not reach consensus on the recommendation due to the lack of confidence in the effect estimates. However, guideline panels often have more resources, time, and information than practicing clinicians. Therefore, they may be in a position to use their best judgments to make recommendations even when there is very low-quality evidence, although some guideline developers disagree with this approach and prefer a general approach of not making recommendations in the face of very low-quality evidence. Guideline panels should consider making research recommendations when there is important uncertainty about the desirable and undesirable effects of an intervention, further research could reduce that uncertainty, and the potential benefits and savings of reducing the uncertainty outweigh the potential harms of not making the research recommendation. Recommendations for additional research should be as precise and specific as possible.

Development of traffic data input resources for the mechanistic empirical pavement design process.

DOT National Transportation Integrated Search

2011-12-12

The Mechanistic-Empirical Pavement Design Guide (MEPDG) for New and Rehabilitated Pavement Structures uses : nationally based data traffic inputs and recommends that state DOTs develop their own site-specific and regional : values. To support the MEP...

Rigour of development does not AGREE with recommendations in practice guidelines on the use of ice for acute ankle sprains.

PubMed

Van de Velde, S; Heselmans, A; Donceel, P; Vandekerckhove, P; Ramaekers, D; Aertgeerts, B

2011-09-01

OBJECTIVE This study evaluated whether the Appraisal of Guidelines Research and Evaluation (AGREE) rigour of development score of practice guidelines on ice for acute ankle sprains is related to the convergence between recommendations. DESIGN The authors systematically reviewed guidelines on ice for acute ankle sprains. Four appraisers independently used the AGREE instrument to evaluate the rigour of development of selected guidelines. For each guideline, one reviewer listed the cited evidence on ice and calculated a cited evidence score. The authors plotted the recommended durations and numbers of ice applications over the standardised rigour of development score to explore the relationships. DATA SOURCES Three reviewers searched for guidelines in Medline, Embase, Sportdiscus, PEDro, G-I-N Guideline Library, Trip Database, SumSearch, National Guideline Clearinghouse and the Health Technology Assessment database, and conducted a web-based search for guideline development organisations. ELIGIBILITY CRITERIA Eligible guidelines had a development methodology that included a process to search or use results from scientific studies and the participation of an expert group to formulate recommendations. RESULTS The authors identified 21 guidelines, containing clinically significant variations in recommended durations and numbers of ice applications. The median standardised rigour of development score was 57% (IQR 18 to 77). Variations occurred evenly among guidelines with low moderate or high rigour scores. The median evidence citation score in the guidelines was 7% (IQR 0 to 61). CONCLUSIONS There is no relationship between the rigour of development score and the recommendations in guidelines on ice for acute ankle sprains. The guidelines suffered from methodological problems which were not captured by the AGREE instrument.

Collaborative Filtering for Expansion of Learner's Background Knowledge in Online Language Learning: Does "Top-Down" Processing Improve Vocabulary Proficiency?

ERIC Educational Resources Information Center

Yamada, Masanori; Kitamura, Satoshi; Matsukawa, Hideya; Misono, Tadashi; Kitani, Noriko; Yamauchi, Yuhei

2014-01-01

In recent years, collaborative filtering, a recommendation algorithm that incorporates a user's data such as interest, has received worldwide attention as an advanced learning support system. However, accurate recommendations along with a user's interest cannot be ideal as an effective learning environment. This study aims to develop and…

A guide to guidelines for professional societies and other developers of recommendations: introduction to integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Schünemann, Holger J; Woodhead, Mark; Anzueto, Antonio; Buist, A Sonia; Macnee, William; Rabe, Klaus F; Heffner, John

2012-12-01

Organizations around the world are recognizing that guidelines should be based on the best available evidence, that the development of recommendations needs to be transparent, and that appropriate processes should be followed. In June 2007, we convened an American Thoracic Society (ATS)/European Respiratory Society (ERS)-sponsored workshop with over 60 representatives from 36 international organizations to provide advice to guideline developers about the required steps and processes for guideline development using the management of chronic obstructive pulmonary disease (COPD) as an example. Following the workshop, participants completed a series of 14 review articles that underwent peer review and incorporated key new literature until June 2011 for most articles in this series. The review articles evaluate the guideline cycle including: priority setting, question formulation, managing conflict of interest, defining appropriate outcomes, stakeholder involvement, grading the quality of evidence and strength of recommendations, integration of values and preferences, considering resource use, reporting of guidelines, implementation, and adaptation. In this Introduction we frame the background and methods of these reviews and provide the key conclusions of the workshop. A summary of the workshop's conclusions and recommendations was published in The Lancet. Given the enormous resources that are spent on research and the importance of providing the best guidance to healthcare decision makers, attributing appropriate funds to research syntheses and transparent, independent guidance for the development of evidence-based guidelines is justified. Furthermore, given the immense amount of work that is required, individuals and organizations need to collaborate to achieve the best possible and cost-effective coordination of these efforts.

Controlled Ecological Life Support System: Research and Development Guidelines

NASA Technical Reports Server (NTRS)

Mason, R. M. (Editor); Carden, J. L. (Editor)

1982-01-01

Results of a workshop designed to provide a base for initiating a program of research and development of controlled ecological life support systems (CELSS) are summarized. Included are an evaluation of a ground based manned demonstration as a milestone in CELSS development, and a discussion of development requirements for a successful ground based CELSS demonstration. Research recommendations are presented concerning the following topics: nutrition and food processing, food production, waste processing, systems engineering and modelling, and ecology-systems safety.

The impact of fear appeals on processing and acceptance of action recommendations.

PubMed

de Hoog, Natascha; Stroebe, Wolfgang; de Wit, John B F

2005-01-01

A stage model of processing of fear-arousing communications was tested in an experiment that examined the impact of vulnerability to a severe health risk, the quality of the arguments supporting a protective action recommendation, and the source to which the recommendation was attributed, on processing and acceptance of the recommendation. Argument quality influenced attitudes toward the recommendation (but not intention to act), and this effect was mediated by negative thoughts about the recommendation. Vulnerability influenced intention to act (but not attitudes), and this effect was mediated by perceived threat and positive thoughts about the recommendation. The pattern of findings suggests that although vulnerability to a severe health risk induces biased processing of the recommendation, biased processing is restricted to intentions and does not compromise the evaluation of the recommendation. The theoretical and practical implications of these findings are discussed.

The Collaborating States Initiative (CSI) Recommended Process for Developing State Policies and Guidelines to Support Social and Emotional Learning

ERIC Educational Resources Information Center

Dusenbury, Linda; Yoder, Nick

2017-01-01

In the work of the authors with states over the years, they have observed that most follow a similar process when they develop policies or guidelines to support statewide implementation of social and emotional learning (SEL), such as establishing learning goals or standards for student social and emotional competencies, or providing guidance to…

Optimum processing of mammographic film.

PubMed

Sprawls, P; Kitts, E L

1996-03-01

Underprocessing of mammographic film can result in reduced contrast and visibility of breast structures and an unnecessary increase in radiation dose to the patient. Underprocessing can be caused by physical factors (low developer temperature, inadequate development time, insufficient developer agitation) or chemical factors (developer not optimized for film type; overdiluted, underreplenished, contaminated, or frequently changed developer). Conventional quality control programs are designed to produce consistent processing but do not address the issue of optimum processing. Optimum processing is defined as the level of processing that produces the film performance characteristics (contrast and sensitivity) specified by the film manufacturer. Optimum processing of mammographic film can be achieved by following a two-step protocol. The first step is to set up the processing conditions according to recommendations from the film and developer chemistry manufacturers. The second step is to verify the processing results by comparing them with sensitometric data provided by the film manufacturer.

The Health Services Researcher of 2020: A Summit to Assess the Field's Workforce Needs

PubMed Central

Pittman, Patricia; Holve, Erin

2009-01-01

Objective To summarize the current state of the health services research (HSR) workforce and recommend ways to improve the field's ability to respond to future challenges facing the health system. Data Summaries of workgroup discussions and recommendations at a stakeholder meeting. Study Design In late 2007, 50 educators, students, employers, and funders of HSR participated in a meeting to discuss findings of three commissioned papers on the HSR workforce. The group undertook a consultative process to develop recommendations for the field. Principal Findings Stakeholders developed recommendations in five major areas focused on HSR workforce needs: (1) improving the size and composition of the field; (2) understanding the growth of HSR in the private sector; (3) improving the graduate training of health services researchers, especially at the master's level; (4) expanding postgraduate training and continuing education opportunities; and (5) increasing awareness of the value of HSR. Conclusions Specific recommendations in the five major areas emphasized developing partnerships between HSR organizations and other professional societies or health organizations, as well as ways to improve training for the future workforce. The need to develop a “client orientation” toward research by improving communication and dissemination skills was discussed, as was the importance of improving diversity in the field. PMID:20459583

An Industrial Engineering Approach to Cost Containment of Pharmacy Education

PubMed Central

Bottenberg, Michelle; Chase, Marilea; Chesnut, Renae; Clarke, Cheryl; Schott, Kathryn; Torry, Ronald; Welty, Tim

2015-01-01

A 2-semester project explored employing teams of fourth-year industrial engineering students to optimize some of our academic management processes. Results included significant cost savings and increases in efficiency, effectiveness, and student and faculty satisfaction. While we did not adopt all of the students’ recommendations, we did learn some important lessons. For example, an initial investment of time in developing a mutually clear understanding of the problems, constraints, and goals maximizes the value of industrial engineering analysis and recommendations. Overall, industrial engineering was a valuable tool for optimizing certain academic management processes. PMID:26839421

ATHENA: A Personalized Platform to Promote an Active Lifestyle and Wellbeing Based on Physical, Mental and Social Health Primitives

PubMed Central

Fahim, Muhammad; Idris, Muhammad; Ali, Rahman; Nugent, Christopher; Kang, Byeong; Huh, Eui-Nam; Lee, Sungyoung

2014-01-01

Technology provides ample opportunities for the acquisition and processing of physical, mental and social health primitives. However, several challenges remain for researchers as how to define the relationship between reported physical activities, mood and social interaction to define an active lifestyle. We are conducting a project, ATHENA(activity-awareness for human-engaged wellness applications) to design and integrate the relationship between these basic health primitives to approximate the human lifestyle and real-time recommendations for wellbeing services. Our goal is to develop a system to promote an active lifestyle for individuals and to recommend to them valuable interventions by making comparisons to their past habits. The proposed system processes sensory data through our developed machine learning algorithms inside smart devices and utilizes cloud infrastructure to reduce the cost. We exploit big data infrastructure for massive sensory data storage and fast retrieval for recommendations. Our contributions include the development of a prototype system to promote an active lifestyle and a visual design capable of engaging users in the goal of increasing self-motivation. We believe that our study will impact the design of future ubiquitous wellness applications. PMID:24859031

Defense Logistics Agency 1995 Defense Base Realignment and Closure Data Collection Process for the Evaluation Phase.

DTIC Science & Technology

1995-05-04

Commission. The specific objective for the audit was to determine whether the evaluation process that the DLA used to develop recommendations reported to the...1995 Commission was consistently applied and adequately supported. The audit also reviewed applicable management controls.

40 CFR 63.543 - What are my standards for process vents?

Code of Federal Regulations, 2013 CFR

2013-07-01

... available. You must develop and follow standard operating procedures designed to minimize emissions of total... the manufacturer's recommended procedures, if available, and the standard operating procedures... 40 Protection of Environment 10 2013-07-01 2013-07-01 false What are my standards for process...

40 CFR 63.543 - What are my standards for process vents?

Code of Federal Regulations, 2012 CFR

2012-07-01

... available. You must develop and follow standard operating procedures designed to minimize emissions of total... the manufacturer's recommended procedures, if available, and the standard operating procedures... 40 Protection of Environment 10 2012-07-01 2012-07-01 false What are my standards for process...

Human Factors Process Task Analysis Liquid Oxygen Pump Acceptance Test Procedure for the Advanced Technology Development Center

NASA Technical Reports Server (NTRS)

Diorio, Kimberly A.

2002-01-01

A process task analysis effort was undertaken by Dynacs Inc. commencing in June 2002 under contract from NASA YA-D6. Funding was provided through NASA's Ames Research Center (ARC), Code M/HQ, and Industrial Engineering and Safety (IES). The John F. Kennedy Space Center (KSC) Engineering Development Contract (EDC) Task Order was 5SMA768. The scope of the effort was to conduct a Human Factors Process Failure Modes and Effects Analysis (HF PFMEA) of a hazardous activity and provide recommendations to eliminate or reduce the effects of errors caused by human factors. The Liquid Oxygen (LOX) Pump Acceptance Test Procedure (ATP) was selected for this analysis. The HF PFMEA table (see appendix A) provides an analysis of six major categories evaluated for this study. These categories include Personnel Certification, Test Procedure Format, Test Procedure Safety Controls, Test Article Data, Instrumentation, and Voice Communication. For each specific requirement listed in appendix A, the following topics were addressed: Requirement, Potential Human Error, Performance-Shaping Factors, Potential Effects of the Error, Barriers and Controls, Risk Priority Numbers, and Recommended Actions. This report summarizes findings and gives recommendations as determined by the data contained in appendix A. It also includes a discussion of technology barriers and challenges to performing task analyses, as well as lessons learned. The HF PFMEA table in appendix A recommends the use of accepted and required safety criteria in order to reduce the risk of human error. The items with the highest risk priority numbers should receive the greatest amount of consideration. Implementation of the recommendations will result in a safer operation for all personnel.

Evaluation of evidence-based literature and formulation of recommendations for the clinical preventive guidelines for immigrants and refugees in Canada

PubMed Central

Tugwell, Peter; Pottie, Kevin; Welch, Vivian; Ueffing, Erin; Chambers, Andrea; Feightner, John

2011-01-01

Background: This article describes the evidence review and guideline development method developed for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada by the Canadian Collaboration for Immigrant and Refugee Health Guideline Committee. Methods: The Appraisal of Guidelines for Research and Evaluation (AGREE) best-practice framework was combined with the recently developed Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to produce evidence-based clinical guidelines for immigrants and refugees in Canada. Results: A systematic approach was designed to produce the evidence reviews and apply the GRADE approach, including building on evidence from previous systematic reviews, searching for and comparing evidence between general and specific immigrant populations, and applying the GRADE criteria for making recommendations. This method was used for priority health conditions that had been selected by practitioners caring for immigrants and refugees in Canada. Interpretation: This article outlines the 14-step method that was defined to standardize the guideline development process for each priority health condition. PMID:20573711

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

PubMed Central

2012-01-01

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

Priority setting in guideline development: article 2 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Atkins, David; Perez-Padilla, Rogelio; Macnee, William; Buist, A Sonia; Cruz, Alvaro A

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. Priority setting is an essential component of developing clinical practice guidelines informed by the best available research evidence. It ensures that resources and attention are devoted to those areas in which clinical recommendations will provide the greatest benefit to patients, clinicians, and policy makers. This is the second of a series of 14 articles that methodologists and researchers from around the world prepared to advise guideline developers in respiratory and other diseases. This review focuses on priority setting, addressing five key questions. In this review, we addressed the following questions. (1) At which steps of guideline development should priorities be considered? (2) How do we create an initial list of potential topics within the guideline? (3) What criteria should be used to establish priorities? (4) What parties should be involved and what processes should be used to set priorities? (5)What are the potential challenges of setting priorities? We updated an existing review on priority setting, and searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on available evidence, our own experience working with guideline developers, and workshop discussions. Existing literature on priority setting largely applies to identifying priorities for which guidelines to develop rather than setting priorities for recommendations within a guideline. Nonetheless, there is substantial consensus about the general factors that should be considered in setting priorities. These include the burdens and costs of illness, potential impact of a recommendation, identified deficits or weak points in practice, variation or uncertainty in practice, and availability of evidence. The input of a variety of stakeholders is useful in setting priorities, although informal consultation is used more often than formal methods. Processes for setting priorities remains poorly described in most guidelines.

Adaptation, evaluation, and updating of guidelines: article 14 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Burgers, Jako S; Anzueto, Antonio; Black, Peter N; Cruz, Alvaro A; Fervers, Béatrice; Graham, Ian D; Metersky, Mark; Woodhead, Mark; Yawn, Barbara P

2012-12-01

Professional societies, like many other organizations, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the last of a series of 14 articles that methodologists and researchers from around the world have prepared to advise guideline developers in respiratory and other diseases on how to achieve this. We updated a review of the literature on guideline adaptation, evaluation, and updating, focusing on four key questions. In this review we addressed the following questions. (1) Which high-quality guidelines on chronic obstructive pulmonary disease (COPD) are available? (2) How should guidelines be adapted to the user's context and culture? (3) How should the use of guidelines be evaluated in clinical practice? and (4) How should guidelines be efficiently kept up-to-date? We did not conduct systematic reviews ourselves. We relied on a literature review published in 2006 and on a manual produced by the ADAPTE Collaboration to inform our judgments, as well as our collective experience and workshop discussions. Guideline adaptation can be seen as an alternative to de novo development and as part of an implementation process, taking into consideration the user's own context. A systematic approach should be followed to ensure high quality of the resulting guidance. On the topic of COPD, many guidelines are available. Guidelines of the Global Initiative for Chronic Obstructive Lung Disease and of the American Thoracic Society and European Respiratory Society are particularly well-suited for adaptation. The adaptation process includes (1) definition of specific questions that need to be answered by the guideline; (2) assessment of guideline quality; (3) assessment of the clinical content, validity, acceptability, applicability, and transferability of the recommendations; and (4) decisions about adoption or adaptation of the recommendations. The use of the guidelines in practice can be measured with performance indicators. Adverse effects of strict adherence to guideline recommendations should be prevented, in particular when the improvement of patient outcomes is unclear. COPD guidelines should be updated at least every 2 years. Collaboration between COPD guideline developers is recommended to prevent duplication of effort.

Donation after cardiocirculatory death in Canada

PubMed Central

Shemie, Sam D.; Baker, Andrew J.; Knoll, Greg; Wall, William; Rocker, Graeme; Howes, Daniel; Davidson, Janet; Pagliarello, Joe; Chambers-Evans, Jane; Cockfield, Sandra; Farrell, Catherine; Glannon, Walter; Gourlay, William; Grant, David; Langevin, Stéphan; Wheelock, Brian; Young, Kimberly; Dossetor, John

2006-01-01

These recommendations are the result of a national, multidisciplinary, year-long process to discuss whether and how to proceed with organ donation after cardiocirculatory death (DCD) in Canada. A national forum was held in February 2005 to discuss and develop recommendations on the principles, procedures and practice related to DCD, including ethical and legal considerations. At the forum's conclusion, a strong majority of participants supported proceeding with DCD programs in Canada. The forum also recognized the need to formulate and emphasize core values to guide the development of programs and protocols based on the medical, ethical and legal framework established at this meeting. Although end-of-life care should routinely include the opportunity to donate organs and tissues, the duty of care toward dying patients and their families remains the dominant priority of health care teams. The complexity and profound implications of death are recognized and should be respected, along with differing personal, ethnocultural and religious perspectives on death and donation. Decisions around withdrawal of life-sustaining therapies, management of the dying process and the determination of death by cardiocirculatory criteria should be separate from and independent of donation and transplant processes. The recommendations in this report are intended to guide individual programs, regional health authorities and jurisdictions in the development of DCD protocols. Programs will develop based on local leadership and advance planning that includes education and engagement of stakeholders, mechanisms to assure safety and quality and public information. We recommend that programs begin with controlled DCD within the intensive care unit where (after a consensual decision to withdraw life-sustaining therapy) death is anticipated, but has not yet occurred, and unhurried consent discussions can be held. Uncontrolled donation (where death has occurred after unanticipated cardiac arrest) should only be considered after a controlled DCD program is well established. Although we recommend that programs commence with kidney donation, regional transplant expertise may guide the inclusion of other organs. The impact of DCD, including pre-and post-mortem interventions, on donor family experiences, organ availability, graft function and recipient survival should be carefully documented and studied. PMID:17124739

Methods for systematic reviews of health economic evaluations: a systematic review, comparison, and synthesis of method literature.

PubMed

Mathes, Tim; Walgenbach, Maren; Antoine, Sunya-Lee; Pieper, Dawid; Eikermann, Michaela

2014-10-01

The quality of systematic reviews of health economic evaluations (SR-HE) is often limited because of methodological shortcomings. One reason for this poor quality is that there are no established standards for the preparation of SR-HE. The objective of this study is to compare existing methods and suggest best practices for the preparation of SR-HE. To identify the relevant methodological literature on SR-HE, a systematic literature search was performed in Embase, Medline, the National Health System Economic Evaluation Database, the Health Technology Assessment Database, and the Cochrane methodology register, and webpages of international health technology assessment agencies were searched. The study selection was performed independently by 2 reviewers. Data were extracted by one reviewer and verified by a second reviewer. On the basis of the overlaps in the recommendations for the methods of SR-HE in the included papers, suggestions for best practices for the preparation of SR-HE were developed. Nineteen relevant publications were identified. The recommendations within them often differed. However, for most process steps there was some overlap between recommendations for the methods of preparation. The overlaps were taken as basis on which to develop suggestions for the following process steps of preparation: defining the research question, developing eligibility criteria, conducting a literature search, selecting studies, assessing the methodological study quality, assessing transferability, and synthesizing data. The differences in the proposed recommendations are not always explainable by the focus on certain evaluation types, target audiences, or integration in the decision process. Currently, there seem to be no standard methods for the preparation of SR-HE. The suggestions presented here can contribute to the harmonization of methods for the preparation of SR-HE. © The Author(s) 2014.

A vision for chronic disease prevention intervention research: report from a workshop.

PubMed

Ashbury, Frederick D; Little, Julian; Ioannidis, John P A; Kreiger, Nancy; Palmer, Lyle J; Relton, Clare; Taylor, Peter

2014-04-17

The Population Studies Research Network of Cancer Care Ontario hosted a strategic planning workshop to establish an agenda for a prevention intervention research program in Ontario, including priority topics for investigation and design considerations. The two-day workshop included: presentations on background papers developed to facilitate participants' preparation for and discussions in the workshop; keynote presentations on intervention research concerning primary prevention of chronic diseases, design and study implementation considerations; a dedicated session on critical and creative thinking to stimulate participation and discussion topics; break out groups to identify, discuss and present study ideas, designs, implementation considerations; and a consensus process to discuss and identify recommendations for research priorities and next steps. The retreat yielded the following recommendations: 1) develop an intervention research agenda that includes working with existing large-scale cohorts; 2) develop an intervention research agenda that includes novel research designs that could target individuals or groups; and 3) develop an intervention research agenda in which studies collect data on costs, define stakeholders, and ensure clear strategies for stakeholder engagement and knowledge transfer. The Population Studies Research Network will develop options from these recommendations and release a call for proposals in 2014 for intervention research pilot projects that reflect these recommendations. Pilot projects will be evaluated based on their fit with the retreat's recommendations, and their potential to scale up to full studies and application in practice.

A Recommended Framework for the Network-Centric Acquisition Process

DTIC Science & Technology

2009-09-01

ISO /IEC 12207 , Systems and Software Engineering-Software Life-Cycle Processes  ANSI/EIA 632, Processes for Engineering a System. There are...engineering [46]. Some of the process models presented in the DAG are:  ISO /IEC 15288, Systems and Software Engineering-System Life-Cycle Processes...e.g., ISO , IA, Security, etc.). Vetting developers helps ensure that they are using industry best industry practices and maximize the IA compliance

Clinical Practice Guideline: Safe Medication Use in the ICU.

PubMed

Kane-Gill, Sandra L; Dasta, Joseph F; Buckley, Mitchell S; Devabhakthuni, Sandeep; Liu, Michael; Cohen, Henry; George, Elisabeth L; Pohlman, Anne S; Agarwal, Swati; Henneman, Elizabeth A; Bejian, Sharon M; Berenholtz, Sean M; Pepin, Jodie L; Scanlon, Mathew C; Smith, Brian S

2017-09-01

To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.

Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare.

PubMed

Richter Sundberg, Linda; Garvare, Rickard; Nyström, Monica Elisabeth

2017-05-11

The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease. A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data. The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals' relative influence on group discussions. The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

PubMed Central

Colebatch, Alexandra N.; Buchbinder, Rachelle; Edwards, Christopher J.; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L.; Radner, Helga; Ramiro, Sofia; Richards, Bethan L.; Tarner, Ingo H.; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B.; Müller-Ladner, Ulf; Bijlsma, Johannes W. J.; Branco, Jaime C.; Bykerk, Vivian P.; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I.; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Østergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

2012-01-01

Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008–09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. Results. A total of 49 242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Conclusions. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice. PMID:22447886

Acoustic emission measurements of aerospace materials and structures

NASA Technical Reports Server (NTRS)

Sachse, Wolfgang; Gorman, Michael R.

1993-01-01

A development status evaluation is given for aerospace applications of AE location, detection, and source characterization. Attention is given to the neural-like processing of AE signals for graphite/epoxy. It is recommended that development efforts for AE make connections between the material failure process and source dynamics, and study the effects of composite material anisotropy and inhomogeneity on the propagation of AE waves. Broadband, as well as frequency- and wave-mode selective sensors, need to be developed.

Selecting a Laboratory Information Management System for Biorepositories in Low- and Middle-Income Countries: The H3Africa Experience and Lessons Learned

PubMed Central

Musinguzi, Henry; Lwanga, Newton; Kezimbira, Dafala; Kigozi, Edgar; Katabazi, Fred Ashaba; Wayengera, Misaki; Joloba, Moses Lutaakome; Abayomi, Emmanuel Akin; Swanepoel, Carmen; Croxton, Talishiea; Ozumba, Petronilla; Thankgod, Anazodo; van Zyl, Lizelle; Mayne, Elizabeth Sarah; Kader, Mukthar; Swartz, Garth

2017-01-01

Biorepositories in Africa need significant infrastructural support to meet International Society for Biological and Environmental Repositories (ISBER) Best Practices to support population-based genomics research. ISBER recommends a biorepository information management system which can manage workflows from biospecimen receipt to distribution. The H3Africa Initiative set out to develop regional African biorepositories where Uganda, Nigeria, and South Africa were successfully awarded grants to develop the state-of-the-art biorepositories. The biorepositories carried out an elaborate process to evaluate and choose a laboratory information management system (LIMS) with the aim of integrating the three geographically distinct sites. In this article, we review the processes, African experience, lessons learned, and make recommendations for choosing a biorepository LIMS in the African context.

Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline.

PubMed

Pottie, Kevin; Thompson, Wade; Davies, Simon; Grenier, Jean; Sadowski, Cheryl A; Welch, Vivian; Holbrook, Anne; Boyd, Cynthia; Swenson, Robert; Ma, Andy; Farrell, Barbara

2018-05-01

To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists (BZRAs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. The overall team comprised 8 clinicians (1 family physician, 2 psychiatrists, 1 clinical psychologist, 1 clinical pharmacologist, 2 clinical pharmacists, and 1 geriatrician) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated by conducting a systematic review of BZRA deprescribing trials for insomnia, as well as performing a review of reviews of the harms of continued BZRA use and narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality of evidence ratings were used to generate recommendations. The team refined guideline content and recommendations through consensus and synthesized clinical considerations to address front-line clinician questions. The draft guideline was reviewed by clinicians and stakeholders. We recommend that deprescribing (tapering slowly) of BZRAs be offered to elderly adults (≥ 65 years) who take BZRAs, regardless of duration of use, and suggest that deprescribing (tapering slowly) be offered to adults aged 18 to 64 who have used BZRAs for more than 4 weeks. These recommendations apply to patients who use BZRAs to treat insomnia on its own (primary insomnia) or comorbid insomnia where potential underlying comorbidities are effectively managed. This guideline does not apply to those with other sleep disorders or untreated anxiety, depression, or other physical or mental health conditions that might be causing or aggravating insomnia. Benzodiazepine receptor agonists are associated with harms, and therapeutic effects might be short term. Tapering BZRAs improves cessation rates compared with usual care without serious harms. Patients might be more amenable to deprescribing conversations if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice. This guideline provides recommendations for making decisions about when and how to reduce and stop BZRAs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients. Copyright© the College of Family Physicians of Canada.

Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach.

PubMed

Zhang, Yuan; Coello, Pablo Alonso; Brożek, Jan; Wiercioch, Wojtek; Etxeandia-Ikobaltzeta, Itziar; Akl, Elie A; Meerpohl, Joerg J; Alhazzani, Waleed; Carrasco-Labra, Alonso; Morgan, Rebecca L; Mustafa, Reem A; Riva, John J; Moore, Ainsley; Yepes-Nuñez, Juan José; Cuello-Garcia, Carlos; AlRayees, Zulfa; Manja, Veena; Falavigna, Maicon; Neumann, Ignacio; Brignardello-Petersen, Romina; Santesso, Nancy; Rochwerg, Bram; Darzi, Andrea; Rojas, Maria Ximena; Adi, Yaser; Bollig, Claudia; Waziry, Reem; Schünemann, Holger J

2017-05-02

There are diverse opinions and confusion about defining and including patient values and preferences (i.e. the importance people place on the health outcomes) in the guideline development processes. This article aims to provide an overview of a process for systematically incorporating values and preferences in guideline development. In 2013 and 2014, we followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to adopt, adapt and develop 226 recommendations in 22 guidelines for the Ministry of Health of the Kingdom of Saudi Arabia. To collect context-specific values and preferences for each recommendation, we performed systematic reviews, asked clinical experts to provide feedback according to their clinical experience, and consulted patient representatives. We found several types of studies addressing the importance of outcomes, including those reporting utilities, non-utility measures of health states based on structured questionnaires or scales, and qualitative studies. Guideline panels used the relative importance of outcomes based on values and preferences to weigh the balance of desirable and undesirable consequences of alternative intervention options. However, we found few studies addressing local values and preferences. Currently there are different but no firmly established processes for integrating patient values and preferences in healthcare decision-making of practice guideline development. With GRADE Evidence-to-Decision (EtD) frameworks, we provide an empirical strategy to find and incorporate values and preferences in guidelines by performing systematic reviews and eliciting information from guideline panel members and patient representatives. However, more research and practical guidance are needed on how to search for relevant studies and grey literature, assess the certainty of this evidence, and best summarize and present the findings.

Development of processing diagrams for polymeric die attach adhesives

NASA Astrophysics Data System (ADS)

Hsiung, Jen-Chou

With a processing diagram, one can reduce the effort required to customize curing process conditions for polymeric die attach adhesives. Polymeric die attach adhesives are often cured per the manufacturer's recommendations during initial screening evaluations. In most cases, the recommended cure schedules have to be modified so as to fit differences in process equipment. Unfortunately, the modified cure schedule is usually determined by a trial-and-error method. An aim of our experiments is to understand the curing process of a wide range of polymeric die attach adhesives (conventional, fast, and snap cure adhesives) and to construct a processing diagram, i.e., "Bondability Diagram", so as to define the processing window. Such diagrams should be helpful in determining both the time and cure temperature required to produce high quality bonds. The bondability diagram can be constructed based on fundamental understandings of the phenomena involved in the curing process using a wide variety of tools. Differential Scanning Calorimetry (DSC) is utilized to study the cure kinetics and the extent of reaction. Dynamic Mechanical Analysis (DMA) is used to determine gelation times and melt viscosity under a shear mode. A modified Rheovibron is employed to perform cure characterizations under a tensile mode so that cure stresses could be determined. Thermogravimetric Analysis (TGA) is used to evaluate the outgassing phenomena. Optical Microscopy (OM) is used to detect voids. Results indicate that the cure behaviors of conventional, fast, and snap cure adhesives are different in several respects. The combination of DSC, DMA, TGA, OM, and lap shear test leads to a frame work of developing the bondability diagram concept. The bondability diagram concept provides a foundation for an understanding of the recommended cure schedule and allows one to design their own cure schedule.

Why certain vaccines have been delayed or not developed at all.

PubMed

Plotkin, Stanley A

2005-01-01

Vaccine development is a long process, with the time from early research to licensure steadily increasing. At one time the process took about ten years; now it takes closer to fifteen to twenty years. The process begins with investigators in universities or biotech firms who have an idea. However, to take things further, there must be a vaccine manufacturer, a regulatory authority ready to give permission for the use of the vaccine, and public health authorities that will recommend and foster vaccination.

EVALUATION OF ALTERNATIVE STRONIUM AND TRANSURANIC SEPARATION PROCESSES

DOE Office of Scientific and Technical Information (OSTI.GOV)

SMALLEY CS

2011-04-25

In order to meet contract requirements on the concentrations of strontium-90 and transuranic isotopes in the immobilized low-activity waste, strontium-90 and transuranics must be removed from the supernate of tanks 241-AN-102 and 241-AN-107. The process currently proposed for this application is an in-tank precipitation process using strontium nitrate and sodium permanganate. Development work on the process has not proceeded since 2005. The purpose of the evaluation is to identify whether any promising alternative processes have been developed since this issue was last examined, evaluate the alternatives and the baseline process, and recommend which process should be carried forward.

UPDATE ON PEC ACTIVITIES INCLUDING NEW EVALUATION CRITERIA, THE APPLICATION COMPLETENESS CHECKLIST, AND STATUS OF THE WEBSITE DEVELOPMENT

EPA Science Inventory

US EPA's Pathogen Equivalency Committee (PEC) has updated the evaluation criteria it uses to make recommendations of equivalency (to processes acceptable under 40CFR503) on innovative or alternative sludge pathogen reduction processes. These criteria will be presented along with ...

40 CFR 63.543 - What are my standards for process vents?

Code of Federal Regulations, 2014 CFR

2014-07-01

... develop and follow standard operating procedures designed to minimize emissions of total hydrocarbon for... manufacturer's recommended procedures, if available, and the standard operating procedures designed to minimize... 40 Protection of Environment 10 2014-07-01 2014-07-01 false What are my standards for process...

A Comparison of Reimbursement Recommendations by European HTA Agencies: Is There Opportunity for Further Alignment?

PubMed Central

Allen, Nicola; Liberti, Lawrence; Walker, Stuart R.; Salek, Sam

2017-01-01

Introduction: In Europe and beyond, the rising costs of healthcare and limited healthcare resources have resulted in the implementation of health technology assessment (HTA) to inform health policy and reimbursement decision-making. European legislation has provided a harmonized route for the regulatory process with the European Medicines Agency, but reimbursement decision-making still remains the responsibility of each country. There is a recognized need to move toward a more objective and collaborative reimbursement environment for new medicines in Europe. Therefore, the aim of this study was to objectively assess and compare the national reimbursement recommendations of 9 European jurisdictions following European Medicines Agency (EMA) recommendation for centralized marketing authorization. Methods: Using publicly available data and newly developed classification tools, this study appraised 9 European reimbursement systems by assessing HTA processes and the relationship between the regulatory, HTA and decision-making organizations. Each national HTA agency was classified according to two novel taxonomies. The System taxonomy, focuses on the position of the HTA agency within the national reimbursement system according to the relationship between the regulator, the HTA-performing agency, and the reimbursement decision-making coverage body. The HTA Process taxonomy distinguishes between the individual HTA agency's approach to economic and therapeutic evaluation and the inclusion of an independent appraisal step. The taxonomic groups were subsequently compared with national HTA recommendations. Results: This study identified European national reimbursement recommendations for 102 new active substances (NASs) approved by the EMA from 2008 to 2012. These reimbursement recommendations were compared using a novel classification tool and identified alignment between the organizational structure of reimbursement systems (System taxonomy) and HTA recommendations. However, there was less alignment between the HTA processes and recommendations. Conclusions: In order to move forward to a more harmonized HTA environment within Europe, it is first necessary to understand the variation in HTA practices within Europe. This study has identified alignment between HTA recommendations and the System taxonomy and one of the major implications of this study is that such alignment could support a more collaborative HTA environment in Europe. PMID:28713265

A Comparison of Reimbursement Recommendations by European HTA Agencies: Is There Opportunity for Further Alignment?

PubMed

Allen, Nicola; Liberti, Lawrence; Walker, Stuart R; Salek, Sam

2017-01-01

Introduction: In Europe and beyond, the rising costs of healthcare and limited healthcare resources have resulted in the implementation of health technology assessment (HTA) to inform health policy and reimbursement decision-making. European legislation has provided a harmonized route for the regulatory process with the European Medicines Agency, but reimbursement decision-making still remains the responsibility of each country. There is a recognized need to move toward a more objective and collaborative reimbursement environment for new medicines in Europe. Therefore, the aim of this study was to objectively assess and compare the national reimbursement recommendations of 9 European jurisdictions following European Medicines Agency (EMA) recommendation for centralized marketing authorization. Methods: Using publicly available data and newly developed classification tools, this study appraised 9 European reimbursement systems by assessing HTA processes and the relationship between the regulatory, HTA and decision-making organizations. Each national HTA agency was classified according to two novel taxonomies. The System taxonomy, focuses on the position of the HTA agency within the national reimbursement system according to the relationship between the regulator, the HTA-performing agency, and the reimbursement decision-making coverage body. The HTA Process taxonomy distinguishes between the individual HTA agency's approach to economic and therapeutic evaluation and the inclusion of an independent appraisal step. The taxonomic groups were subsequently compared with national HTA recommendations. Results: This study identified European national reimbursement recommendations for 102 new active substances (NASs) approved by the EMA from 2008 to 2012. These reimbursement recommendations were compared using a novel classification tool and identified alignment between the organizational structure of reimbursement systems (System taxonomy) and HTA recommendations. However, there was less alignment between the HTA processes and recommendations. Conclusions: In order to move forward to a more harmonized HTA environment within Europe, it is first necessary to understand the variation in HTA practices within Europe. This study has identified alignment between HTA recommendations and the System taxonomy and one of the major implications of this study is that such alignment could support a more collaborative HTA environment in Europe.

Modular space station, phase B extension. Information management advanced development. Volume 5: Software assembly

NASA Technical Reports Server (NTRS)

Gerber, C. R.

1972-01-01

The development of uniform computer program standards and conventions for the modular space station is discussed. The accomplishments analyzed are: (1) development of computer program specification hierarchy, (2) definition of computer program development plan, and (3) recommendations for utilization of all operating on-board space station related data processing facilities.

Developing a Modeling Framework for Ecosystem Forecasting: The Lake Michigan Pilot

EPA Science Inventory

Recent multi-party efforts to coordinate modeling activities that support ecosystem management decision-making in the Great Lakes have resulted in the recommendation to convene an interagency working group that will develop a pilot approach for Lake Michigan. The process will br...

5 CFR 2640.203 - Miscellaneous exemptions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... develop recommendations for new standards for AIDS vaccine trials involving human subjects. Even though the chemist's employer is in the process of developing an experimental AIDS vaccine and therefore will..., in advance, authority to make such approvals in accordance with agency policy. Example 4: A GS-14...

5 CFR 2640.203 - Miscellaneous exemptions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... develop recommendations for new standards for AIDS vaccine trials involving human subjects. Even though the chemist's employer is in the process of developing an experimental AIDS vaccine and therefore will..., in advance, authority to make such approvals in accordance with agency policy. Example 4: A GS-14...

5 CFR 2640.203 - Miscellaneous exemptions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... develop recommendations for new standards for AIDS vaccine trials involving human subjects. Even though the chemist's employer is in the process of developing an experimental AIDS vaccine and therefore will..., in advance, authority to make such approvals in accordance with agency policy. Example 4: A GS-14...

The appraisal of clinical guidelines in dentistry.

PubMed

Glenny, Anne-Marie; Worthington, Helen V; Clarkson, Jan E; Esposito, Marco

2009-01-01

To appraise the reported processes involved in the development of published dental guidelines. Electronic databases were searched to identify guidelines making recommendations for any health professional within dentistry. All included guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. A total of 105 guidelines met the inclusion criteria. The appraised guidelines showed lack of rigour in their development (median score 14.3%; range 0% to 100%). Only 10 (9.5%) were coded as 'strongly recommend' by at least two assessors. If recommendations within clinical guidelines are to be relied upon, the methods used in their development must be explicit and free from bias. When using the AGREE checklist to make decisions on whether or not to implement individual sets of guidelines, the findings of the present assessment reinforce the need for more than two assessors to be included in the appraisal of each set of guidelines.

Use of failure mode, effect and criticality analysis to improve safety in the medication administration process.

PubMed

Rodriguez-Gonzalez, Carmen Guadalupe; Martin-Barbero, Maria Luisa; Herranz-Alonso, Ana; Durango-Limarquez, Maria Isabel; Hernandez-Sampelayo, Paloma; Sanjurjo-Saez, Maria

2015-08-01

To critically evaluate the causes of preventable adverse drug events during the nurse medication administration process in inpatient units with computerized prescription order entry and profiled automated dispensing cabinets in order to prioritize interventions that need to be implemented and to evaluate the impact of specific interventions on the criticality index. This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary consensus committee composed of pharmacists, nurses and doctors evaluated the process of administering medications in a hospital setting in Spain. By analysing the process, all failure modes were identified and criticality was determined by rating severity, frequency and likelihood of failure detection on a scale of 1 to 10, using adapted versions of already published scales. Safety strategies were identified and prioritized. Through consensus, the committee identified eight processes and 40 failure modes, of which 20 were classified as high risk. The sum of the criticality indices was 5254. For the potential high-risk failure modes, 21 different potential causes were found resulting in 24 recommendations. Thirteen recommendations were prioritized and developed over a 24-month period, reducing total criticality from 5254 to 3572 (a 32.0% reduction). The recommendations with a greater impact on criticality were the development of an electronic medication administration record (-582) and the standardization of intravenous drug compounding in the unit (-168). Other improvements, such as barcode medication administration technology (-1033), were scheduled for a longer period of time because of lower feasibility. FMECA is a useful approach that can improve the medication administration process. © 2015 John Wiley & Sons, Ltd.

Advanced technology for America's future in space

NASA Technical Reports Server (NTRS)

1990-01-01

In response to Recommendation 8 of the Augustine Committee Report, NASA's Office of Aeronautics, Exploration and Technology (OAET) developed a proposed 'Integrated Technology Plan for the Civil Space Program' that entails substantial changes in the processes, structure and the content of NASA's space research and technology program. The Space Systems and Technology Advisory Committee (SSTAC, a subcommittee of the NASA Advisory Committee) and several other senior, expert, informed advisory groups conducted a review of NASA's proposed Integrated Technology Plan (ITP). This review was in response to the specific request in Recommendation 8 that 'NASA utilize an expert, outside review process, managed from headquarters, to assist in the allocation of technology funds'. This document, the final report from that review, addresses: (1) summary recommendations; (2) mission needs; (3) the integrated technology plan; (4) summary reports of the technical panels; and (5) conclusions and observations.

Reintegration of Emigrant Manpower and Promotion of Local Opportunities for Development (REMPLOD)

ERIC Educational Resources Information Center

Penninx, Rinus; And Others

1976-01-01

The REMPLOD project (Reintegration of Emigrant Manpower and the Promotion of Local Opportunities for Development) investigates ways in which foreign workers can contribute to development processes in their countries of origin (Morocco, Tunisia and Turkey). Three experts involved with the Turkish project make recommendations on the Turkish-Dutch…

E-book recommender system design and implementation based on data mining

NASA Astrophysics Data System (ADS)

Wang, Zongjiang

2011-12-01

In the knowledge explosion, rapid development of information age, how quickly the user or users interested in useful information for feedback to the user problem to be solved in this article. This paper based on data mining, association rules to the model and classification model a combination of electronic books on the recommendation of the user's neighboring users interested in e-books to target users. Introduced the e-book recommendation and the key technologies, system implementation algorithms, and implementation process, was proved through experiments that this system can help users quickly find the required e-books.

Mobilising Open Access to Research Data: Recommendations from the RECODE project

NASA Astrophysics Data System (ADS)

Finn, Rachel; Sveinsdottir, Thordis

2015-04-01

This paper will introduce the findings and policy recommendations from the FP7 project RECODE (Policy RECommendations for Open Access to Research Data in Europe) which aims to leverage existing networks, communities and projects to address challenges within the open access and data dissemination and preservation sector. We will introduce the key recommendations, which provide solutions relevant to opening access to PSI. The project is built on case study research of five scientific disciplines with the aim of recognizing and working with disciplinary fragmentation associated with open access to research data. The RECODE findings revealed that the mobilisation of open access to research data requires a partnership approach for developing a coherent and flexible ecosystem that is easy and transparent to embed in research practice and process. As such, the development of open access to research data needs to be: • Informed by research practices and processes in different fields • Supported by an integrated institutional and technological data infrastructure and guided by ethical and regulatory frameworks • Underpinned by infrastructure and guiding frameworks that allow for differences in disciplinary research and data management practices • Characterised by a partnership approach involving the key stakeholders, researchers, and institutions The proposed presentation will examine each of these aspects in detail and use information and good practices from the RECODE project to consider how stakeholders within the PSI movement might action each of these points. It will also highlight areas where RECODE findings and good practice recommendations have clear relevance for the PSI sector.

Dutch evidence statement for pelvic physical therapy in patients with anal incontinence.

PubMed

Berghmans, L C M; Groot, J A M; van Heeswijk-Faase, I C; Bols, E M J

2015-04-01

To promote agreement among and support the quality of pelvic physiotherapists' skills and clinical reasoning in The Netherlands, an Evidence Statement Anal Incontinence (AI) was developed based on the practice-driven problem definitions outlined. We present a summary of the current state of knowledge and formulate recommendations for a methodical assessment and treatment for patients with AI, and place the evidence in a broader perspective of current developments. Electronic literature searches were conducted in relevant databases with regard to prevalence, incidence, costs, etiological and prognostic factors, predictors of response to therapy, prevention, assessment, and treatment. The recommendations have been formulated on the basis of scientific evidence and where no evidence was available, recommendations were consensus-based. The evidence statement incorporates a practice statement with corresponding notes that clarify the recommendations, and accompanying flowcharts, describing the steps and recommendations with regard to the diagnostic and therapeutic process. The diagnostic process consists of history-taking and physical examination supported by measurement instruments. For each problem category for patients with AI, a certain treatment plan can be distinguished dependent on the presence of pelvic floor dysfunction, awareness of loss of stools, comorbidity, neurological problems, adequate anorectal sensation, and (in)voluntary control. Available evidence and expert opinion support the use of education, pelvic floor muscle training, biofeedback, and electrostimulation in selected patients. The evidence statement reflects the current state of knowledge for a methodical and systematic physical therapeutic assessment and treatment for patients with AI.

Cochrane Qualitative and Implementation Methods Group guidance series-paper 6: reporting guidelines for qualitative, implementation, and process evaluation evidence syntheses.

PubMed

Flemming, Kate; Booth, Andrew; Hannes, Karin; Cargo, Margaret; Noyes, Jane

2018-05-01

To outline contemporary and novel developments for the presentation and reporting of syntheses of qualitative, implementation, and process evaluation evidence and provide recommendations for the use of reporting guidelines. An overview of reporting guidelines for qualitative, implementation, and process evaluation evidence syntheses drawing on current international literature and the collective expert knowledge of the Cochrane Qualitative and Implementation Methods Group. Several reporting guidelines exist that can be used or adapted to report syntheses of qualitative, implementation, and process evaluation evidence. Methods to develop individual guidance varied. The use of a relevant reporting guideline can enhance the transparency, consistency, and quality of reporting. Guidelines that exist are generic, method specific, and for particular aspects of the reviewing process, searching. Caution is expressed over the potential for reporting guidelines to produce a mechanistic approach moving the focus away from the content and toward the procedural aspects of the review. The use of a reporting guideline is recommended and a five-step decision flowchart to guide the choice of reporting guideline is provided. Gaps remain in method-specific reporting guidelines such as mixed-study, implementation, and process evaluation evidence syntheses. Copyright © 2017 Elsevier Inc. All rights reserved.

Is “Processed” a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations123

PubMed Central

Dwyer, Johanna T.; Fulgoni, Victor L.; Clemens, Roger A.; Schmidt, David B.

2012-01-01

This paper, based on the symposium “Is ‘Processed’ a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations in the U.S.” describes ongoing efforts and challenges at the nutrition–food science interface and public health; addresses misinformation about processed foods by showing that processed fruits and vegetables made important dietary contributions (e.g., fiber, folate, potassium, vitamins A and C) to nutrient intake among NHANES 2003–2006 participants, that major sources of vitamins (except vitamin K) were provided by enrichment and fortification and that enrichment and fortification helped decrease the percentage of the population below the Estimated Average Requirement for vitamin A, thiamin, folate, and iron; describes how negative consumer perceptions and consumer confusion about processed foods led to the development of science-based information on food processing and technology that aligns with health objectives; and examines challenges and opportunities faced by food scientists who must balance consumer preferences, federal regulations, and issues surrounding food safety, cost, unintended consequences, and sustainability when developing healthful foods that align with dietary guidelines. PMID:22797990

[Implementation of clinical practice guidelines: how can we close the evidence-practice gap?].

PubMed

Muche-Borowski, Cathleen; Nothacker, M; Kopp, I

2015-01-01

Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior.

[Early childhood growth and development].

PubMed

Arce, Melitón

2015-01-01

This article describes and discusses issues related to the process of childhood growth and development, with emphasis on the early years, a period in which this process reaches critical speed on major structures and functions of the human economy. We reaffirm that this can contribute to the social availability of a generation of increasingly better adults, which in turn will be able to contribute to building a better world and within it a society that enjoys greater prosperity. In the first chapter, we discuss the general considerations on the favorable evolution of human society based on quality of future adults, meaning the accomplishments that today’s children will gain. A second chapter mentions the basics of growth and development in the different fields and the various phenomena that occur in it. In the third we refer to lost opportunities and negative factors that can affect delaying the process and thereby result in not obtaining the expected accomplishments. In the fourth, conclusions and recommendations are presented confirming the initial conception that good early child care serves to build a better society and some recommendations are formulated to make it a good practice.

Workshop on Critical Issues in Microgravity Fluids, Transport, and Reaction Processes in Advanced Human Support Technology

NASA Technical Reports Server (NTRS)

Chiaramonte, Francis P.; Joshi, Jitendra A.

2004-01-01

This workshop was designed to bring the experts from the Advanced Human Support Technologies communities together to identify the most pressing and fruitful areas of research where success hinges on collaborative research between the two communities. Thus an effort was made to bring together experts in both advanced human support technologies and microgravity fluids, transport and reaction processes. Expertise was drawn from academia, national laboratories, and the federal government. The intent was to bring about a thorough exchange of ideas and develop recommendations to address the significant open design and operation issues for human support systems that are affected by fluid physics, transport and reaction processes. This report provides a summary of key discussions, findings, and recommendations.

Implementing AORN recommended practices for environmental cleaning.

PubMed

Allen, George

2014-05-01

In recent years, researchers have developed an increasing awareness of the role of the environment in the development of health care-associated infections. AORN's "Recommended practices for environmental cleaning" is an evidence-based document that provides specific guidance for cleaning processes, for the selection of appropriate cleaning equipment and supplies, and for ongoing education and quality improvement. This updated recommended practices document has an expanded focus on the need for health care personnel to work collaboratively to accomplish adequately thorough cleanliness in a culture of safety and mutual support. Perioperative nurses, as the primary advocates for patients while they are being cared for in the perioperative setting, should help ensure that a safe, clean environment is reestablished after each surgical procedure. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

On Deep Learning for Trust-Aware Recommendations in Social Networks.

PubMed

Deng, Shuiguang; Huang, Longtao; Xu, Guandong; Wu, Xindong; Wu, Zhaohui

2017-05-01

With the emergence of online social networks, the social network-based recommendation approach is popularly used. The major benefit of this approach is the ability of dealing with the problems with cold-start users. In addition to social networks, user trust information also plays an important role to obtain reliable recommendations. Although matrix factorization (MF) becomes dominant in recommender systems, the recommendation largely relies on the initialization of the user and item latent feature vectors. Aiming at addressing these challenges, we develop a novel trust-based approach for recommendation in social networks. In particular, we attempt to leverage deep learning to determinate the initialization in MF for trust-aware social recommendations and to differentiate the community effect in user's trusted friendships. A two-phase recommendation process is proposed to utilize deep learning in initialization and to synthesize the users' interests and their trusted friends' interests together with the impact of community effect for recommendations. We perform extensive experiments on real-world social network data to demonstrate the accuracy and effectiveness of our proposed approach in comparison with other state-of-the-art methods.

EPA guidance on building trust in mental health services.

PubMed

Gaebel, W; Muijen, M; Baumann, A E; Bhugra, D; Wasserman, D; van der Gaag, R J; Heun, R; Zielasek, J

2014-02-01

To advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system. We performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process. We developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization. Trust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust. Evidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Decision making about healthcare-related tests and diagnostic test strategies. Paper 4: International guidelines show variability in their approaches.

PubMed

Mustafa, Reem A; Wiercioch, Wojtek; Arevalo-Rodriguez, Ingrid; Cheung, Adrienne; Prediger, Barbara; Ivanova, Liudmila; Ventresca, Matthew; Brozek, Jan; Santesso, Nancy; Bossuyt, Patrick; Garg, Amit X; Lloyd, Nancy; Lelgemann, Monika; Bühler, Diedrich; Schünemann, Holger J

2017-12-01

The objective of the study was to describe and compare current practices in developing guidelines about the use of healthcare-related tests and diagnostic strategies (HCTDS). We sampled 37 public health and clinical practice guidelines about HCTDS from various sources without language restrictions. Detailed descriptions of the systems used to assess the quality of evidence and develop recommendations were challenging to find within guidelines. We observed much variability among and within organizations with respect to how they develop recommendations about HCTDS. Twenty-four percent of the guidelines did not consider health benefits and harms but based decisions solely on test accuracy. We did not identify guidelines that described the main potential care pathways involving tests for a healthcare problem. In addition, we did not identify guidelines that systematically assessed, described, and referenced the evidence that linked test accuracy and patient-important outcomes. There is considerable variability among the processes used and factors considered in developing recommendations about the use of tests. This variability may be the cause for the disagreement we observed in recommendations about testing for the same condition. Copyright © 2017 Elsevier Inc. All rights reserved.

RAPADAPTE for rapid guideline development: high-quality clinical guidelines can be rapidly developed with limited resources.

PubMed

Alper, Brian S; Tristan, Mario; Ramirez-Morera, Anggie; Vreugdenhil, Maria M T; Van Zuuren, Esther J; Fedorowicz, Zbys

2016-06-01

Guideline development is challenging, expensive and labor-intensive. A high-quality guideline with 90 recommendations for breast cancer treatment was developed within 6 months with limited resources in Costa Rica. We describe the experience and propose a process others can use and adapt.The ADAPTE method (using existing guidelines to minimize repeating work that has been done) was used but existing guidelines were not current. The method was extended to use databases that systematically identify, appraise and synthesize evidence for clinical application (DynaMed, EBM Guidelines) to provide current evidence searches and critical appraisal of evidence. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence and the strength of recommendations. Draft recommendations with supporting evidence were provided to panel members for facilitated voting to target panel discussion to areas necessary for reaching consensus.Training panelists in guideline development methodology facilitated rapid consensus development. Extending 'guideline adaptation' to 'evidence database adaptation' was highly effective and efficient. Methods were created to simplify mapping DynaMed evidence ratings to GRADE ratings. Twelve steps are presented to facilitate rapid guideline development and enable further adaptation by others.This is a case report and the RAPADAPTE method was retrospectively derived. Prospective replication and validation will support advances for the guideline development community. If guideline development can be accelerated without compromising validity and relevance of the resulting recommendations this would greatly improve our ability to impact clinical care. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Consensus-based recommendations for the management of juvenile dermatomyositis

PubMed Central

Enders, Felicitas Bellutti; Bader-Meunier, Brigitte; Baildam, Eileen; Constantin, Tamas; Dolezalova, Pavla; Feldman, Brian M; Lahdenne, Pekka; Magnusson, Bo; Nistala, Kiran; Ozen, Seza; Pilkington, Clarissa; Ravelli, Angelo; Russo, Ricardo; Uziel, Yosef; van Brussel, Marco; van der Net, Janjaap; Vastert, Sebastiaan; Wedderburn, Lucy R; Wulffraat, Nicolaas; McCann, Liza J; van Royen-Kerkhof, Annet

2017-01-01

Background In 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile dermatomyositis (JDM) is a rare disease within the group of paediatric rheumatic diseases (PRDs) and can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physicians' experience. Consequently, treatment regimens differ throughout Europe. Objectives To provide recommendations for diagnosis and treatment of JDM. Methods Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of 19 experienced paediatric rheumatologists and 2 experts in paediatric exercise physiology and physical therapy, mainly from Europe. Recommendations derived from a validated systematic literature review were evaluated by an online survey and subsequently discussed at two consensus meetings using nominal group technique. Recommendations were accepted if >80% agreement was reached. Results In total, 7 overarching principles, 33 recommendations on diagnosis and 19 recommendations on therapy were accepted with >80% agreement among experts. Topics covered include assessment of skin, muscle and major organ involvement and suggested treatment pathways. Conclusions The SHARE initiative aims to identify best practices for treatment of patients suffering from PRD. Within this remit, recommendations for the diagnosis and treatment of JDM have been formulated by an evidence-informed consensus process to produce a standard of care for patients with JDM throughout Europe. PMID:27515057

Views of collaboration among administrators and teachers involved in science education reform

NASA Astrophysics Data System (ADS)

Trax, Mark Francis

The purposes of this study were to investigate the perceptions of collaboration among administrators and teachers involved in science education reform, determine similarities and difference in perception among administrators and teachers, and examine the progress of district reform efforts in terms of reform recommendations advanced in the research literature. Naturalistic constructivist theory guided the generation of the instruments and the analysis of data. Instruments for this investigation included a questionnaire and structured surveys. Audio-taped responses to the surveys were transcribed and analyzed for patterns of interaction. Support for science teacher collaboration and science education reform depended on the district's overall organizational style (classified as top-down, bottom-up, or a combination of these two styles), was connected to the level of commitment of the sciences teachers and administrators interviewed, and was linked to the level of solidarity for that support among teachers and administrators in the district. Reform-oriented districts addressed resource allocation in ways that supported science education reform. Science teachers, identified as the agents for educational reform, facilitated the overall process by providing specific evidence in support of reform, recruiting teachers and administrators to a reform-oriented agenda, and creating close-knit cadres engaged in the reform process. District activities in support of science education reforms which reflect the overall school reform recommendations maintained their focus provided that such activities were monitored and adjusted to furnish opportunities to include all the district science teachers, utilized a committed cadre of science teachers that supported the overall recommendations, and facilitated the inclusion of all district staff in the overall process. For success, it is important for the staff in each district to identify a clear need and establish a high level of commitment to the reform before embarking on it. Involvement of the entire district staff in the processes of reform is vital if long-term educational reform and development is to occur. Strategies to develop a process of professional development need to be in concert with the recommendations of reform and applicable to the policies and philosophies of the particular school system.

Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis.

PubMed

Mc Hugh, Sheena M; Perry, Ivan J; Bradley, Colin; Brugha, Ruairí

2014-09-18

In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. This study uses Kingdon's Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval. Diabetes care is coming on to the agenda again in Ireland under the National Clinical Care Programme. This may represent the opening of a new policy window for diabetes services, the challenge will be maintaining momentum and interest in the absence of dedicated resources.

Turbulence Modeling: Progress and Future Outlook

NASA Technical Reports Server (NTRS)

Marvin, Joseph G.; Huang, George P.

1996-01-01

Progress in the development of the hierarchy of turbulence models for Reynolds-averaged Navier-Stokes codes used in aerodynamic applications is reviewed. Steady progress is demonstrated, but transfer of the modeling technology has not kept pace with the development and demands of the computational fluid dynamics (CFD) tools. An examination of the process of model development leads to recommendations for a mid-course correction involving close coordination between modelers, CFD developers, and application engineers. In instances where the old process is changed and cooperation enhanced, timely transfer is realized. A turbulence modeling information database is proposed to refine the process and open it to greater participation among modeling and CFD practitioners.

Earth Sciences Data and Information System (ESDIS) program planning and evaluation methodology development

NASA Technical Reports Server (NTRS)

Dickinson, William B.

1995-01-01

An Earth Sciences Data and Information System (ESDIS) Project Management Plan (PMP) is prepared. An ESDIS Project Systems Engineering Management Plan (SEMP) consistent with the developed PMP is also prepared. ESDIS and related EOS program requirements developments, management and analysis processes are evaluated. Opportunities to improve the effectiveness of these processes and program/project responsiveness to requirements are identified. Overall ESDIS cost estimation processes are evaluated, and recommendations to improve cost estimating and modeling techniques are developed. ESDIS schedules and scheduling tools are evaluated. Risk assessment, risk mitigation strategies and approaches, and use of risk information in management decision-making are addressed.

Significant achievements in the Planetary Geology Program. [geologic processes, comparative planetology, and solar system evolution

NASA Technical Reports Server (NTRS)

Head, J. W. (Editor)

1978-01-01

Developments reported at a meeting of principal investigators for NASA's planetology geology program are summarized. Topics covered include: constraints on solar system formation; asteriods, comets, and satellites; constraints on planetary interiors; volatiles and regoliths; instrument development techniques; planetary cartography; geological and geochemical constraints on planetary evolution; fluvial processes and channel formation; volcanic processes; Eolian processes; radar studies of planetary surfaces; cratering as a process, landform, and dating method; and the Tharsis region of Mars. Activities at a planetary geology field conference on Eolian processes are reported and techniques recommended for the presentation and analysis of crater size-frequency data are included.

Informing public health policy through deliberative public engagement: perceived impact on participants and citizen-government relations.

PubMed

Molster, Caron; Potts, Ayla; McNamara, Beverley; Youngs, Leanne; Maxwell, Susannah; Dawkins, Hugh; O'Leary, Peter

2013-09-01

Deliberative public engagement has been proposed for policy development, where issues are complex and there are diverse public perspectives and low awareness of competing issues. Scholars suggest a range of potential outcomes for citizens and government agencies from involvement in such processes. Few studies have examined outcomes from the perspective of citizen participants in deliberative processes. To examine participant perceptions of their involvement in and outcomes of a deliberative engagement exercise. A case study using semistructured interviews was conducted with participants following a deliberative forum on biobanking. From their involvement in the deliberative exercise, participants described transformations in their knowledge and beliefs about the policy issues. They reported being more informed to the extent of having confidence to educate others and effectively contribute to public policy development. They had developed greater trust in government policymakers who they believed would take reasonable account of their recommendations. We conclude that the participants were satisfied with the outcomes of the deliberative public engagement process and viewed it as an effective means of citizen involvement in public policy development. Particularly for citizens who participate in deliberative processes, such processes may promote active citizenship, empower citizens to undertake representative and educative roles, and improve relations between citizens and government agencies. Actions taken by policymakers subsequent to the deliberative exercise, whereby the majority of citizen recommendations were incorporated in the policy developed, may have contributed to participants holding sustained levels of trust in the commissioning government agency.

Application of science-based restoration planning to a desert river system.

PubMed

Laub, Brian G; Jimenez, Justin; Budy, Phaedra

2015-06-01

Persistence of many desert river species is threatened by a suite of impacts linked to water infrastructure projects that provide human water security where water is scarce. Many desert rivers have undergone regime shifts from spatially and temporally dynamic ecosystems to more stable systems dominated by homogenous physical habitat. Restoration of desert river systems could aid in biodiversity conservation, but poses formidable challenges due to multiple threats and the infeasibility of recovery to pre-development conditions. The challenges faced in restoring desert rivers can be addressed by incorporating scientific recommendations into restoration planning efforts at multiple stages, as demonstrated here through an example restoration project. In particular, use of a watershed-scale planning process can identify data gaps and irreversible constraints, which aid in developing achievable restoration goals and objectives. Site-prioritization focuses limited the resources for restoration on areas with the greatest potential to improve populations of target organisms. Investment in research to understand causes of degradation, coupled with adoption of a guiding vision is critical for identifying feasible restoration actions that can enhance river processes. Setting monitoring as a project goal, developing hypotheses for expected outcomes, and implementing restoration as an experimental design will facilitate adaptive management and learning from project implementation. Involvement of scientists and managers during all planning stages is critical for developing process-based restoration actions and an implementation plan to maximize learning. The planning process developed here provides a roadmap for use of scientific recommendations in future efforts to recover dynamic processes in imperiled riverine ecosystems.

Application of Science-Based Restoration Planning to a Desert River System

NASA Astrophysics Data System (ADS)

Laub, Brian G.; Jimenez, Justin; Budy, Phaedra

2015-06-01

Persistence of many desert river species is threatened by a suite of impacts linked to water infrastructure projects that provide human water security where water is scarce. Many desert rivers have undergone regime shifts from spatially and temporally dynamic ecosystems to more stable systems dominated by homogenous physical habitat. Restoration of desert river systems could aid in biodiversity conservation, but poses formidable challenges due to multiple threats and the infeasibility of recovery to pre-development conditions. The challenges faced in restoring desert rivers can be addressed by incorporating scientific recommendations into restoration planning efforts at multiple stages, as demonstrated here through an example restoration project. In particular, use of a watershed-scale planning process can identify data gaps and irreversible constraints, which aid in developing achievable restoration goals and objectives. Site-prioritization focuses limited the resources for restoration on areas with the greatest potential to improve populations of target organisms. Investment in research to understand causes of degradation, coupled with adoption of a guiding vision is critical for identifying feasible restoration actions that can enhance river processes. Setting monitoring as a project goal, developing hypotheses for expected outcomes, and implementing restoration as an experimental design will facilitate adaptive management and learning from project implementation. Involvement of scientists and managers during all planning stages is critical for developing process-based restoration actions and an implementation plan to maximize learning. The planning process developed here provides a roadmap for use of scientific recommendations in future efforts to recover dynamic processes in imperiled riverine ecosystems.

Application of science-based restoration planning to a desert river system

USGS Publications Warehouse

Laub, Brian G.; Jimenez, Justin; Budy, Phaedra

2015-01-01

Persistence of many desert river species is threatened by a suite of impacts linked to water infrastructure projects that provide human water security where water is scarce. Many desert rivers have undergone regime shifts from spatially and temporally dynamic ecosystems to more stable systems dominated by homogenous physical habitat. Restoration of desert river systems could aid in biodiversity conservation, but poses formidable challenges due to multiple threats and the infeasibility of recovery to pre-development conditions. The challenges faced in restoring desert rivers can be addressed by incorporating scientific recommendations into restoration planning efforts at multiple stages, as demonstrated here through an example restoration project. In particular, use of a watershed-scale planning process can identify data gaps and irreversible constraints, which aid in developing achievable restoration goals and objectives. Site-prioritization focuses limited the resources for restoration on areas with the greatest potential to improve populations of target organisms. Investment in research to understand causes of degradation, coupled with adoption of a guiding vision is critical for identifying feasible restoration actions that can enhance river processes. Setting monitoring as a project goal, developing hypotheses for expected outcomes, and implementing restoration as an experimental design will facilitate adaptive management and learning from project implementation. Involvement of scientists and managers during all planning stages is critical for developing process-based restoration actions and an implementation plan to maximize learning. The planning process developed here provides a roadmap for use of scientific recommendations in future efforts to recover dynamic processes in imperiled riverine ecosystems.

[Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology].

PubMed

Reyes García, Rebeca; Jódar Gimeno, Esteban; García Martín, Antonia; Romero Muñoz, Manuel; Gómez Sáez, José Manuel; Luque Fernández, Inés; Varsavsky, Mariela; Guadalix Iglesias, Sonsoles; Cano Rodriguez, Isidoro; Ballesteros Pomar, María Dolores; Vidal Casariego, Alfonso; Rozas Moreno, Pedro; Cortés Berdonces, María; Fernández García, Diego; Calleja Canelas, Amparo; Palma Moya, Mercedes; Martínez Díaz-Guerra, Guillermo; Jimenez Moleón, José J; Muñoz Torres, Manuel

2012-03-01

To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process.

PubMed

Pottie, Kevin; Welch, Vivian; Morton, Rachael; Akl, Elie A; Eslava-Schmalbach, Javier H; Katikireddi, Vittal; Singh, Jasvinder; Moja, Lorenzo; Lang, Eddy; Magrini, Nicola; Thabane, Lehana; Stanev, Roger; Matovinovic, Elizabeth; Snellman, Alexandra; Briel, Matthias; Shea, Beverly; Tugwell, Peter; Schunemann, Holger; Guyatt, Gordon; Alonso-Coello, Pablo

2017-10-01

The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading Recommendations Assessment and Development Evidence) evidence to decision process. We developed this guidance based on the GRADE evidence to decision framework, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. Considering the impact on health equity may be required, both in general guidelines and guidelines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup. Copyright © 2017 Elsevier Inc. All rights reserved.

Recommendations on breast cancer screening and prevention in the context of implementing risk stratification: impending changes to current policies

PubMed Central

Gagnon, J.; Lévesque, E.; Borduas, F.; Chiquette, J.; Diorio, C.; Duchesne, N.; Dumais, M.; Eloy, L.; Foulkes, W.; Gervais, N.; Lalonde, L.; L’Espérance, B.; Meterissian, S.; Provencher, L.; Richard, J.; Savard, C.; Trop, I.; Wong, N.; Knoppers, B.M.; Simard, J.

2016-01-01

In recent years, risk stratification has sparked interest as an innovative approach to disease screening and prevention. The approach effectively personalizes individual risk, opening the way to screening and prevention interventions that are adapted to subpopulations. The international perspective project, which is developing risk stratification for breast cancer, aims to support the integration of its screening approach into clinical practice through comprehensive tool-building. Policies and guidelines for risk stratification—unlike those for population screening programs, which are currently well regulated—are still under development. Indeed, the development of guidelines for risk stratification reflects the translational aspects of perspective. Here, we describe the risk stratification process that was devised in the context of perspective, and we then explain the consensus-based method used to develop recommendations for breast cancer screening and prevention in a risk-stratification approach. Lastly, we discuss how the recommendations might affect current screening policies. PMID:28050152

Expert consensus v. evidence-based approaches in the revision of the DSM.

PubMed

Kendler, K S; Solomon, M

2016-08-01

The development of DSM-III through DSM-5 has relied heavily on expert consensus. In this essay, we provide an historical and critical perspective on this process. Over the last 40 years, medicine has struggled to find appropriate methods for summarizing research results and making clinical recommendations. When such recommendations are issued by authorized organizations, they can have widespread influence (i.e. DSM-III and its successors). In the 1970s, expert consensus conferences, led by the NIH, reviewed research about controversial medical issues and successfully disseminated results. However, these consensus conferences struggled with aggregating the complex available evidence. In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field. Like the recommendations made for the NIH consensus conferences, we argue that the DSM process should be modified to require systematic evidence-based reviews before Work Groups make their assessments. Our suggestions - which would require leadership and additional resources to set standards for appropriate evidence hierarchies, carry out systematic reviews, and upgrade the group process - should improve the objectivity of the DSM, increase the validity of its results, and improve the reception of any changes in nosology.

Adaptation of evidence-based guideline recommendations to address urinary incontinence in nursing home residents according to the ADAPTE-process.

PubMed

Hoedl, Manuela; Schoberer, Daniela; Halfens, Ruud J G; Lohrmann, Christa

2018-04-27

To adapt international guideline recommendations for the conservative management of urinary incontinence (UI), defined as any involuntary loss of urine, in Austrian nursing home residents following the ADAPTE-process. Many international guidelines for managing UI are available. Nevertheless, the international recommendations have not yet been adapted to address the Austrian nursing home context. This crucial adaptation process will enhance the acceptance and applicability of the recommendations as well as encourage adherence among Austrian nurses and nursing home residents. This study is a methodological study based on the ADAPTE-process, including a systematic search, quality appraisal of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) instrument as well as an external review by means of a Delphi technique. The guidelines had to be topic-relevant, published within the last 3 years and achieve a rigor of development score of 80% using the AGREE II instrument. We searched international guideline databases to identify adequate guidelines. Two raters assessed the quality of each guideline, ascertaining that it fulfilled the inclusion criteria using the AGREE II instrument. We translated the identified recommendations into German and externally reviewed for their applicability in the Austrian context. We identified 1,612 hits in 10 databases. After applying inclusion and exclusion criteria, we assessed five international clinical guidelines for quality using the AGREE II instrument. One clinical guideline fulfilled the inclusion criteria. This clinical guideline contains 116 recommendations, of which 29 were applicable in the Austrian nursing home setting. We identified only one suitable guideline, possibly due to the stringent nature of the inclusion criteria. However, following low-quality guidelines may result in the use of recommendations that are not based on evidence and, therefore, may lead to suboptimal nursing care and outcomes. © 2018 John Wiley & Sons Ltd.

Effects of Training in Functional Behavior Assessment

ERIC Educational Resources Information Center

Dukes, Charles; Rosenberg, Howard; Brady, Michael

2008-01-01

The purpose of this study was to investigate the effectiveness of training special education teachers in the process of functional behavioral assessment (FBA) and subsequent development of recommendations to promote behavior change. An original evaluation instrument was developed that included measures of special education teachers' knowledge of…

Cost Benefit Analysis of Enterprise Resource Planning System for the Naval Postgraduate School

DTIC Science & Technology

2002-06-01

Department-wide introduction and use of appropriate commercial financial practices and reporting • Develop a strategic plan for implementing a business... Development of a process innovation approach given the current capabilities of the system, recommend possible alternatives to close gaps. E

[Development process of Evidence-based "Return-to-work Guidance in Occupational Health 2017"].

PubMed

Kojimahara, Noriko; Fukumoto, Masakatsu; Yoshikawa, Etsuko; Shinada, Kayoko; Tsuiki, Hirokazu

2018-06-05

Objective"Return-to-work Guidance in Occupational Health 2017 (RTW Guidance 2017) " is the first occupational health guide in Japan that evaluates the quality of evidence and offers recommendations based on results of the systematic review of randomized controlled trials. Details of the systematic review of each review question (RQs) will be described separately. This article presents an overview of the method and process of developing the "RTW Guidance 2017."Materials and MethodsThe guidance was developed following the previously-published "Method for developing evidence based occupational health guidance," which included the composition of a highly-transparent guidance developing group as well as the recruitment and selection of RQs. Using the Cochrane Library, PubMed, and Ichushi-Web, a literature search for the six RQs was conducted in January 2016 by partly modifying the search terms of the existing systematic review. Articles were selected according to the inclusion criteria, and the quality of evidence was evaluated using the GRADE approach. Meta-analysis was conducted for RQ2 and RQ4, and a qualitative systematic review was conducted for RQ5, RQ6, and cost-effectiveness. Recommendations were subsequently made after a thorough consideration for feasibility in Japan by examining the costs and available resources.ResultsBased on a comprehensive literature search, eleven RQ2, four RQ4, one RQ5, and three RQ6 were selected. Support program for returning to work, such as "Re-work" for those who are temporarily not working due to musculoskeletal disorders or mental health disorder, was recommended based on moderate evidence (RQ2). For RQ4, the collaboration between occupational health practice and clinical practice was weakly recommended based on low evidence. For RQ5 that evaluated the usefulness of social support, intervention by the manager/co-worker was proposed as a "best practice statement" without indicating it as a recommendation. Work accommodation was weakly recommended based on low evidence in RQ6.Discussion and ConclusionFrom the result of systematic reviews, it was recommended for workers on sick leave more than four weeks regardless of sick leave and sickness absence that interventions during leave would improve work-related outcomes, such as earlier reinstatement. Although there is limited evidence regarding occupational health in Japan, it is important for many occupational health professionals to learn the method of developing guidance and to identify issues for future studies with priority in Japan.

Evaluation of Vitrification Processing Step for Rocky Flats Incinerator Ash

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wigent, W.L.; Luey, J.K.; Scheele, R.D.

In 1997, Pacific Northwest National Laboratory (PNNL) staff developed a processing option for incinerator ash at the Rocky Flats Environmental Technology Sites (RFETS). This work was performed with support from Los Alamos National Laboratory (LANL) and Safe Sites of Colorado (SSOC). A description of the remediation needs for the RFETS incinerator ash is provided in a report summarizing the recommended processing option for treatment of the ash (Lucy et al. 1998). The recommended process flowsheet involves a calcination pretreatment step to remove carbonaceous material followed by a vitrification processing step for a mixture of glass tit and calcined incinerator ash.more » Using the calcination pretreatment step to remove carbonaceous material reduced process upsets for the vitrification step, allowed for increased waste loading in the final product, and improved the quality of the final product. Figure 1.1 illustrates the flow sheet for the recommended processing option for treatment of RFETS incinerator ash. In 1998, work at PNNL further developed the recommended flow sheet through a series of studies to better define the vitrification operating parameters and to address secondary processing issues (such as characterizing the offgas species from the calcination process). Because a prototypical rotary calciner was not available for use, studies to evaluate the offgas from the calcination process were performed using a benchtop rotary calciner and laboratory-scale equipment (Lucy et al. 1998). This report focuses on the vitrification process step after ash has been calcined. Testing with full-scale containers was performed using ash surrogates and a muffle furnace similar to that planned for use at RFETS. Small-scale testing was performed using plutonium-bearing incinerator ash to verify performance of the waste form. Ash was not obtained from RFETS because of transportation requirements to calcine the incinerator ash prior to shipment of the material. Because part of PNNL's work was to characterize the ash prior to calcination and to investigate the effect of calcination on product quality, representative material was obtained from LANL. Ash obtained from LANL was selected based on its similarity to that currently stored at RFETS. The plutonium-bearing ashes obtained from LANL are likely from a RFETS incinerator, but the exact origin was not identified.« less

USEtox - The UNEP-SETAC toxicity model: recommended characterisation factors for human toxicity and freshwater ecotoxicity in Life Cycle Impact Assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rosenbaum, Ralph K.; Bachmann, Till M.; Swirsky Gold, Lois

2008-02-03

Background, Aim and Scope. In 2005 a comprehensive comparison of LCIA toxicity characterisation models was initiated by the UNEP-SETAC Life Cycle Initiative, directly involving the model developers of CalTOX, IMPACT 2002, USES-LCA, BETR, EDIP, WATSON, and EcoSense. In this paper we describe this model-comparison process and its results--in particular the scientific consensus model developed by the model developers. The main objectives of this effort were (i) to identify specific sources of differences between the models' results and structure, (ii) to detect the indispensable model components, and (iii) to build a scientific consensus model from them, representing recommended practice. Methods. Amore » chemical test set of 45 organics covering a wide range of property combinations was selected for this purpose. All models used this set. In three workshops, the model comparison participants identified key fate, exposure and effect issues via comparison of the final characterisation factors and selected intermediate outputs for fate, human exposure and toxic effects for the test set applied to all models. Results. Through this process, we were able to reduce inter-model variation from an initial range of up to 13 orders of magnitude down to no more than 2 orders of magnitude for any substance. This led to the development of USEtox, a scientific consensus model that contains only the most influential model elements. These were, for example, process formulations accounting for intermittent rain, defining a closed or open system environment, or nesting an urban box in a continental box. Discussion. The precision of the new characterisation factors (CFs) is within a factor of 100-1000 for human health and 10-100 for freshwater ecotoxicity of all other models compared to 12 orders of magnitude variation between the CFs of each model respectively. The achieved reduction of inter-model variability by up to 11 orders of magnitude is a significant improvement.Conclusions. USEtox provides a parsimonious and transparent tool for human health and ecosystem CF estimates. Based on a referenced database, it has now been used to calculate CFs for several thousand substances and forms the basis of the recommendations from UNEP-SETAC's Life Cycle Initiative regarding characterization of toxic impacts in Life Cycle Assessment. Recommendations and Perspectives. We provide both recommended and interim (not recommended and to be used with caution) characterisation factors for human health and freshwater ecotoxicity impacts. After a process of consensus building among stakeholders on a broad scale as well as several improvements regarding a wider and easier applicability of the model, USEtox will become available to practitioners for the calculation of further CFs.« less

World Health Organization strong recommendations based on low-quality evidence (study quality) are frequent and often inconsistent with GRADE guidance.

PubMed

Alexander, Paul E; Brito, Juan P; Neumann, Ignacio; Gionfriddo, Michael R; Bero, Lisa; Djulbegovic, Benjamin; Stoltzfus, Rebecca; Montori, Victor M; Norris, Susan L; Schünemann, Holger J; Guyatt, Gordon H

2016-04-01

In 2007 the World Health Organization (WHO) adopted the GRADE system for development of public health guidelines. Previously we found that many strong recommendations issued by WHO are based on evidence for which there is only low or very low confidence in the estimates of effect (discordant recommendations). GRADE guidance indicates that such discordant recommendations are rarely appropriate but suggests five paradigmatic situations in which discordant recommendations may be warranted. We sought to provide insight into the many discordant recommendations in WHO guidelines. We examined all guidelines that used the GRADE method and were approved by the WHO Guideline Review Committee between 2007 and 2012. Teams of reviewers independently abstracted data from eligible guidelines and classified recommendations either into one of the five paradigms for appropriately-formulated discordant recommendations or into three additional categories in which discordant recommendations were inconsistent with GRADE guidance: 1) the evidence warranted moderate or high confidence (a misclassification of evidence) rather than low or very low confidence; 2) good practice statements; or 3) uncertainty in the estimates of effect would best lead to a conditional (weak) recommendation. The 33 eligible guidelines included 160 discordant recommendations, of which 98 (61.3%) addressed drug interventions and 132 (82.5%) provided some rationale (though not entirely explicit at times) for the strong recommendation. Of 160 discordant recommendations, 25 (15.6%) were judged consistent with one of the five paradigms for appropriate recommendations; 33 (21%) were based on evidence warranting moderate or high confidence in the estimates of effect; 29 (18%) were good practice statements; and 73 (46%) warranted a conditional, rather than a strong recommendation. WHO discordant recommendations are often inconsistent with GRADE guidance, possibly threatening the integrity of the process. Further training in GRADE methods for WHO guideline development group members may be necessary, along with further research on what motivates the formulation of such recommendations. Copyright © 2016 Elsevier Inc. All rights reserved.

Government 101: how an idea becomes law.

PubMed

Griffith, James T

2006-01-01

The passing of a law is frequently accompanied by media attention and citizen apathy. In today's healthcare delivery situation, we should understand how a bill becomes law and what happens to the idea that engenders that process. Laws arise from the recommendations of ordinary citizens, but the recommendations follow a complicated process developed by the writers of our constitution to prevent abuses. Laws begin as ideas, they become bills considered by the legislature, they are expanded and enforced by the executive branch, and they are further interpreted by the judiciary branch. The laws governing healthcare issues are particularly complex, as most arise from the state legislatures.

Creating a dashboard to track progress toward IOM recommendations for the future of nursing.

PubMed

Spetz, Joanne; Bates, Timothy; Chu, Lela; Lin, Jessica; Fishman, Nancy W; Melichar, Lori

2013-01-01

This article explains the process used to identify and develop a set of data used to track national progress toward the recommendations of the Institute of Medicine Committee for the Future of Nursing. The data are presented in a dashboard format to visually summarize information and quickly measure progress. The approach selected by the research team is outlined, the criteria for selecting candidate metrics are detailed, the process for seeking external guidance is described, and the final dashboard measures are presented. Finally, the methods for data collection for each metric are explicated, to guide states and local regions in the collection of their own data.

Clinical practice guidelines for the treatment of primary liver cancer with integrative traditional Chinese and Western medicine.

PubMed

Ling, Chang-Quan; Fan, Jia; Lin, Hong-Sheng; Shen, Feng; Xu, Zhen-Ye; Lin, Li-Zhu; Qin, Shu-Kui; Zhou, Wei-Ping; Zhai, Xiao-Feng; Li, Bai; Zhou, Qing-Hui

2018-05-17

Traditional Chinese medicine (TCM) is an important part of the treatment of primary liver cancer (PLC) in China; however, the current instructions for the integrative use of traditional Chinese and Western medicine for PLC are mostly based on expert opinion. There is no evidence-based guideline for clinical practice in this field. Therefore, the Shanghai Association of Chinese Integrative Medicine has established a multidisciplinary working group to develop this guideline, which focuses on the most important questions about the use of TCM during PLC treatment. This guideline was developed following the methodological process recommended by the World Health Organization Handbook for Guideline Development. Two rounds of questionnaire survey were performed to identify clinical questions; published evidence was searched; the Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the body of evidence; and recommendations were formulated by combining the quality of evidence, patient preferences and values, and other risk factors. The guideline was written based on the Reporting Items for Practice Guidelines in Healthcare tool. This guideline contains 10 recommendations related to 8 questions, including recommendations for early treatment by TCM after surgery, TCM combined with transcatheter arterial chemoembolization for advanced PLC, TCM drugs for external use, and acupuncture and moxibustion therapy. Copyright © 2018 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.

PubMed Central

Toth, Bettina; Würfel, Wolfgang; Bohlmann, Michael; Zschocke, Johannes; Rudnik-Schöneborn, Sabine; Nawroth, Frank; Schleußner, Ekkehard; Rogenhofer, Nina; Wischmann, Tewes; von Wolff, Michael; Hancke, Katharina; von Otte, Sören; Kuon, Ruben; Feil, Katharina; Tempfer, Clemens

2018-01-01

Purpose Official guideline of the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (ÖGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). The aim of this guideline was to standardize the diagnosis and treatment of couples with recurrent miscarriage (RM). Recommendations were based on the current literature and the views of the involved committee members. Methods Based on the current literature, the committee members developed the statements and recommendations of this guideline in a formalized process which included DELPHI rounds and a formal consensus meeting. Recommendations Recommendations for the diagnosis and treatment of patients with RM were compiled based on the international literature. Specific established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders were taken into consideration. PMID:29720743

[The German Program for Disease Management Guidelines: COPD Guideline 2006. Short review].

PubMed

Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika

2007-01-15

In Germany, the first national consensus on evidence-based recommendations for COPD prevention and disease management was reached in spring 2006. After a development period of 9 months, the National Disease Management Guideline COPD was finalized by nominal group process under the authorship of the scientific societies for pneumology (DGP and Atemwegsliga), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the NICE COPD Guideline 2004, the GOLD Recommendations as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline COPD 2006 (www.copd.versorgungsleitlinien.de).

Topical fluoride for caries prevention

PubMed Central

Weyant, Robert J.; Tracy, Sharon L.; Anselmo, Theresa (Tracy); Beltrán-Aguilar, Eugenio D.; Donly, Kevin J.; Frese, William A.; Hujoel, Philippe P.; Iafolla, Timothy; Kohn, William; Kumar, Jayanth; Levy, Steven M.; Tinanoff, Norman; Wright, J. Timothy; Zero, Domenick; Aravamudhan, Krishna; Frantsve-Hawley, Julie; Meyer, Daniel M.

2015-01-01

Background A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies. Types of Studies Reviewed The authors conducted a search of MEDLINE and the Cochrane Library for clinical trials of professionally applied and prescription-strength topical fluoride agents—including mouthrinses, varnishes, gels, foams and pastes—with caries increment outcomes published in English through October 2012. Results The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries-preventive agents. The panel makes recommendations for further research. Practical Implications The panel recommends the following for people at risk of developing dental caries: 2.26 percent fluoride varnish or 1.23 percent fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.5 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse for patients 6 years or older. Only 2.26 percent fluoride varnish is recommended for children younger than 6 years. The strengths of the recommendations for the recommended products varied from “in favor” to “expert opinion for.” As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. PMID:24177407

Challenges to decision-making processes in the national HTA agency in Brazil: operational procedures, evidence use and recommendations.

PubMed

Yuba, Tania Yuka; Novaes, Hillegonda Maria Dutilh; de Soárez, Patrícia Coelho

2018-05-11

The quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this study was to analyse CONITEC recommendation reports, the type of scientific evidence used in them and their compliance with operational procedures. This is a descriptive study based on CONITEC official reports from July 2012 through December 2016. Data were collected with a specific extraction form and analysed using descriptive statistics. We evaluated 199 CONITEC recommendation reports. The annual number of reports increased during the study period. The absolute annual number of new technologies incorporated in 2013 (n = 24) was similar to that observed for 2014 (n = 24) and 2015 (n = 22), decreasing in 2016 (n = 13). The type of technology most frequently evaluated was 'drugs' (68.3%), followed by 'procedures' (20.1%). Overall, 117 (58.8%) reports were internal demands, 75 (37.7%) were external demands and 7 (3.5%) were mixed demands. There were differences between internal and external demands in terms of the evidence used in the reports and the decision regarding the recommendation to incorporate the technologies. Among the internal demands, the recommendation to incorporate the new technology was made for 70.9% of the reports, only 9.6% of which included full HTAs. Among the external demands, the incorporation of the new technology was recommended for 17.3% of the reports, 76.9% of which included full HTAs. Of the 101 reports in which incorporation of the new technology was recommended, 88 (87.1%) did not include a full health economic evaluation and ICER calculation. There are compliance difficulties with the recommendations in the CONITEC internal regulations regarding the type and quality of evidence considered in the analysis of recommendation reports. The characteristics of the evidence used in recommendation reports and those considered to be mandatory were very different, indicating problems in decision-making processes. There is a need to study, with a broader perspective, the factors that influence the type of evidence used in decision-making processes in order to contribute to the development of better practices and policies.

University Strategic Planning: A Process for Change in a Principal Preparation Program

ERIC Educational Resources Information Center

Guerra, Federico R.; Zamora, Roberto; Hernandez, Rosalinda; Menchaca, Velma

2017-01-01

This study describes a strategic planning process used for developing an educational leadership program that prepares principals for leading 21st century schools. The plan is based on recommendations received from the External reviewers representing Southern Association of Colleges and Schools, the Texas Education Agency, survey responses received…

WHO Expert Committee on Specifications for Pharmaceutical Preparations.

PubMed

2012-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use: Development of monographs for The International Pharmacopoeia; WHO good manufacturing practices: water for pharmaceutical use; Pharmaceutical development of multisource (generic) pharmaceutical products--points to consider; Guidelines on submission of documentation for a multisource (generic) finished pharmaceutical product for the WHO Prequalification of Medicines Programme: quality part; Development of paediatric medicines: points to consider in formulation; Recommendations for quality requirements for artemisinin as a starting material in the production of antimalarial active pharmaceutical ingredients.

Recommendations of Common Data Elements to Advance the Science of Self-management of Chronic Conditions

PubMed Central

Moore, Shirley M.; Schiffman, Rachel; Waldrop-Valverde, Drenna; Redeker, Nancy S.; McCloskey, Donna Jo; Kim, Miyong T.; Heitkemper, Margaret M.; Guthrie, Barbara J.; Dorsey, Susan G.; Docherty, Sharron L.; Barton, Debra; Bailey, Donald E.; Austin, Joan K.; Grady, Patricia

2017-01-01

Purpose Common data elements (CDEs) are increasingly being used by researchers to promote data sharing across studies. The purposes of this article are to (a) describe the theoretical, conceptual, and definition issues in the development of a set of CDEs for research addressing self-management of chronic conditions; (b) propose an initial set of CDEs and their measures to advance the science of self-management; and (c) recommend implications for future research and dissemination. Design and Methods Between July 2014 and December 2015 the directors of the National Institute of Nursing Research (NINR)-funded P20 and P30 centers of excellence and NINR staff met in a series of telephone calls and a face-to-face NINR-sponsored meeting to select a set of recommended CDEs to be used in self-management research. A list of potential CDEs was developed from examination of common constructs in current self-management frameworks, as well as identification of variables frequently used in studies conducted in the centers of excellence. Findings The recommended CDEs include measures of three self-management processes: activation, self-regulation, and self-efficacy for managing chronic conditions, and one measure of a self-management outcome, global health. Conclusions The self-management of chronic conditions, which encompasses a considerable number of processes, behaviors, and outcomes across a broad range of chronic conditions, presents several challenges in the identification of a parsimonious set of CDEs. This initial list of recommended CDEs for use in self-management research is provisional in that it is expected that over time it will be refined. Comment and recommended revisions are sought from the research and practice communities. Clinical Relevance The use of CDEs can facilitate generalizability of research findings across diverse population and interventions. PMID:27486851

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.

PubMed

Lentine, Krista L; Kasiske, Bertram L; Levey, Andrew S; Adams, Patricia L; Alberú, Josefina; Bakr, Mohamed A; Gallon, Lorenzo; Garvey, Catherine A; Guleria, Sandeep; Li, Philip Kam-Tao; Segev, Dorry L; Taler, Sandra J; Tanabe, Kazunari; Wright, Linda; Zeier, Martin G; Cheung, Michael; Garg, Amit X

2017-08-01

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.

Recommendations of Common Data Elements to Advance the Science of Self-Management of Chronic Conditions.

PubMed

Moore, Shirley M; Schiffman, Rachel; Waldrop-Valverde, Drenna; Redeker, Nancy S; McCloskey, Donna Jo; Kim, Miyong T; Heitkemper, Margaret M; Guthrie, Barbara J; Dorsey, Susan G; Docherty, Sharron L; Barton, Debra; Bailey, Donald E; Austin, Joan K; Grady, Patricia

2016-09-01

Common data elements (CDEs) are increasingly being used by researchers to promote data sharing across studies. The purposes of this article are to (a) describe the theoretical, conceptual, and definition issues in the development of a set of CDEs for research addressing self-management of chronic conditions; (b) propose an initial set of CDEs and their measures to advance the science of self-management; and (c) recommend implications for future research and dissemination. Between July 2014 and December 2015 the directors of the National Institute of Nursing Research (NINR)-funded P20 and P30 centers of excellence and NINR staff met in a series of telephone calls and a face-to-face NINR-sponsored meeting to select a set of recommended CDEs to be used in self-management research. A list of potential CDEs was developed from examination of common constructs in current self-management frameworks, as well as identification of variables frequently used in studies conducted in the centers of excellence. The recommended CDEs include measures of three self-management processes: activation, self-regulation, and self-efficacy for managing chronic conditions, and one measure of a self-management outcome, global health. The self-management of chronic conditions, which encompasses a considerable number of processes, behaviors, and outcomes across a broad range of chronic conditions, presents several challenges in the identification of a parsimonious set of CDEs. This initial list of recommended CDEs for use in self-management research is provisional in that it is expected that over time it will be refined. Comment and recommended revisions are sought from the research and practice communities. The use of CDEs can facilitate generalizability of research findings across diverse population and interventions. © 2016 Sigma Theta Tau International.

Cervical spondylotic myelopathy: methodological approaches to evaluate the literature and establish best evidence.

PubMed

Skelly, Andrea C; Hashimoto, Robin E; Norvell, Daniel C; Dettori, Joseph R; Fischer, Dena J; Wilson, Jefferson R; Tetreault, Lindsay A; Fehlings, Michael G

2013-10-15

Review of methods. To provide a detailed description of the methods undertaken in the articles in this focus issue pertaining to cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) and to describe the process used to develop summary statements and clinical recommendations regarding factors associated with the mechanisms, diagnosis, progression, and treatment of CSM and OPLL. We present methods used in conducting the systematic, evidence-based reviews and development of expert panel summary statements and clinical recommendations of the mechanisms, diagnosis, progression, and treatment of CSM and OPLL. Our intent is that clinicians will combine the information from these systematic reviews, narrative reviews, and primary research studies with an understanding of their own capacities and experience to better manage patients with CSM or OPLL and consider future research for the diagnosis and treatment of these diseases. For the systematic reviews, which make up the bulk of the studies in this focus issue, a systematic search and critical review of the English language literature was undertaken for articles published on the mechanisms, diagnosis, progression, and treatment of CSM and OPLL. Articles were screened for relevance using a priori criteria and relevant articles were critically reviewed. Whether an article was included for review depended on whether the study question was descriptive, one of therapy, or one of prognosis. The strength of evidence for the overall body of literature in each topic area was determined by 2 independent reviewers considering risk of bias, consistency, directness, and precision of results using a modification of the Grading of Recommendation Assessment, Development and Evaluation criteria. Disagreements were resolved by consensus. Findings from articles meeting inclusion criteria were summarized. From these summaries, summary statements or clinical recommendations were formulated among subject experts through a modified Delphi process using the Grading of Recommendation Assessment, Development and Evaluation approach. Methods for the 2 primary research studies and the narrative reviews are also reviewed. Because of the nature of questions that needed to be addressed, not all studies in this focus issue were amenable to systematic review. As a result, this focus issue consists of several different article types, including 1 research protocol, 2 primary research studies, 2 narrative literature reviews, 7 systematic reviews, and 3 articles that combine a systematic review component with either a narrative section (n = 2) or a provider survey (n = 1). In general, the strength of evidence ratings ranged from insufficient to moderate. Summary statements or clinical recommendations were made according to available evidence and study type: 16 summary statements were made across 8 articles, and 17 clinical recommendations were made across 9 articles. Three articles had both summary statements and clinical recommendations, 5 had summary statements only, 6 had clinical recommendations only, and 1 (the research protocol) was not amenable to either. Systematic reviews, narrative reviews, and primary research studies were undertaken to understand the mechanisms, diagnosis, progression, and treatment of CSM and OPLL and to provide summary statements and clinical recommendations. This article reports the methods used in the studies in this focus issue. SUMMARY STATEMENTS: The objectives of this focus issue were met using a variety of article and study designs, each of which has some unique methodological aspects associated with it. The reader should refer to the full article in this issue for additional details specific to that topic. The methods for systematic review follow accepted standards for rigor and, together with the application of Grading of Recommendation Assessment, Development and Evaluation, are intended to allow for transparency in the process for creating the clinical recommendation.

The AHA and Faculty Development.

ERIC Educational Resources Information Center

Thompson, Mack

The American Historical Association's (AHA) involvement in Faculty Development Programs (FDP) in history instruction is described. The purpose of FDP is to improve teaching as part of a continuing process. AHA guidelines recommend that these programs be initiated and supported by AHA under the following conditions: (1) a regional confederation of…

75 FR 9638 - Surface Transportation Project Delivery Pilot Program; Caltrans Audit Report

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-03

... practice on a case- by-case basis. The FHWA recommends that Caltrans develop a departmentwide, holistic corrective action management approach and system that will develop and implement an internal process review... the Pilot Program. During the on-site audit, Caltrans staff and management continued to express...

Career Development of Lesbian and Gay Youth: Effects of Sexual Orientation, Coming Out, and Homophobia.

ERIC Educational Resources Information Center

Morrow, Susan L.

1997-01-01

Describes the factors that impinge on the identity and career development of lesbian and gay adolescents, especially the process of coming out to self and dealing with homophobia. Theorizes about the impacts of coming out and homophobia on career development and choice, and makes recommendations for school practice. (SLD)

The Use of Online Surveys to Measure Satisfaction in Job Training and Workforce Development

ERIC Educational Resources Information Center

Schmidt, Steve; Strachota, Elaine; Conceicao, Simone

2006-01-01

This paper examines two empirical studies that used online surveys to collect data to measure satisfaction in job training and workforce development. A description of each study, findings related to response rate, the processes used in online survey development and implementation, as well as recommendations for the future use of online surveys…

Working Together To Become Proficient Readers. Early Impact of the Talent Development Middle School's Student Team Literature Program. Report No. 15.

ERIC Educational Resources Information Center

Mac Iver, Douglas J.; Plank, Stephen B.; Balfanz, Robert

The Talent Development Model of Middle School Reform includes a "Student Team Literature" (STL) program that relies on: (1) curricular materials designed to assist students to study great literature; (2) recommended instructional practices, peer assistance processes, and assessments; and (3) staff development, mentoring, and advising to…

Quality Measures for the Care of Patients with Insomnia

PubMed Central

Edinger, Jack D.; Buysse, Daniel J.; Deriy, Ludmila; Germain, Anne; Lewin, Daniel S.; Ong, Jason C.; Morgenthaler, Timothy I.

2015-01-01

The American Academy of Sleep Medicine (AASM) commissioned five Workgroups to develop quality measures to optimize management and care for patients with common sleep disorders including insomnia. Following the AASM process for quality measure development, this document describes measurement methods for two desirable outcomes of therapy, improving sleep quality or satisfaction, and improving daytime function, and for four processes important to achieving these goals. To achieve the outcome of improving sleep quality or satisfaction, pre- and post-treatment assessment of sleep quality or satisfaction and providing an evidence-based treatment are recommended. To realize the outcome of improving daytime functioning, pre- and post-treatment assessment of daytime functioning, provision of an evidence-based treatment, and assessment of treatment-related side effects are recommended. All insomnia measures described in this report were developed by the Insomnia Quality Measures Workgroup and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with insomnia. Citation: Edinger JD, Buysse DJ, Deriy L, Germain A, Lewin DS, Ong JC, Morgenthaler TI. Quality measures for the care of patients with insomnia. J Clin Sleep Med 2015;11(3):311–334. PMID:25700881

Development and demonstration of a lignite-pelletizing process. Phase II report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1980-01-01

The current work began with scale-up of laboratory equipment to commercial size equipment. For this purpose, BCI used an existing pilot plant that had been assembled to pelletize and indurate taconite ore. BCI determined therewith that lignite pellets can be produced continuously on a pilot scale using the basic process developed in the laboratory. The resulting pellets were found to be similar to the laboratory pellets at equivalent binder compositions. Tests of product made during a 5-ton test run are reported. A 50-ton demonstration test run was made with the pilot plant. Pellet production was sustained for a two-week period.more » The lignite pelletizing process has, therefore, been developed to the point of demonstration in a 50-ton test. BCI has completed and cost estimated a conceptually designed 4000 TPD facility. BCI believes it has demonstrated a technically feasible process to agglomerate lignite by using an asphalt emulsion binder. Product quality is promising. Capital and operating costs appear acceptable to justify continuing support and development. The next step should focus on three areas: production development, process refinement, and cost reduction. For further development, BCI recommends consideration of a 5 to 10 ton/h pilot plant or a 20 to 40 ton/h module of a full sized plant, the lower first cost of the former being offset by the ability to incorporate the latter into a future production unit. Other specific recommendations are made for future study that could lead to process and cost improvements: Binder Formulation, disc Sizing, Drier Bed Depth, and Mixing Approach. Pellet use other than power plant fuel is considered.« less

Methodological recommendations for comparative research on the treatment of chronic wounds.

PubMed

Sonnad, S S; Goldsack, J C; Mohr, P; Tunis, S

2013-09-01

To provide specific recommendations to product developers and clinical researchers on the design of comparative effectiveness studies for the treatment of chronic wounds, specifically those pertaining to arterial and venous-disease related ulcers, diabetic foot ulcers, pressure ulcers and burn wounds. The recommendations were developed based on a process defined by the Center for Medical Technology Policy (CMTP). After selecting the subject area, semi-structured phone interviews were conducted by one of the authors (SSS) with representatives of payers, manufacturers, clinicians, clinician/researchers and patient advocates. Next, a broad range of stakeholders participated in a meeting convened by CMTP to determine their needs. A technical working group comprising key stakeholders then participated in clarifying recommendations developed by CMTP staff and adding important considerations for their implementation. The resulting draft document was finalised based on public and solicited comment from individual manufacturers; a consortium of product developers and manufacturers; and an alliance of physicians, providers, manufacturers and patient organisations. This article is a summary of the full effectiveness guidance document. To address the needs of patients, clinicians, guideline developers, payers and other post-regulatory decision makers, this work makes ten recommendations to guide comparative effectiveness research for chronic wound care. These recommendations fall into four categories: study design, population, comparators and outcomes. This paper suggests that using the recommendations outlined to conduct comparative effectiveness research on treatments for chronic wound therapies would facilitate trials that provide patients, clinicians, and payers with the information they need to make optimal treatment decisions. These recommendations focus on design changes that would have the largest impact in improving the usability of the results by decision makers and provide specific guidance on the design of prospective studies intended to inform decision making by patients, clinicians and payers. There were no external sources of funding for these recommendations. The Value Institute and the Center for Medical Technology Policy (CMTP) are both private, non-profit organisations. The authors have no financial, commercial or social conflicts of interest to declare with respect to the article or its content.

Analysis of Investment IT Planning on Logistic Company Using COBIT 5

NASA Astrophysics Data System (ADS)

Fachri Pane, Syafrial; Maulana Awangga, Rolly; Nuraini, Rd.; Fathonah, Siti

2018-04-01

IT Investment planning to review goals business strategy development needs to support IT governance. Planning its investments will be assessed with a framework is issued by ISACA that COBIT 5 focus on domain EDM, APO, BAI, and MEA. Mapping from framework COBIT 5 with Val IT lead nine domain consisting of EDM01, EDM02, APO01, APO02, APO05, APO06, APO07, BAI01, and MEA01. Article search google using RACI diagram generating mapping organisation telecoms and authority structures for the review identify respondents from any domain. Under selected area be used to review counting process capability level, and for a discussion of development, priorities make recommendations shall perform in accordance process needs PT.XYZ logistics company. The translating process capability level determined by the company prior currently at on level 4. The capability level domain process in the EDM is level 4, while at domain APO, BAI, and MEA are on level 3 and gap on APO, BAI, and MEA. The company recommendation domain subscription APO, BAI, and MEA to increase the capabilities of the rate review process to achieve the targets that have can determine the company.

Developing interprofessional health competencies in a virtual world

PubMed Central

King, Sharla; Chodos, David; Stroulia, Eleni; Carbonaro, Mike; MacKenzie, Mark; Reid, Andrew; Torres, Lisa; Greidanus, Elaine

2012-01-01

Background Virtual worlds provide a promising means of delivering simulations for developing interprofessional health skills. However, developing and implementing a virtual world simulation is a challenging process, in part because of the novelty of virtual worlds as a simulation platform and also because of the degree of collaboration required among technical and subject experts. Thus, it can be difficult to ensure that the simulation is both technically satisfactory and educationally appropriate. Methods To address this challenge, we propose the use of de Freitas and Oliver's four-dimensional framework as a means of guiding the development process. We give an overview of the framework and describe how its principles can be applied to the development of virtual world simulations. Results We present two virtual world simulation pilot projects that adopted this approach, and describe our development experience in these projects. We directly connect this experience to the four-dimensional framework, thus validating the framework's applicability to the projects and to the context of virtual world simulations in general. Conclusions We present a series of recommendations for developing virtual world simulations for interprofessional health education. These recommendations are based on the four-dimensional framework and are also informed by our experience with the pilot projects. PMID:23195649

Marshmallow Meiosis.

ERIC Educational Resources Information Center

Soderberg, Patti

1992-01-01

Presents an activity in which students model the processes of meiosis, fertilization, development, and birth using model creatures called reebops. Students breed reebops to analyze chromosome combinations. Makes recommendations for activity utilization and identifies the strengths of the activity. (MDH)

Return of results in translational iPS cell research: considerations for donor informed consent

PubMed Central

2013-01-01

Efforts have emerged internationally to recruit donors with specific disease indications and to derive induced pluripotent cell lines. These disease-specific induced pluripotent stem cell lines have the potential to accelerate translational goals such as drug discovery and testing. One consideration for donor recruitment and informed consent is the possibility that research will result in findings that are clinically relevant to the cell donor. Management protocols for such findings should be developed a priori and disclosed during the informed consent process. The California Institute for Regenerative Medicine has developed recommendations for informing donors in sponsored research. These recommendations include obtaining consent to recontact tissue donors for a range of scientific, medical and ethical considerations. This article reviews the basis for these recommendations and suggests conditions that may be appropriate when reporting findings to donors. PMID:23336317

Comparative effectiveness of colony-stimulating factors in febrile neutropenia prophylaxis: how results are affected by research design.

PubMed

Henk, Henry J; Li, Xiaoyan; Becker, Laura K; Xu, Hairong; Gong, Qi; Deeter, Robert G; Barron, Richard L

2015-01-01

To examine the impact of research design on results in two published comparative effectiveness studies. Guidelines for comparative effectiveness research have recommended incorporating disease process in study design. Based on the recommendations, we develop a checklist of considerations and apply the checklist in review of two published studies on comparative effectiveness of colony-stimulating factors. Both studies used similar administrative claims data, but different methods, which resulted in directionally different estimates. Major design differences between the two studies include: whether the timing of intervention in disease process was identified and whether study cohort and outcome assessment period were defined based on this temporal relationship. Disease process and timing of intervention should be incorporated into the design of comparative effectiveness studies.

GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale.

PubMed

Welch, Vivian A; Akl, Elie A; Guyatt, Gordon; Pottie, Kevin; Eslava-Schmalbach, Javier; Ansari, Mohammed T; de Beer, Hans; Briel, Matthias; Dans, Tony; Dans, Inday; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Meerpohl, Joerg; Morton, Rachael; Mosdol, Annhild; Petkovic, Jennifer; Schünemann, Holger J; Sharaf, Ravi N; Singh, Jasvinder A; Stanev, Roger; Tonia, Thomy; Tristan, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter

2017-10-01

This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines. We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Progress on plutonium stabilization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hurt, D.

1996-05-01

The Defense Nuclear Facilities Safety Board has safety oversight responsibility for most of the facilities where unstable forms of plutonium are being processed and packaged for interim storage. The Board has issued recommendations on plutonium stabilization and has has a considerable influence on DOE`s stabilization schedules and priorities. The Board has not made any recommendations on long-term plutonium disposition, although it may get more involved in the future if DOE develops plans to use defense nuclear facilities for disposition activities.

Summary of the NACI Statement on Seasonal Influenza Vaccine for 2017-2018.

PubMed

Vaudry, W; Stirling, R

2017-05-04

Influenza is a respiratory infection caused primarily by influenza A and B viruses. Vaccination is the most effective way to prevent influenza and its complications. The National Advisory Committee on Immunization (NACI) provides recommendations regarding seasonal influenza vaccines annually to the Public Health Agency of Canada (PHAC). To summarize the NACI recommendations regarding the use of seasonal influenza vaccines for the 2017-2018 influenza season. Annual influenza vaccine recommendations are developed by NACI's Influenza Working Group for consideration and approval by NACI, based on NACI's evidence-based process for developing recommendations. The recommendations include a consideration of the burden of influenza illness and the target populations for vaccination; efficacy and effectiveness, immunogenicity and safety of influenza vaccines; vaccine schedules; and other aspects of influenza immunization. These recommendations are published annually on the Agency's website in the NACI Advisory Committee Statement: Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine (the Statement). The annual statement has been updated for the 2017-2018 influenza season to incorporate recommendations for the use of live attenuated influenza vaccine (LAIV) that were contained in two addenda published after the 2016-2017 statement. These recommendations were 1) that egg-allergic individuals may be vaccinated against influenza using the low ovalbumin-containing LAIV licensed for use in Canada and 2) to continue to recommend the use of LAIV in children and adolescents 2-17 years of age, but to remove the preferential recommendation for its use. NACI continues to recommend annual influenza vaccination for all individuals aged six months and older, with particular focus on people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk, and others as indicated.

United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).

PubMed

Löhr, J Matthias; Dominguez-Munoz, Enrique; Rosendahl, Jonas; Besselink, Marc; Mayerle, Julia; Lerch, Markus M; Haas, Stephan; Akisik, Fatih; Kartalis, Nikolaos; Iglesias-Garcia, Julio; Keller, Jutta; Boermeester, Marja; Werner, Jens; Dumonceau, Jean-Marc; Fockens, Paul; Drewes, Asbjorn; Ceyhan, Gürlap; Lindkvist, Björn; Drenth, Joost; Ewald, Nils; Hardt, Philip; de Madaria, Enrique; Witt, Heiko; Schneider, Alexander; Manfredi, Riccardo; Brøndum, Frøkjer J; Rudolf, Sasa; Bollen, Thomas; Bruno, Marco

2017-03-01

There have been substantial improvements in the management of chronic pancreatitis, leading to the publication of several national guidelines during recent years. In collaboration with United European Gastroenterology, the working group on 'Harmonizing diagnosis and treatment of chronic pancreatitis across Europe' (HaPanEU) developed these European guidelines using an evidence-based approach. Twelve multidisciplinary review groups performed systematic literature reviews to answer 101 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation system and the answers were assessed by the entire group in a Delphi process online. The review groups presented their recommendations during the 2015 annual meeting of United European Gastroenterology. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting (Test and Evaluation Directorate). After a final round of adjustments based on these comments, a draft version was sent out to external reviewers. The 101 recommendations covered 12 topics related to the clinical management of chronic pancreatitis: aetiology (working party (WP)1), diagnosis of chronic pancreatitis with imaging (WP2 and WP3), diagnosis of pancreatic exocrine insufficiency (WP4), surgery in chronic pancreatitis (WP5), medical therapy (WP6), endoscopic therapy (WP7), treatment of pancreatic pseudocysts (WP8), pancreatic pain (WP9), nutrition and malnutrition (WP10), diabetes mellitus (WP11) and the natural course of the disease and quality of life (WP12). Using the Grading of Recommendations Assessment, Development and Evaluation system, 70 of the 101 (70%) recommendations were rated as 'strong' and plenary voting revealed 'strong agreement' for 99 (98%) recommendations. The 2016 HaPanEU/United European Gastroenterology guidelines provide evidence-based recommendations concerning key aspects of the medical and surgical management of chronic pancreatitis based on current available evidence. These recommendations should serve as a reference standard for existing management of the disease and as a guide for future clinical research.

Developing an evidence-based Guide to Community Preventive Services--methods. The Task Force on Community Preventive Services.

PubMed

Briss, P A; Zaza, S; Pappaioanou, M; Fielding, J; Wright-De Agüero, L; Truman, B I; Hopkins, D P; Mullen, P D; Thompson, R S; Woolf, S H; Carande-Kulis, V G; Anderson, L; Hinman, A R; McQueen, D V; Teutsch, S M; Harris, J R

2000-01-01

Systematic reviews and evidence-based recommendations are increasingly important for decision making in health and medicine. Over the past 20 years, information on the science of synthesizing research results has exploded. However, some approaches to systematic reviews of the effectiveness of clinical preventive services and medical care may be less appropriate for evaluating population-based interventions. Furthermore, methods for linking evidence to recommendations are less well developed than methods for synthesizing evidence. The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) will evaluate and make recommendations on population-based and public health interventions. This paper provides an overview of the Guide's process to systematically review evidence and translate that evidence into recommendations. The Guide reviews evidence on effectiveness, the applicability of effectiveness data, (i.e., the extent to which available effectiveness data is thought to apply to additional populations and settings), the intervention's other effects (i.e., important side effects), economic impact, and barriers to implementation of interventions. The steps for obtaining and evaluating evidence into recommendations involve: (1) forming multidisciplinary chapter development teams, (2) developing a conceptual approach to organizing, grouping, selecting and evaluating the interventions in each chapter; (3) selecting interventions to be evaluated; (4) searching for and retrieving evidence; (5) assessing the quality of and summarizing the body of evidence of effectiveness; (6) translating the body of evidence of effectiveness into recommendations; (7) considering information on evidence other than effectiveness; and (8) identifying and summarizing research gaps. Systematic reviews of and evidence-based recommendations for population-health interventions are challenging and methods will continue to evolve. However, using an evidence-based approach to identify and recommend effective interventions directed at specific public health goals may reduce errors in how information is collected and interpreted, identify important gaps in current knowledge thus guiding further research, and enhance the Guide users' ability to assess whether recommendations are valid and prudent from their own perspectives. Over time, all of these advantages could help to increase agreement regarding appropriate community health strategies and help to increase their implementation.

Improving the adaptability of WHO evidence-informed guidelines for nutrition actions: results of a mixed methods evaluation.

PubMed

Dedios, Maria Cecilia; Esperato, Alexo; De-Regil, Luz Maria; Peña-Rosas, Juan Pablo; Norris, Susan L

2017-03-21

Over the past decade, the World Health Organization (WHO) has implemented a standardized, evidence-informed guideline development process to assure technically sound and policy-relevant guidelines. This study is an independent evaluation of the adaptability of the guidelines produced by the Evidence and Programme Guidance unit, at the Department of Nutrition for Health and Development (NHD). The study systematizes the lessons learned by the NHD group at WHO. We used a mixed methods approach to determine the adaptability of the nutrition guidelines. Adaptability was defined as having two components; methodological quality and implementability of guidelines. Additionally, we gathered recommendations to improve future guideline development in nutrition actions for health and development. Data sources for this evaluation were official documentation and feedback (both qualitative and quantitative) from key stakeholders involved in the development of nutrition guidelines. The qualitative data was collected through a desk review and two waves of semi-structured interviews (n = 12) and was analyzed through axial coding. Guideline adaptability was assessed quantitatively using two standardized instruments completed by key stakeholders. The Appraisal Guideline for Research and Evaluation questionnaire, version II was used to assess guideline quality (n = 6), while implementability was assessed with the electronic version of the GuideLine Implementability Appraisal (n = 7). The nutrition evidence-informed guideline development process has several strengths, among them are the appropriate management of conflicts of interest of guideline developers and the systematic use of high-quality evidence to inform the recommendations. These features contribute to increase the methodological quality of the guidelines. The key areas for improvement are the limited implementability of the recommendations, the lack of explicit and precise implementation advice in the guidelines and challenges related to collaborative work within interdisciplinary groups. Overall, our study found that the nutrition evidence-informed guidelines are of good methodological quality but that the implementability requires improvement. The recommendations to improve guideline adaptability address the guideline content, the dynamics shaping interdisciplinary work, and actions for implementation feasibility. As WHO relies heavily on a standardized procedure to develop guidelines, the lessons learned may be applicable to guideline development across the organization and to other groups developing guidelines.

Development of water quality standards criteria. [for consumables (spacecrew supplies)

NASA Technical Reports Server (NTRS)

1976-01-01

Qualitative and semiquantitative analyses were made of volatile organic compounds in water supplies collected at various stages of processing in the space station prototype vacuum compression distillation unit to evaluate the process and the product water. Additional evaluation was made of specific ingredients required to adequately enhance the taste of the reclaimed water. A concept for the in-flight addition of these ingredients was developed. Revisions to previously recommended potable water criteria and specifications are included.

Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology.

PubMed

Basch, Ethan; Abernethy, Amy P; Mullins, C Daniel; Reeve, Bryce B; Smith, Mary Lou; Coons, Stephen Joel; Sloan, Jeff; Wenzel, Keith; Chauhan, Cynthia; Eppard, Wayland; Frank, Elizabeth S; Lipscomb, Joseph; Raymond, Stephen A; Spencer, Merianne; Tunis, Sean

2012-12-01

Examining the patient's subjective experience in prospective clinical comparative effectiveness research (CER) of oncology treatments or process interventions is essential for informing decision making. Patient-reported outcome (PRO) measures are the standard tools for directly eliciting the patient experience. There are currently no widely accepted standards for developing or implementing PRO measures in CER. Recommendations for the design and implementation of PRO measures in CER were developed via a standardized process including multistakeholder interviews, a technical working group, and public comments. Key recommendations are to include assessment of patient-reported symptoms as well as health-related quality of life in all prospective clinical CER studies in adult oncology; to identify symptoms relevant to a particular study population and context based on literature review and/or qualitative and quantitative methods; to assure that PRO measures used are valid, reliable, and sensitive in a comparable population (measures particularly recommended include EORTC QLQ-C30, FACT, MDASI, PRO-CTCAE, and PROMIS); to collect PRO data electronically whenever possible; to employ methods that minimize missing patient reports and include a plan for analyzing and reporting missing PRO data; to report the proportion of responders and cumulative distribution of responses in addition to mean changes in scores; and to publish results of PRO analyses simultaneously with other clinical outcomes. Twelve core symptoms are recommended for consideration in studies in advanced or metastatic cancers. Adherence to methodologic standards for the selection, implementation, and analysis/reporting of PRO measures will lead to an understanding of the patient experience that informs better decisions by patients, providers, regulators, and payers.

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

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

Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium

PubMed Central

van Dorp, Wendy; Mulder, Renée L.; Kremer, Leontien C.M.; Hudson, Melissa M.; van den Heuvel-Eibrink, Marry M.; van den Berg, Marleen H.; Levine, Jennifer M.; van Dulmen-den Broeder, Eline; di Iorgi, Natascia; Albanese, Assunta; Armenian, Saro H.; Bhatia, Smita; Constine, Louis S.; Corrias, Andreas; Deans, Rebecca; Dirksen, Uta; Gracia, Clarisa R.; Hjorth, Lars; Kroon, Leah; Lambalk, Cornelis B.; Landier, Wendy; Levitt, Gill; Leiper, Alison; Meacham, Lillian; Mussa, Alesandro; Neggers, Sebastian J.; Oeffinger, Kevin C.; Revelli, Alberto; van Santen, Hanneke M.; Skinner, Roderick; Toogood, Andrew; Haupt, Riccardo

2016-01-01

Purpose Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors’ access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening. Patients and Methods The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer. Results and Conclusion The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer. PMID:27458300

Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium.

PubMed

van Dorp, Wendy; Mulder, Renée L; Kremer, Leontien C M; Hudson, Melissa M; van den Heuvel-Eibrink, Marry M; van den Berg, Marleen H; Levine, Jennifer M; van Dulmen-den Broeder, Eline; di Iorgi, Natascia; Albanese, Assunta; Armenian, Saro H; Bhatia, Smita; Constine, Louis S; Corrias, Andreas; Deans, Rebecca; Dirksen, Uta; Gracia, Clarisa R; Hjorth, Lars; Kroon, Leah; Lambalk, Cornelis B; Landier, Wendy; Levitt, Gill; Leiper, Alison; Meacham, Lillian; Mussa, Alesandro; Neggers, Sebastian J; Oeffinger, Kevin C; Revelli, Alberto; van Santen, Hanneke M; Skinner, Roderick; Toogood, Andrew; Wallace, William H; Haupt, Riccardo

2016-10-01

Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors' access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening. The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer. The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer. © 2016 by American Society of Clinical Oncology.

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.

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

Developing and Evaluating the GriefLink Web Site: Processes, Protocols, Dilemmas and Lessons Learned

ERIC Educational Resources Information Center

Clark, Sheila; Burgess, Teresa; Laven, Gillian; Bull, Michael; Marker, Julie; Browne, Eric

2004-01-01

Despite a profusion of recommendations regarding the quality of web sites and guidelines related to ethical issues surrounding health-related sites, there is little guidance for the design and evaluation of sites relating to loss and grief. This article, which addresses these deficiencies, results from a community consultation process of designing…

Context Aware Recommendations in the Course Enrolment Process Based on Curriculum Guidelines

ERIC Educational Resources Information Center

Ajanovski, Vangel V.

2013-01-01

This research is a part of an ongoing project for development of an integrated student information system, aiming to incorporate self-adaptivity, personalization and social navigation, both in the overall management of university processes, and throughout the course work. In this paper the focus is on the advancement of the existing course…

Miniaturized Power Processing Unit Study: A Cubesat Electric Propulsion Technology Enabler Project

NASA Technical Reports Server (NTRS)

Ghassemieh, Shakib M.

2014-01-01

This study evaluates High Voltage Power Processing Unit (PPU) technology and driving requirements necessary to enable the Microfluidic Electric Propulsion technology research and development by NASA and university partners. This study provides an overview of the state of the art PPU technology with recommendations for technology demonstration projects and missions for NASA to pursue.

36 CFR § 1237.26 - What materials and processes must agencies use to create audiovisual records?

Code of Federal Regulations, 2013 CFR

2013-07-01

... recommendations. (3) If using reversal type processing, require full photographic reversal; i.e., develop, bleach...-digital or scanned digital images that are scheduled as permanent or unscheduled, a record (or master) version of each image must be comparable in quality to a 35 mm film photograph or better, and must be...

Building Student-Centered Web Sites in the K12 Classroom.

ERIC Educational Resources Information Center

Hall, Alison; Basile, Brigitte

This paper examines the process of constructing a student-centered World Wide Web site and provides recommendations for improving this process. In the project, preservice teachers instructed the fifth grade students about how to design and develop a Web site on weather. The topics of the sessions included Internet ethics, using the Web,…

Engaging Teachers in the School Improvement Process. Turning Points: Recommendations into Action.

ERIC Educational Resources Information Center

Painter, Bryan; Valentine, Jerry

This publication is the second in a series of monographs developed as a resource for middle-level leaders. It presents case studies at three fictional schools to show variations in improvement efforts and to examine faculty members' participation in the process. The teachers at one school were informed about change initiatives but were never…

Systematic Barriers to Schooling of Migrant Workers' Children and Policy Recommendations

ERIC Educational Resources Information Center

Wang, Zhichao

2009-01-01

A population of migrant workers have appearing during the process of China's urbanization, and is an important part of the society that cannot be ignored. In the process of integration into cities, the equal development between the rights and obligations of migrant workers is gaining attention. Especially, the issue of schooling of their children…

Solutions for acceleration measurement in vehicle crash tests

NASA Astrophysics Data System (ADS)

Dima, D. S.; Covaciu, D.

2017-10-01

Crash tests are useful for validating computer simulations of road traffic accidents. One of the most important parameters measured is the acceleration. The evolution of acceleration versus time, during a crash test, form a crash pulse. The correctness of the crash pulse determination depends on the data acquisition system used. Recommendations regarding the instrumentation for impact tests are given in standards, which are focused on the use of accelerometers as impact sensors. The goal of this paper is to present the device and software developed by authors for data acquisition and processing. The system includes two accelerometers with different input ranges, a processing unit based on a 32-bit microcontroller and a data logging unit with SD card. Data collected on card, as text files, is processed with a dedicated software running on personal computers. The processing is based on diagrams and includes the digital filters recommended in standards.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stayner, L.T.; Meinhardt, T.; Hardin, B.

Under the Occupational Safety and Health, and Mine Safety and Health Acts, the National Institute for Occupational Safety and Health (NIOSH) is charged with development of recommended occupational safety and health standards, and with conducting research to support the development of these standards. Thus, NIOSH has been actively involved in the analysis of risk associated with occupational exposures, and in the development of research information that is critical for the risk assessment process. NIOSH research programs and other information resources relevant to the risk assessment process are described in this paper. Future needs for information resources are also discussed.

Mood as a resource in dealing with health recommendations: how mood affects information processing and acceptance of quit-smoking messages.

PubMed

Das, Enny; Vonkeman, Charlotte; Hartmann, Tilo

2012-01-01

An experimental study tested the effects of positive and negative mood on the processing and acceptance of health recommendations about smoking in an online experiment. It was hypothesised that positive mood would provide smokers with the resources to systematically process self-relevant health recommendations. One hundred and twenty-seven participants (smokers and non-smokers) read a message in which a quit smoking programme was recommended. Participants were randomly assigned to one of four conditions: positive versus negative mood, and strong versus weak arguments for the recommended action. Systematic message processing was inferred when participants were able to distinguish between high- and low-quality arguments, and by congruence between attitudes and behavioural intentions. Persuasion was measured by participant's attitudes towards smoking and the recommended action, and by their intentions to follow the action recommendation. As predicted, smokers systematically processed the health message only under positive mood conditions; non-smokers systematically processed the health message only under negative mood conditions. Moreover, smokers' attitudes towards the health message predicted intentions to quit smoking only under positive mood conditions. Findings suggest that positive mood may decrease defensive processing of self-relevant health information.

Development of a Washington State freight data system

DOT National Transportation Integrated Search

2007-08-01

This study identified freight data uses, needs, and gaps, both nationally and in the state of Washington. Specific recommendations for providing the needed data and data generating processes include the following: : Phase I: Identification of Dat...

Cochrane Qualitative and Implementation Methods Group guidance series-paper 4: methods for assessing evidence on intervention implementation.

PubMed

Cargo, Margaret; Harris, Janet; Pantoja, Tomas; Booth, Andrew; Harden, Angela; Hannes, Karin; Thomas, James; Flemming, Kate; Garside, Ruth; Noyes, Jane

2018-05-01

This article provides reviewers with guidance on methods for identifying and processing evidence to understand intervention implementation. Strategies, tools, and methods are applied to the systematic review process to illustrate how process and implementation can be addressed using quantitative, qualitative, and other sources of evidence (i.e., descriptive textual and nonempirical). Reviewers can take steps to navigate the heterogeneity and level of uncertainty present in the concepts, measures, and methods used to assess implementation. Activities can be undertaken in advance of a Cochrane quantitative review to develop program theory and logic models that situate implementation in the causal chain. Four search strategies are offered to retrieve process and implementation evidence. Recommendations are made for addressing rigor or risk of bias in process evaluation or implementation evidence. Strategies are recommended for locating and extracting data from primary studies. The basic logic is presented to assist reviewers to make initial review-level judgments about implementation failure and theory failure. Although strategies, tools, and methods can assist reviewers to address process and implementation using quantitative, qualitative, and other forms of evidence, few exemplar reviews exist. There is a need for further methodological development and trialing of proposed approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of an evidence-informed leisure time physical activity resource for adults with spinal cord injury: the SCI Get Fit Toolkit.

PubMed

Arbour-Nicitopoulos, K P; Martin Ginis, K A; Latimer-Cheung, A E; Bourne, C; Campbell, D; Cappe, S; Ginis, S; Hicks, A L; Pomerleau, P; Smith, K

2013-06-01

To systematically develop an evidence-informed leisure time physical activity (LTPA) resource for adults with spinal cord injury (SCI). Canada. The Appraisal of Guidelines, Research and Evaluation (AGREE) II protocol was used to develop a toolkit to teach and encourage adults with SCI how to make smart and informed choices about being physically active. A multidisciplinary expert panel appraised the evidence and generated specific recommendations for the content of the toolkit. Pilot testing was conducted to refine the toolkit's presentation. Recommendations emanating from the consultation process were that the toolkit be a brief, evidence-based resource that contains images of adults with tetraplegia and paraplegia, and links to more detailed online information. The content of the toolkit should include the physical activity guidelines (PAGs) for adults with SCI, activities tailored to manual and power chair users, the benefits of LTPA, and strategies to overcome common LTPA barriers for adults with SCI. The inclusion of action plans and safety tips was also recommended. These recommendations have resulted in the development of an evidence-informed LTPA resource to assist adults with SCI in meeting the PAGs. This toolkit will have important implications for consumers, health care professionals and policy makers for encouraging LTPA in the SCI community.

Exploration of developmental approaches to companion animal antimicrobials: providing for the unmet therapeutic needs of dogs and cats.

PubMed

Apley, M; Claxton, R; Davis, C; DeVeau, I; Donecker, J; Lucas, A; Neal, A; Papich, M

2010-04-01

The American Academy of Veterinary Pharmacology and Therapeutics (AAVPT) and the United States Pharmacopeia (USP) co-sponsored a workshop to explore approaches for developing companion animal antimicrobials. This workshop was developed in response to the shortage of antimicrobials labeled for dogs and cats, as there is a shortage of approved antimicrobials for the range of infectious diseases commonly treated in small animal practice. The objective of the workshop was to identify alternative approaches to data development to support new indications consistent with the unmet therapeutic needs of dogs and cats. The indications for currently approved antimicrobials do not reflect the broader range of infectious diseases that are commonly diagnosed and treated by the veterinarian. Therefore, the labels for these approved antimicrobials provide limited information to the veterinarian for appropriate therapeutic decision-making beyond the few indications listed. Industry, veterinary practice, and regulatory challenges to the development of new antimicrobial indications were discussed. The workshop resulted in short- and long-term recommendations. Short-term recommendations focus on the use of additional data considerations for product labeling. Long-term recommendations center on legislative or regulatory legal initiatives. The workshop recommendations will need collaboration from industry, academia, and regulatory authorities and a legal shift in the drug approval and availability processes.

Recommended techniques for effective maintainability. A continuous improvement initiative of the NASA Reliability and Maintainability Steering Committee

NASA Technical Reports Server (NTRS)

1994-01-01

This manual presents a series of recommended techniques that can increase overall operational effectiveness of both flight and ground based NASA systems. It provides a set of tools that minimizes risk associated with: (1) restoring failed functions (both ground and flight based); (2) conducting complex and highly visible maintenance operations; and (3) sustaining a technical capability to support the NASA mission using aging equipment or facilities. It considers (1) program management - key elements of an effective maintainability effort; (2) design and development - techniques that have benefited previous programs; (3) analysis and test - quantitative and qualitative analysis processes and testing techniques; and (4) operations and operational design techniques that address NASA field experience. This document is a valuable resource for continuous improvement ideas in executing the systems development process in accordance with the NASA 'better, faster, smaller, and cheaper' goal without compromising safety.

Implementing AORN recommended practices for product selection.

PubMed

Conrardy, Julie A

2012-06-01

This article focuses on the revised AORN "Recommended practices for product selection in perioperative practice settings." Hospitals and ambulatory surgery facilities should have protocols in place for product evaluation that includes a multidisciplinary team approach. The process for product evaluation and selection includes gathering information; establishing consistent requirements for product evaluation; performing a financial impact analysis; investigating a plan to standardize products; conducting an environmental impact analysis; determining whether to purchase single-use, reposable, or reusable products or reprocess single-use devices; developing an evaluation process based on objective criteria; and developing and implementing a comprehensive plan to introduce and use new products. Use of an evaluation tool that is based on objective criteria is one way to obtain valuable input during product evaluations. Because of varied roles and experiences, the perioperative RN is an integral member of the product selection committee. Published by Elsevier Inc.

The coaching process: an effective tool for professional development.

PubMed

Kowalski, Karren; Casper, Colleen

2007-01-01

A model for coaching in nursing is described. Criteria for selecting a coach are discussed. Competencies for a coach are recommended. In addition, guidelines for caching sessions are provided as well as an example of an action plan outline to help the coachee identify areas of desired growth and options for developing these areas.

Analysis of rocket engine injection combustion processes

NASA Technical Reports Server (NTRS)

Salmon, J. W.; Saltzman, D. H.

1977-01-01

Mixing methodology improvement for the JANNAF DER and CICM injection/combustion analysis computer programs was accomplished. ZOM plane prediction model development was improved for installation into the new standardized DER computer program. An intra-element mixing model developing approach was recommended for gas/liquid coaxial injection elements for possible future incorporation into the CICM computer program.

The Extra Strand of the Maori Science Curriculum

ERIC Educational Resources Information Center

Stewart, Georgina

2011-01-01

This paper comments on the process of re-development of the Maori-medium Science (Putaiao) curriculum, as part of overall curriculum development in Aotearoa New Zealand. A significant difference from the English Science curriculum was the addition of an "extra strand" covering the history and philosophy of science. It is recommended that…

Embedding Marketing in International Campus Development: Lessons from UK Universities

ERIC Educational Resources Information Center

Lewis, Vicky

2016-01-01

This paper provides recommendations for embedding a market- and marketing-informed approach within the development process for a new international campus. It includes a brief outline of the current global profile of international campuses (as one form of transnational education) before highlighting the role of marketing at key stages of campus…

77 FR 37387 - New England Fishery Management Council; Northeast Multispecies Fishery; Notice of Intent to...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

... and Prudent Alternatives (RPAs) to avert survival jeopardy, or Reasonable and Prudent Measures (RPMs... necessary to develop and implement either RPAs or RPMs following completion of NMFS's Section 7 consultation... will recommend RPAs or RPMs. These may include a process to develop and put in place mitigation...

Vaccination policies and programs: the federal government's role in making the system work.

PubMed

Schwartz, B; Orenstein, W A

2001-12-01

Government agencies play a key role, from preclinical development to postlicensure monitoring, in making vaccinations one of the leading public health interventions. Important steps in this process include development and testing of vaccine antigens, evaluation of clinical and manufacturing data leading to licensure, formulation of recommendations, vaccine purchase, defining strategies to improve coverage, compensation of those injured by vaccine adverse reactions, and monitoring vaccine impact and safety. Using examples of newly recommended vaccines, this article describes the infrastructure that underlies a safe and effective program and highlights some of the opportunities and threats likely to impact the system in coming years.

Narratives of change and reform processes: global and local transactions in French psychiatric hospital reform after the Second World War.

PubMed

Henckes, Nicolas

2009-02-01

As with the rest of biomedicine, psychiatry has, since the Second World War, developed under the strong influence of the transnational accumulation of a whole series of practices and knowledge. Anthropology has taught us to pay attention to the transactions between local-level actors and those operating at the global level in the construction of this new world of medicine. This article examines the role played by the recommendations of the WHO Expert Committee of Mental Health in the reform of the French mental health system during the 1950s. Rooted in the experience of practitioners and administrators participating in the process of reforming local psychiatric systems, the recommendations of the WHO Expert Committee developed a new vision of regulating psychiatry, based on professionalism and an idea of a normativity of the doctor-patient relation. This article shows how, by mobilizing the WHO reports' recommendations, French administrators and doctors succeeded in creating a typically French object: "the psychiatric sector", founded on elaborating a new mandate for the psychiatric profession. The article thus questions the deinstitutionalization model as an explanation of transformations of the structure of the French psychiatry system in the post-war period.

Development of independent MU/treatment time verification algorithm for non-IMRT treatment planning: A clinical experience

NASA Astrophysics Data System (ADS)

Tatli, Hamza; Yucel, Derya; Yilmaz, Sercan; Fayda, Merdan

2018-02-01

The aim of this study is to develop an algorithm for independent MU/treatment time (TT) verification for non-IMRT treatment plans, as a part of QA program to ensure treatment delivery accuracy. Two radiotherapy delivery units and their treatment planning systems (TPS) were commissioned in Liv Hospital Radiation Medicine Center, Tbilisi, Georgia. Beam data were collected according to vendors' collection guidelines, and AAPM reports recommendations, and processed by Microsoft Excel during in-house algorithm development. The algorithm is designed and optimized for calculating SSD and SAD treatment plans, based on AAPM TG114 dose calculation recommendations, coded and embedded in MS Excel spreadsheet, as a preliminary verification algorithm (VA). Treatment verification plans were created by TPSs based on IAEA TRS 430 recommendations, also calculated by VA, and point measurements were collected by solid water phantom, and compared. Study showed that, in-house VA can be used for non-IMRT plans MU/TT verifications.

Ethical practice in Telehealth and Telemedicine.

PubMed

Chaet, Danielle; Clearfield, Ron; Sabin, James E; Skimming, Kathryn

2017-10-01

This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).

Developing Federal Clinical Care Recommendations for Women.

PubMed

Godfrey, Emily M; Tepper, Naomi K; Curtis, Kathryn M; Moskosky, Susan B; Gavin, Loretta E

2015-08-01

The provision of family planning services has important health benefits for the U.S. Approximately 25 million women in the U.S. receive contraceptive services annually and 44 million make at least one family planning-related clinical visit each year. These services are provided by private clinicians, as well as publicly funded clinics, including specialty family planning clinics, health departments, Planned Parenthoods, community health centers, and primary care clinics. Recommendations for providing quality family planning services have been published by CDC and the Office of Population Affairs of the DHHS. This paper describes the process used to develop the women's clinical services portion of the new recommendations and the rationale underpinning them. The recommendations define family planning services as contraceptive care, pregnancy testing and counseling, achieving pregnancy, basic infertility care, sexually transmitted disease services, and preconception health. Because many women who seek family planning services have no other source of care, the recommendations also include additional screening services related to women's health, such as cervical cancer screening. These clinical guidelines are aimed at providing the highest-quality care and are designed to establish a national standard for family planning in the U.S. Published by Elsevier Inc.

A survey of tobacco dependence treatment guidelines in 121 countries

PubMed Central

Piné-Abata, Hembadoon; McNeill, Ann; Raw, Martin; Bitton, Asaf; Rigotti, Nancy; Murray, Rachael

2013-01-01

Aims To report progress among Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in developing national tobacco treatment guidelines in accordance with FCTC Article 14 guideline recommendations. Design Cross-sectional study. Setting Electronic survey from December 2011 to August 2012; participants were asked to complete either an online or attached Microsoft Word questionnaire. Participants One hundred and sixty-three of the 173 Parties to the FCTC at the time of our survey. Measurements The 51-item questionnaire contained 30 items specifically on guidelines. Questions covered the areas of guidelines writing process, content, key recommendations and other characteristics. Findings One hundred and twenty-one countries (73%) responded. Fifty-three countries (44%) had guidelines, ranging from 75% among high-income countries to 11% among low-income countries. Nearly all guidelines recommended brief advice (93%), intensive specialist support (93%) and medications (96%), while 66% recommended quitlines. Fifty-seven percent had a dissemination strategy, 76% stated funding source and 68% had professional endorsement. Conclusion Fewer than half of the Parties to the WHO FCTC have developed national tobacco treatment guidelines, but, where guidelines exist, they broadly follow FCTC Article 14 guideline recommendations. PMID:23437892

Assessing and Managing Multiple Risks in a Changing World ...

EPA Pesticide Factsheets

Roskilde University hosted a November 2015 workshop on “Environmental Risk – Assessing and Managing Multiple Risks in a Changing World”. Thirty attendees from 9 countries developed consensus recommendations regarding: implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process involving both universal and site-, region-, or problem-specific protection goals; addressing societal issues; risk management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. We encourage both cross- and inter-disciplinary approaches to address 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and non-chemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk assessment process; 4) fully integrate risk assessors and communities of interest into the risk management process; 5) consider socio-economics and increase transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference con

Research in software allocation for advanced manned mission communications and tracking systems

NASA Technical Reports Server (NTRS)

Warnagiris, Tom; Wolff, Bill; Kusmanoff, Antone

1990-01-01

An assessment of the planned processing hardware and software/firmware for the Communications and Tracking System of the Space Station Freedom (SSF) was performed. The intent of the assessment was to determine the optimum distribution of software/firmware in the processing hardware for maximum throughput with minimum required memory. As a product of the assessment process an assessment methodology was to be developed that could be used for similar assessments of future manned spacecraft system designs. The assessment process was hampered by changing requirements for the Space Station. As a result, the initial objective of determining the optimum software/firmware allocation was not fulfilled, but several useful conclusions and recommendations resulted from the assessment. It was concluded that the assessment process would not be completely successful for a system with changing requirements. It was also concluded that memory requirements and hardware requirements were being modified to fit as a consequence of the change process, and although throughput could not be quantitized, potential problem areas could be identified. Finally, inherent flexibility of the system design was essential for the success of a system design with changing requirements. Recommendations resulting from the assessment included development of common software for some embedded controller functions, reduction of embedded processor requirements by hardwiring some Orbital Replacement Units (ORUs) to make better use of processor capabilities, and improvement in communications between software development personnel to enhance the integration process. Lastly, a critical observation was made regarding the software integration tasks did not appear to be addressed in the design process to the degree necessary for successful satisfaction of the system requirements.

National workshop on core competencies for success in the veterinary profession.

PubMed

Lloyd, James W; King, Lonnie J; Klausner, Jeffrey S; Harris, Donna

2003-01-01

A workshop was designed to (1) present results of the Core Competencies for Veterinary Medicine project conducted by Personnel Decisions International (PDI); (2) discuss and analyze the implications of the PDI study results for academia, private practice, and industry; (3) identify actionable items-discuss opportunities and barriers; and (4) develop appropriate recommendations-devise specific actions for implementation as next steps. In total, 25 veterinary colleges were represented at the workshop and a total of 110 attendees participated, a broad cross-section of the veterinary profession (both academic and non-academic). Through an orchestrated combination of general sessions and facilitated, small group discussions, prioritized recommendations for implementation and initial action plans for next steps were developed. Recommendations included publicizing results of the PDI study, reconsidering current admissions policies and processes, evaluating the applicant pool and current recruitment programs, developing structured mentoring programs, enhancing DVM/VMD training programs, coordinating the development of continuing education programs, and overcoming existing barriers to change. Next steps should involve collaborative efforts across all sectors of the veterinary profession to develop plans for implementing the workshop's recommendations. Leadership for follow-up might reasonably come from the Association of American Veterinary Medical Colleges (AAVMC), the American Veterinary Medical Association (AVMA), and the American Animal Hospital Association (AAHA), either individually or collectively, through the National Commission on Veterinary Economic Issues (NCVEI). Partnerships with industry are also possible and should be strongly considered.

Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder.

PubMed

2015-12-01

Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment.

EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis.

PubMed

Yates, M; Watts, R A; Bajema, I M; Cid, M C; Crestani, B; Hauser, T; Hellmich, B; Holle, J U; Laudien, M; Little, M A; Luqmani, R A; Mahr, A; Merkel, P A; Mills, J; Mooney, J; Segelmark, M; Tesar, V; Westman, K; Vaglio, A; Yalçındağ, N; Jayne, D R; Mukhtyar, C

2016-09-01

In this article, the 2009 European League Against Rheumatism (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have been updated. The 2009 recommendations were on the management of primary small and medium vessel vasculitis. The 2015 update has been developed by an international task force representing EULAR, the European Renal Association and the European Vasculitis Society (EUVAS). The recommendations are based upon evidence from systematic literature reviews, as well as expert opinion where appropriate. The evidence presented was discussed and summarised by the experts in the course of a consensus-finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) determined. In addition to the voting by the task force members, the relevance of the recommendations was assessed by an online voting survey among members of EUVAS. Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients. More specific items relate to starting immunosuppressive therapy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance; for remission induction in life-threatening or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy; plasma exchange which is recommended, where licensed, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

WHO policy development processes for a new vaccine: case study of malaria vaccines.

PubMed

Milstien, Julie; Cárdenas, Vicky; Cheyne, James; Brooks, Alan

2010-06-24

Recommendations from the World Health Organization (WHO) are crucial to inform developing country decisions to use, or not, a new intervention. This article analysed the WHO policy development process to predict its course for a malaria vaccine. The decision-making processes for one malaria intervention and four vaccines were classified through (1) consultations with staff and expert advisors to WHO's Global Malaria Programme (GMP) and Immunization, Vaccines and Biologicals Department (IVB); (2) analysis of the procedures and recommendations of the major policy-making bodies of these groups; (3) interviews with staff of partnerships working toward new vaccine availability; and (4) review and analyses of evidence informing key policy decisions. WHO policy formulation related to use of intermittent preventive treatment in infancy (IPTi) and the following vaccine interventions: Haemophilus influenzae type b conjugate vaccine (Hib), pneumococcal conjugate vaccine (PCV), rotavirus vaccine (RV), and human papillomavirus vaccine (HPV), five interventions which had relatively recently been through systematic WHO policy development processes as currently constituted, was analysed. Required information was categorized in three areas defined by a recent WHO publication on development of guidelines: safety and efficacy in relevant populations, implications for costs and population health, and localization of data to specific epidemiological situations. Data needs for a malaria vaccine include safety; the demonstration of efficacy in a range of epidemiological settings in the context of other malaria prevention interventions; and information on potential rebound in which disease increases subsequent to the intervention. In addition, a malaria vaccine would require attention to additional factors, such as costs and cost-effectiveness, supply and demand, impact of use on other interventions, and distribution issues. Although policy issues may be more complex for future vaccines, the lead-time between the date of product regulatory approval and a recommendation for its use in developing countries is decreasing. This study presents approaches to define in advance core data needs to support evidence-based decisions, to further decrease this lead-time, accelerating the availability of a malaria vaccine. Specific policy areas for which information should be collected are defined, including studying its use within the context of other malaria interventions.

Robot welding process control

NASA Technical Reports Server (NTRS)

Romine, Peter L.

1991-01-01

This final report documents the development and installation of software and hardware for Robotic Welding Process Control. Primary emphasis is on serial communications between the CYRO 750 robotic welder, Heurikon minicomputer running Hunter & Ready VRTX, and an IBM PC/AT, for offline programming and control and closed-loop welding control. The requirements for completion of the implementation of the Rocketdyne weld tracking control are discussed. The procedure for downloading programs from the Intergraph, over the network, is discussed. Conclusions are made on the results of this task, and recommendations are made for efficient implementation of communications, weld process control development, and advanced process control procedures using the Heurikon.

High adherence to the ‘Wise List’ treatment recommendations in Stockholm: a 15-year retrospective review of a multifaceted approach promoting rational use of medicines

PubMed Central

Gustafsson, Lars L; Ateva, Kristina; Bastholm-Rahmner, Pia; Ovesjö, Marie-Louise; Jirlow, Malena; Juhasz-Haverinen, Maria; Lärfars, Gerd; Malmström, Rickard E; Wettermark, Björn; Andersén-Karlsson, Eva

2017-01-01

Objectives To present the ‘Wise List’ (a formulary of essential medicines for primary and specialised care in Stockholm Healthcare Region) and assess adherence to the recommendations over a 15-year period. Design Retrospective analysis of all prescription data in the Stockholm Healthcare Region between 2000 and 2015 in relation to the Wise List recommendations during the same time period. Setting All outpatient care in the Stockholm Healthcare Region. Participants All prescribers in the Stockholm Healthcare Region. Main outcome measures The number of core and complementary substances included in the Wise List, the adherence to recommendations by Anatomic Therapeutic Chemical (ATC) 1st level using defined daily doses (DDDs) adjusted to the DDD for 2015, adherence to recommendations over time measured by dispensed prescriptions yearly between 2002 and 2015. Results The number of recommended core substances was stable (175–212). Overall adherence to the recommendations for core medicines for all prescribers increased from 75% to 84% (2000 to 2015). The adherence to recommendations in primary care for core medicines increased from 80% to 90% (2005 to 2015) with decreasing range in practice variation (32% to 13%). Hospital prescriber adherence to core medicine recommendations was stable but increased for the combination core and complementary medicines from 77% to 88% (2007 to 2015). Adherence varied between the 4 therapeutic areas studied. Conclusions High and increasing adherence to the Wise List recommendations was seen for all prescriber categories. The transparent process for developing recommendations involving respected experts and clinicians using strict criteria for handling potential conflicts of interests, feedback to prescribers, continuous medical education and financial incentives are possible contributing factors. High-quality evidence-based recommendations to prescribers, such as the Wise List, disseminated through a multifaceted approach, will become increasingly important and should be developed further to include recommendations and introduction protocols for new expensive medicines. PMID:28465306

Clinical practice guidelines for the management of patients with endometrial cancer in France: recommendations of the Institut National du Cancer and the Société Française d'Oncologie Gynécologique.

PubMed

Querleu, Denis; Planchamp, François; Narducci, Fabrice; Morice, Philippe; Joly, Florence; Genestie, Catherine; Haie-Meder, Christine; Thomas, Laurence; Quénel-Tueux, Nathalie; Daraï, Emile; Dorangeon, Pierre-Hervé; Marret, Henri; Taïeb, Sophie; Mazeau-Woynar, Valérie

2011-07-01

Endometrial cancer is the most common gynecological malignancy in France, with more than 6500 new cases in 2010. The French National Cancer Institute has been leading a clinical practice guidelines (CPG) project since 2008. This project involves the development and updating of evidence-based CPG in oncology. To develop CPG for diagnosis, treatment, and follow-up for patients with endometrial cancer. The guideline development process is based on systematic literature review and critical appraisal by experts, with feedback from specialists in cancer care delivery. The recommendations are thus based on the best available evidence and expert agreement. Main recommendations include a routine pelvic magnetic resonance imaging in association with magnetic resonance imaging exploration of the para-aortic lymph nodes for locoregional staging, surgical treatment based on total hysterectomy with bilateral salpingo-oophorectomy with or without lymphadenectomy, and clinical examination for the follow-up. The initial laparoscopic surgical approach is recommended for stage I tumors. Lymphadenectomy and postoperative external radiotherapy are recommended for patients with high risk of recurrence but are restricted for patients with low or intermediate risk. If brachytherapy is indicated, it should be given at a high-dose rate rather than a low-dose rate. Routine imaging, biologic tests, and vaginal smears are not indicated for follow-up.

On the problem of zinc extraction from the slags of lead heat

NASA Astrophysics Data System (ADS)

Kozyrev, V. V.; Besser, A. D.; Paretskii, V. M.

2013-12-01

The possibilities of zinc extraction from the slags of lead heat are studied as applied to the ZAO Karat-TsM lead plant to be built for processing ore lead concentrates. The process of zinc extraction into commercial fumes using the technology of slag fuming by natural gas developed in Gintsvetmet is recommended for this purpose. Technological rules are developed for designing a commercial fuming plant, as applied to the conditions of the ZAO Karat-TsM plant.

A systematic collaborative process for assessing launch vehicle propulsion technologies

NASA Astrophysics Data System (ADS)

Odom, Pat R.

1999-01-01

A systematic, collaborative process for prioritizing candidate investments in space transportation systems technologies has been developed for the NASA Space Transportation Programs Office. The purpose of the process is to provide a repeatable and auditable basis for selecting technology investments to enable achievement of NASA's strategic space transportation objectives. The paper describes the current multilevel process and supporting software tool that has been developed. Technologies are prioritized across system applications to produce integrated portfolios for recommended funding. An example application of the process to the assessment of launch vehicle propulsion technologies is described and illustrated. The methodologies discussed in the paper are expected to help NASA and industry ensure maximum returns from technology investments under constrained budgets.

Welding process modelling and control

NASA Technical Reports Server (NTRS)

Romine, Peter L.; Adenwala, Jinen A.

1993-01-01

The research and analysis performed, and software developed, and hardware/software recommendations made during 1992 in development of the PC-based data acquisition system for support of Welding Process Modeling and Control is reported. A need was identified by the Metals Processing Branch of NASA Marshall Space Flight Center, for a mobile data aquisition and analysis system, customized for welding measurement and calibration. Several hardware configurations were evaluated and a PC-based system was chosen. The Welding Measurement System (WMS) is a dedicated instrument, strictly for the use of data aquisition and analysis. Although the WMS supports many of the functions associated with the process control, it is not the intention for this system to be used for welding process control.

75 FR 63888 - Occupational Information Development Advisory Panel Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-18

... independent advice and recommendations on plans and activities to replace the Dictionary of Occupational...: Medical and vocational analysis of disability claims; occupational analysis, including definitions... to our disability programs and improve the medical-vocational adjudication policies and processes...

US EPA Freedom of Information Act Workgroup Report: Prepared for Robert Perciasepe, Deputy Administrator

EPA Pesticide Factsheets

Deputy Administrator Robert Perciasepe requested a workgroup develop options and recommendations to ensure that the Agency’s administration of FOIA and related processes are effective, efficient and promote open government and transparency policies.

Alternate Models of Needs Assessment: Selecting the Right One for Your Organization.

ERIC Educational Resources Information Center

Leigh, Doug; Watkins, Ryan; Platt, William A.; Kaufman, Roger

2000-01-01

Defines needs assessment and compares different models in terms of levels (mega, macro, micro) and process and input. Recommends assessment of strengths and weakness of a model before using it in human resource development. (SK)

The development of a guideline implementability tool (GUIDE-IT): a qualitative study of family physician perspectives

PubMed Central

2014-01-01

Background The potential of clinical practice guidelines has not been realized due to inconsistent adoption in clinical practice. Optimising intrinsic characteristics of guidelines (e.g., its wording and format) that are associated with uptake (as perceived by their end users) may have potential. Using findings from a realist review on guideline uptake and consultation with experts in guideline development, we designed a conceptual version of a future tool called Guideline Implementability Tool (GUIDE-IT). The tool will aim to involve family physicians in the guideline development process by providing a process to assess draft guideline recommendations. This feedback will then be given back to developers to consider when finalizing the recommendations. As guideline characteristics are best assessed by end-users, the objectives of the current study were to explore how family physicians perceive guideline implementability, and to determine what components should comprise the final GUIDE-IT prototype. Methods We conducted a qualitative study with family physicians inToronto, Ontario. Two experienced investigators conducted one-hour interviews with family physicians using a semi-structured interview guide to 1) elicit feedback on perceptions on guideline implementability; 2) to generate a discussion in response to three draft recommendations; and 3) to provide feedback on the conceptual GUIDE-IT. Sessions were audio taped and transcribed verbatim. Data collection and analysis were guided by content analyses. Results 20 family physicians participated. They perceived guideline uptake according to facilitators and barriers across 6 categories of guideline implementability (format, content, language, usability, development, and the practice environment). Participants’ feedback on 3 draft guideline recommendations were grouped according to guideline perception, cognition, and agreement. When asked to comment on GUIDE-IT, most respondents believed that the tool would be useful, but urged to involve “regular” or community family physicians in the process, and suggested that an online system would be the most efficient way to deliver it. Conclusions Our study identified facilitators and barriers of guideline implementability from the perspective of community and academic family physicians that will be used to build our GUIDE-IT prototype. Our findings build on current knowledge by showing that family physicians perceive guideline uptake mostly according to factors that are in the control of guideline developers. PMID:24476491

Recommended approach to sofware development

NASA Technical Reports Server (NTRS)

Mcgarry, F. E.; Page, J.; Eslinger, S.; Church, V.; Merwarth, P.

1983-01-01

A set of guideline for an organized, disciplined approach to software development, based on data collected and studied for 46 flight dynamics software development projects. Methods and practices for each phase of a software development life cycle that starts with requirements analysis and ends with acceptance testing are described; maintenance and operation is not addressed. For each defined life cycle phase, guidelines for the development process and its management, and the products produced and their reviews are presented.

The Development of NASA's Fault Management Handbook

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Fesq, Lorraine M.; Barth, Timothy; Clark, Micah; Day, John; Fretz, Kristen; Friberg, Kenneth; Johnson, Stephen; Hattis, Philip; McComas, David;

Streamlining Software Aspects of Certification: Report on the SSAC Survey

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J.; Dorsey, Cheryl A.; Knight, John C.; Leveson, Nancy G.; McCormick, G. Frank

1999-01-01

The aviation system now depends on information technology more than ever before to ensure safety and efficiency. To address concerns about the efficacy of software aspects of the certification process, the Federal Aviation Administration (FAA) began the Streamlining Software Aspects of Certification (SSAC) program. The SSAC technical team was commissioned to gather data, analyze results, and propose recommendations to maximize efficiency and minimize cost and delay, without compromising safety. The technical team conducted two public workshops to identify and prioritize software approval issues, and conducted a survey to validate the most urgent of those issues. The SSAC survey, containing over two hundred questions about the FAA's software approval process, reached over four hundred industry software developers, aircraft manufacturers, and FAA designated engineering representatives. Three hundred people responded. This report presents the SSAC program rationale, survey process, preliminary findings, and recommendations.

NSF Perspective on Engaging the NRC and the Community in Developing Priorities

NASA Astrophysics Data System (ADS)

Wakimoto, R. M.

2015-12-01

NSF pursued a new strategy to assess the balance between funding for core research and infrastructure in a time of limited budgets in the Division of Ocean Sciences (OCE). The latter constraint uniquely distinguished this report from previous community attempts to define future research priorities. The process that ultimately led to "Sea Change: 2015-2025: Decadal Survey of Ocean Sciences" report was closely monitored by Congress, OMB/OSTP, the National Science Board, NSF Senior Management, and the community. The Sea Change recommendations were specific and difficult but highly strategic. They also recommended immediate implementation. NSF and GEO were pleased with the outcome of a process that was initially viewed with some trepidation. Additional thoughts on the report and the process will be presented as well as future plans to engage the NAS and community in defining research priorities.

Building an Australasian paramedicine research agenda: a narrative review.

PubMed

O'Meara, Peter; Maguire, Brian; Jennings, Paul; Simpson, Paul

2015-12-15

The need for paramedicine research has been recognised internationally through efforts to develop out-of-hospital research agendas in several developed countries. Australasia has a substantial paramedicine research capacity compared to the discipline internationally and is well positioned as a potential leader in the drive towards evidence-based policy and practice in paramedicine. Our objective was to draw on international experiences to identify and recommend the best methodological approach that should be employed to develop an Australasian paramedicine research agenda. A search and critical appraisal process was employed to produce an overview of the literature related to the development of paramedicine research agendas throughout the world. Based on these international experiences, and our own analysis of the Australasian context, we recommend that a mixed methods approach be used to develop an inclusive Australasian Paramedicine Research Agenda. This approach will capture the views and interests of a wide range of expert stakeholders through multiple data collection strategies, including interviews, roundtable discussions and an online Delphi consensus survey. Paramedic researchers and industry leaders have the opportunity to use this multidisciplinary process of inquiry to develop a paramedicine research agenda that will provide a framework for the development of a culture of open evaluation, innovation and improvement. This research agenda would assess the progress of paramedicine research in Australia and New Zealand, map the research capacity of the paramedicine discipline, paramedic services, universities and professional organisations, identify current strengths and opportunities, make recommendations to capitalize on opportunities, and identify research priorities. Success will depend on ensuring the participation of a representative sample of expert stakeholders, fostering an open and collaborative roundtable discussion, and adhering to a predefined approach to measure consensus on each topic.

[Implementation of a Clinical Practice Guidelines for the Management of Adults With Schizophrenia in Colombia].

PubMed

Sánchez Díaz, Natalia; Duarte Osorio, Andrés; Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia

2016-01-01

To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPC_E) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPC_E, and develop a monitoring and evaluation system for the key recommendations. The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. the conclusions and final adjustments were discussed with the GPC_E leaders. The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor and evaluate o the implementation process, five (5) indicators were designed one (1) structure, two (2) process and two (2)outcome indicators. The GPC_E implementation within the Colombian General health System of Social Security (SGSSSC) poses multiple challenges. Potential barriers, enabling strategies and indicators for monitoring and evaluation described in this article, can provide efficient support to ensure the success of this process in the institutions that will adopt the guideline. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Capital Improvements Programming: A Proposal for a Revised Process to Develop the Annual Capital Budget for the Orleans Parish School Board. Revised.

ERIC Educational Resources Information Center

Ducote, Kenneth J.

A study by the United States General Accounting Office found that successful organizations incorporate in their capital budgeting process extensive links between planning and budgeting, up-to-date information on existing capital facilities, and consideration of long-term effects in making capital budgeting decisions. This paper recommends the…

Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force

PubMed Central

Smolen, Josef S; Braun, Jürgen; Dougados, Maxime; Emery, Paul; FitzGerald, Oliver; Helliwell, Philip; Kavanaugh, Arthur; Kvien, Tore K; Landewé, Robert; Luger, Thomas; Mease, Philip; Olivieri, Ignazio; Reveille, John; Ritchlin, Christopher; Rudwaleit, Martin; Schoels, Monika; Sieper, Joachim; de Wit, Martinus; Baraliakos, Xenofon; Betteridge, Neil; Burgos-Vargas, Ruben; Collantes-Estevez, Eduardo; Deodhar, Atul; Elewaut, Dirk; Gossec, Laure; Jongkees, Merryn; Maccarone, Mara; Redlich, Kurt; van den Bosch, Filip; Wei, James Cheng-Chung; Winthrop, Kevin; van der Heijde, Désirée

2014-01-01

Background Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Objective To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. Methods Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. Results Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9–10 (10: maximum agreement) for all recommendations. A research agenda was formulated. Conclusions The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA. PMID:23749611

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

PubMed

Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuk; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

2017-03-01

To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

PubMed

Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuck; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

2017-03-01

To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Customizing for clients: developing a library liaison program from need to plan.

PubMed

Tennant, M R; Butson, L C; Rezeau, M E; Tucker, P J; Boyle, M E; Clayton, G

2001-01-01

Building on the experiences of librarian representatives to curriculum committees in the colleges of dentistry, medicine, and nursing, the Health Science Center Libraries (HSCL) Strategic Plan recommended the formation of a Library Liaison Work Group to create a formal Library Liaison Program to serve the six Health Science Center (HSC) colleges and several affiliated centers and institutes. The work group's charge was to define the purpose and scope of the program, identify models of best practice, and recommend activities for liaisons. The work group gathered background information, performed an environmental scan, and developed a philosophy statement, a program of liaison activities focusing on seven primary areas, and a forum for liaison communication. Hallmarks of the plan included intensive subject specialization (beyond collection development), extensive communication with users, and personal information services. Specialization was expected to promote competence, communication, confidence, comfort, and customization. Development of the program required close coordination with other strategic plan implementation teams, including teams for collection development, education, and marketing. This paper discusses the HSCL's planning process and the resulting Library Liaison Program. Although focusing on an academic health center, the planning process and liaison model may be applied to any library serving diverse, subject-specific user populations.

Customizing for clients: developing a library liaison program from need to plan*

PubMed Central

Tennant, Michele R.; Butson, Linda C.; Rezeau, Michelle E.; Tucker, Prudence J.; Boyle, Marian E.; Clayton, Greg

2001-01-01

Building on the experiences of librarian representatives to curriculum committees in the colleges of dentistry, medicine, and nursing, the Health Science Center Libraries (HSCL) Strategic Plan recommended the formation of a Library Liaison Work Group to create a formal Library Liaison Program to serve the six Health Science Center (HSC) colleges and several affiliated centers and institutes. The work group's charge was to define the purpose and scope of the program, identify models of best practice, and recommend activities for liaisons. The work group gathered background information, performed an environmental scan, and developed a philosophy statement, a program of liaison activities focusing on seven |primary areas, and a forum for liaison communication. Hallmarks of the plan included intensive subject specialization (beyond collection development), extensive communication with users, and personal information services. Specialization was expected to promote competence, communication, confidence, comfort, and customization. Development of the program required close coordination with other strategic plan implementation teams, including teams for collection development, education, and marketing. This paper discusses the HSCL's planning process and the resulting Library Liaison Program. Although focusing on an academic health center, the planning process and liaison model may be applied to any library serving diverse, subject-specific user populations. PMID:11209807

Best practice guidelines for stroke in Cameroon: An innovative and participatory knowledge translation project.

PubMed

Cockburn, Lynn; Fanfon, Timothy N; Bramall, Alexa; Ngole, Eta M; Kuwoh, Pius; Anjonga, Emmanuel; Difang, Brenda M E; Kiani, Shirin; Muso, Petra S; Trivedi, Navjyot; Sama, Julius; Teboh, Sylvian

2014-01-01

Although the adherence to stroke guidelines in high-income countries has been shown to be associated with improved patient outcomes, the research, development and implementation of rehabilitation related guidelines in African countries is lacking. The purpose of this article is to describe how a group of front-line practitioners collaborated with academics and students to develop best practice guidelines (BPG) for the management and rehabilitation of stroke in adult patients in Cameroon. A working group was established and adapted internationally recognised processes for the development of best practice guidelines. The group determined the scope of the guidelines, documented current practices, and critically appraised evidence to develop guidelines relevant to the Cameroon context. The primary result of this project is best practice guidelines which provided an overview of the provision of stroke rehabilitation services in the region, and made 83 practice recommendations to improve these services. We also report on the successes and challenges encountered during the process, and the working group's recommendations aimed at encouraging others to consider similar projects. This project demonstrated that there is interest and capacity for improving stroke rehabilitation practices and for stroke guideline development in Africa.

Recommendations for accreditation of laboratories in molecular biology of hematologic malignancies.

PubMed

Flandrin-Gresta, Pascale; Cornillet, Pascale; Hayette, Sandrine; Gachard, Nathalie; Tondeur, Sylvie; Mauté, Carole; Cayuela, Jean-Michel

2015-01-01

Over recent years, the development of molecular biology techniques has improved the hematological diseases diagnostic and follow-up. Consequently, these techniques are largely used in the biological screening of these diseases; therefore the Hemato-oncology molecular diagnostics laboratories must be actively involved in the accreditation process according the ISO 15189 standard. The French group of molecular biologists (GBMHM) provides requirements for the implementation of quality assurance for the medical molecular laboratories. This guideline states the recommendations for the pre-analytical, analytical (methods validation procedures, quality controls, reagents), and post-analytical conditions. In addition, herein we state a strategy for the internal quality control management. These recommendations will be regularly updated.

Sharing and reuse of individual participant data from clinical trials: principles and recommendations

PubMed Central

Ohmann, Christian; Banzi, Rita; Canham, Steve; Battaglia, Serena; Matei, Mihaela; Ariyo, Christopher; Becnel, Lauren; Bierer, Barbara; Bowers, Sarion; Clivio, Luca; Dias, Monica; Druml, Christiane; Faure, Hélène; Fenner, Martin; Galvez, Jose; Ghersi, Davina; Gluud, Christian; Houston, Paul; Karam, Ghassan; Kalra, Dipak; Krleža-Jerić, Karmela; Kubiak, Christine; Kuchinke, Wolfgang; Kush, Rebecca; Lukkarinen, Ari; Marques, Pedro Silverio; Newbigging, Andrew; O’Callaghan, Jennifer; Ravaud, Philippe; Schlünder, Irene; Shanahan, Daniel; Sitter, Helmut; Spalding, Dylan; Tudur-Smith, Catrin; van Reusel, Peter; van Veen, Evert-Ben; Visser, Gerben Rienk; Wilson, Julia; Demotes-Mainard, Jacques

2017-01-01

Objectives We examined major issues associated with sharing of individual clinical trial data and developed a consensus document on providing access to individual participant data from clinical trials, using a broad interdisciplinary approach. Design and methods This was a consensus-building process among the members of a multistakeholder task force, involving a wide range of experts (researchers, patient representatives, methodologists, information technology experts, and representatives from funders, infrastructures and standards development organisations). An independent facilitator supported the process using the nominal group technique. The consensus was reached in a series of three workshops held over 1 year, supported by exchange of documents and teleconferences within focused subgroups when needed. This work was set within the Horizon 2020-funded project CORBEL (Coordinated Research Infrastructures Building Enduring Life-science Services) and coordinated by the European Clinical Research Infrastructure Network. Thus, the focus was on non-commercial trials and the perspective mainly European. Outcome We developed principles and practical recommendations on how to share data from clinical trials. Results The task force reached consensus on 10 principles and 50 recommendations, representing the fundamental requirements of any framework used for the sharing of clinical trials data. The document covers the following main areas: making data sharing a reality (eg, cultural change, academic incentives, funding), consent for data sharing, protection of trial participants (eg, de-identification), data standards, rights, types and management of access (eg, data request and access models), data management and repositories, discoverability, and metadata. Conclusions The adoption of the recommendations in this document would help to promote and support data sharing and reuse among researchers, adequately inform trial participants and protect their rights, and provide effective and efficient systems for preparing, storing and accessing data. The recommendations now need to be implemented and tested in practice. Further work needs to be done to integrate these proposals with those from other geographical areas and other academic domains. PMID:29247106

PL-3, PHASE I, TASK 3, RESEARCH AND DEVELOPMENT REPORT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Humphries, G. E.

1962-03-12

Results of researeh and development tasks are presented along with recommendations for future development work Work (s reported ofn the areas of plant assembly and relocation, housings and footings, waste heat dissipation, instrumentation, refueling systems, waste disposal, shiceding, core nuclear thermal and hydraulic studies, gaseous waste processing, and critical experiments on a 5 x 5 array of Type 3 fuel elements. (auth)

A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone <20 mm in Diameter.

PubMed

Gökce, Mehmet İlker; Esen, Barış; Sancı, Adem; Akpınar, Cağrı; Süer, Evren; Gülpınar, Ömer

2017-07-01

Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones <20 mm in diameter. The DA development process was established based on the recommended guides. General characteristics of the stone disease and details of the shockwave lithotripsy and retrograde intrarenal surgery were included in the content of the DA. The DA was further revised based on the suggestions of different physician groups and patients. The DA was evaluated by three physicians (Delphi assessment-International Patient Decision Aid Standards [IPDAS] Collaboration standards) and 25 patients (questionnaire of six questions with five-point Likert scale). The DA was designed as a booklet, and Delphi group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

A Recommendation System to Facilitate Business Process Modeling.

PubMed

Deng, Shuiguang; Wang, Dongjing; Li, Ying; Cao, Bin; Yin, Jianwei; Wu, Zhaohui; Zhou, Mengchu

2017-06-01

This paper presents a system that utilizes process recommendation technology to help design new business processes from scratch in an efficient and accurate way. The proposed system consists of two phases: 1) offline mining and 2) online recommendation. At the first phase, it mines relations among activity nodes from existing processes in repository, and then stores the extracted relations as patterns in a database. At the second phase, it compares the new process under construction with the premined patterns, and recommends proper activity nodes of the most matching patterns to help build a new process. Specifically, there are three different online recommendation strategies in this system. Experiments on both real and synthetic datasets are conducted to compare the proposed approaches with the other state-of-the-art ones, and the results show that the proposed approaches outperform them in terms of accuracy and efficiency.

Developing dimensions for a multicomponent multidisciplinary approach to obesity management: a qualitative study.

PubMed

Cochrane, Anita J; Dick, Bob; King, Neil A; Hills, Andrew P; Kavanagh, David J

2017-10-16

There have been consistent recommendations for multicomponent and multidisciplinary approaches for obesity management. However, there is no clear agreement on the components, disciplines or processes to be considered within such an approach. In this study, we explored multicomponent and multidisciplinary approaches through an examination of knowledge, skills, beliefs, and recommendations of stakeholders involved in obesity management. These stakeholders included researchers, practitioners, educators, and patients. We used qualitative action research methods, including convergent interviewing and observation, to assist the process of inquiry. The consensus was that a multicomponent and multidisciplinary approach should be based on four central meta-components (patient, practitioner, process, and environmental factors), and specific components of these factors were identified. Psychologists, dieticians, exercise physiologists and general practitioners were nominated as key practitioners to be included. A complex condition like obesity requires that multiple components be addressed, and that both patients and multiple disciplines are involved in developing solutions. Implementing cycles of continuous improvement to deal with complexity, instead of trying to control for it, offers an effective way to deal with complex, changing multisystem problems like obesity.

Preserving Self: Theorizing the Social and Psychological Processes of Living With Parkinson Disease.

PubMed

Vann-Ward, Terrie; Morse, Janice M; Charmaz, Kathy

2017-06-01

The purpose of this constructivist grounded theory article is to identify, explore, and theorize the social and psychological processes used by people with Parkinson disease. Analytic procedures generated the five-stage theory of Preserving self of people with Parkinson disease: (a) making sense of symptoms, (b) defining turning points, (c) experiencing identity dilemmas, (d) reconnecting the self, and (e) envisioning a future. Reminders of former selves and capabilities were painful; participants desperately sought normalcy. Participants developed creative methods for maintaining independence but frequently overestimated their abilities and took risks. Participants were 15 men and 10 women (ages 40-95), most of whom lived with their families. Disease status was ascertained through medication logs and two scales: Hoehn and Yahr staging and Activities of Daily Living. Data included 62 in-depth interviews, nonparticipant observation, and participant photos, videos, and related documents. Recommendations were derived from the theory to support processes of Preserving Self as interventions designed to reduce the loss of self and to enhance Preserving self. These recommendations included developing relationships, teaching expected and unexpected feelings and behaviors, and involvement with sensory integrating activities.

Peer-led Aboriginal parent support: Program development for vulnerable populations with participatory action research.

PubMed

Munns, Ailsa; Toye, Christine; Hegney, Desley; Kickett, Marion; Marriott, Rhonda; Walker, Roz

2017-10-01

Participatory action research (PAR) is a credible, culturally appropriate methodology that can be used to effect collaborative change within vulnerable populations. This PAR study was undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting programme. A secondary aim, addressed in this paper, was to explore and describe research methodology used for the study and provide recommendations for its implementation in other similar situations. PAR using action learning sets was employed to develop the parent support programme and data addressing the secondary, methodological aim were collected through focus groups using semi-structured and unstructured interview schedules. Findings were addressed throughout the action research process to enhance the research process. The themes that emerged from the data and addressed the methodological aim were the need for safe communication processes; supportive engagement processes and supportive organisational processes. Aboriginal peer support workers (PSWs) and community support agencies identified three important elements central to their capacity to engage and work within the PAR methodology. This research has provided innovative data, highlighting processes and recommendations for child health nurses to engage with the PSWs, parents and community agencies to explore culturally acceptable elements for an empowering methodology for peer-led home visiting support. There is potential for this nursing research to credibly inform policy development for Aboriginal child and family health service delivery, in addition to other vulnerable population groups. Child health nurses/researchers can use these new understandings to work in partnership with Aboriginal communities and families to develop empowering and culturally acceptable strategies for developing Aboriginal parent support for the early years. Impact Statement Child health nurses and Aboriginal communities can collaborate through participatory action research to develop peer-led support for the early years. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.

Social network supported process recommender system.

PubMed

Ye, Yanming; Yin, Jianwei; Xu, Yueshen

2014-01-01

Process recommendation technologies have gained more and more attention in the field of intelligent business process modeling to assist the process modeling. However, most of the existing technologies only use the process structure analysis and do not take the social features of processes into account, while the process modeling is complex and comprehensive in most situations. This paper studies the feasibility of social network research technologies on process recommendation and builds a social network system of processes based on the features similarities. Then, three process matching degree measurements are presented and the system implementation is discussed subsequently. Finally, experimental evaluations and future works are introduced.

BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

PubMed Central

Bennett, Cathy; Moayyedi, Paul; Corley, Douglas A.; DeCaestecker, John; Falck-Ytter, Yngve; Falk, Gary; Vakil, Nimish; Sanders, Scott; Vieth, Michael; Inadomi, John; Aldulaimi, David; Ho, Khek-Yu; Odze, Robert; Meltzer, Stephen J.; Quigley, Eamonn; Gittens, Stuart; Watson, Peter; Zaninotto, Giovanni; Iyer, Prasad G.; Alexandre, Leo; Ang, Yeng; Callaghan, James; Harrison, Rebecca; Singh, Rajvinder; Bhandari, Pradeep; Bisschops, Raf; Geramizadeh, Bita; Kaye, Philip; Krishnadath, Sheila; Fennerty, M. Brian; Manner, Hendrik; Nason, Katie S.; Pech, Oliver; Konda, Vani; Ragunath, Krish; Rahman, Imdadur; Romero, Yvonne; Sampliner, Richard; Siersema, Peter D.; Tack, Jan; Tham, Tony C.K.; Trudgill, Nigel; Weinberg, David S.; Wang, Jean; Wang, Kenneth; Wong, Jennie Y.Y.; Attwood, Stephen; Malfertheiner, Peter; MacDonald, David; Barr, Hugh; Ferguson, Mark K.; Jankowski, Janusz

2015-01-01

OBJECTIVES Barrett’s esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research. PMID:25869390

Consensus-based recommendations for the management of juvenile dermatomyositis.

PubMed

Enders, Felicitas Bellutti; Bader-Meunier, Brigitte; Baildam, Eileen; Constantin, Tamas; Dolezalova, Pavla; Feldman, Brian M; Lahdenne, Pekka; Magnusson, Bo; Nistala, Kiran; Ozen, Seza; Pilkington, Clarissa; Ravelli, Angelo; Russo, Ricardo; Uziel, Yosef; van Brussel, Marco; van der Net, Janjaap; Vastert, Sebastiaan; Wedderburn, Lucy R; Wulffraat, Nicolaas; McCann, Liza J; van Royen-Kerkhof, Annet

2017-02-01

In 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile dermatomyositis (JDM) is a rare disease within the group of paediatric rheumatic diseases (PRDs) and can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physicians' experience. Consequently, treatment regimens differ throughout Europe. To provide recommendations for diagnosis and treatment of JDM. Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of 19 experienced paediatric rheumatologists and 2 experts in paediatric exercise physiology and physical therapy, mainly from Europe. Recommendations derived from a validated systematic literature review were evaluated by an online survey and subsequently discussed at two consensus meetings using nominal group technique. Recommendations were accepted if >80% agreement was reached. In total, 7 overarching principles, 33 recommendations on diagnosis and 19 recommendations on therapy were accepted with >80% agreement among experts. Topics covered include assessment of skin, muscle and major organ involvement and suggested treatment pathways. The SHARE initiative aims to identify best practices for treatment of patients suffering from PRD. Within this remit, recommendations for the diagnosis and treatment of JDM have been formulated by an evidence-informed consensus process to produce a standard of care for patients with JDM throughout Europe. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative.

PubMed

Constantin, Tamas; Foeldvari, Ivan; Anton, Jordi; de Boer, Joke; Czitrom-Guillaume, Severine; Edelsten, Clive; Gepstein, Raz; Heiligenhaus, Arnd; Pilkington, Clarissa A; Simonini, Gabriele; Uziel, Yosef; Vastert, Sebastian J; Wulffraat, Nico M; Haasnoot, Anne-Mieke; Walscheid, Karoline; Pálinkás, Annamária; Pattani, Reshma; Györgyi, Zoltán; Kozma, Richárd; Boom, Victor; Ponyi, Andrea; Ravelli, Angelo; Ramanan, Athimalaipet V

2018-03-28

In 2012, a European initiative called S ingle Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is possibly its most devastating extra-articular manifestation. Evidence-based guidelines are sparse and management is mostly based on physicians' experience. Consequently, treatment practices differ widely, within and between nations. To provide recommendations for the diagnosis and treatment of JIA-associated uveitis. Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of nine experienced paediatric rheumatologists and three experts in ophthalmology from Europe. Recommendations derived from a validated systematic literature review were evaluated by an Expert Committee and subsequently discussed at two consensus meetings using nominal group techniques. Recommendations were accepted if >80% agreement was reached (including all three ophthalmologists). In total, 22 recommendations were accepted (with >80% agreement among experts): 3 on diagnosis, 5 on disease activity measurements, 12 on treatment and 2 on future recommendations. The SHARE initiative aims to identify best practices for treatment of patients suffering from JIA-associated uveitis. Within this remit, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated by an evidence-informed consensus process to suggest a standard of care for JIA-associated uveitis patients throughout Europe. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The GRADE approach for assessing new technologies as applied to apheresis devices in ulcerative colitis

PubMed Central

2010-01-01

Background In the last few years, a new non-pharmacological treatment, termed apheresis, has been developed to lessen the burden of ulcerative colitis (UC). Several methods can be used to establish treatment recommendations, but over the last decade an informal collaboration group of guideline developers, methodologists, and clinicians has developed a more sensible and transparent approach known as the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). GRADE has mainly been used in clinical practice guidelines and systematic reviews. The aim of the present study is to describe the use of this approach in the development of recommendations for a new health technology, and to analyse the strengths, weaknesses, opportunities, and threats found when doing so. Methods A systematic review of the use of apheresis for UC treatment was performed in June 2004 and updated in May 2008. Two related clinical questions were selected, the outcomes of interest defined, and the quality of the evidence assessed. Finally, the overall quality of each question was taken into account to formulate recommendations following the GRADE approach. To evaluate this experience, a SWOT (strengths, weaknesses, opportunities and threats) analysis was performed to enable a comparison with our previous experience with the SIGN (Scottish Intercollegiate Guidelines Network) method. Results Application of the GRADE approach allowed recommendations to be formulated and the method to be clarified and made more explicit and transparent. Two weak recommendations were proposed to answer to the formulated questions. Some challenges, such as the limited number of studies found for the new technology and the difficulties encountered when searching for the results for the selected outcomes, none of which are specific to GRADE, were identified. GRADE was considered to be a more time-consuming method, although it has the advantage of taking into account patient values when defining and grading the relevant outcomes, thereby avoiding any influence from literature precedents, which could be considered to be a strength of this method. Conclusions The GRADE approach could be appropriate for making the recommendation development process for Health Technology Assessment (HTA) reports more explicit, especially with regard to new technologies. PMID:20553616

Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline.

PubMed

Chuang, Linus T; Temin, Sarah; Camacho, Rolando; Dueñas-Gonzalez, Alfonso; Feldman, Sarah; Gultekin, Murat; Gupta, Vandana; Horton, Susan; Jacob, Graciela; Kidd, Elizabeth A; Lishimpi, Kennedy; Nakisige, Carolyn; Nam, Joo-Hyun; Ngan, Hextan Yuen Sheung; Small, William; Thomas, Gillian; Berek, Jonathan S

2016-10-01

To provide evidence-based, resource-stratified global recommendations to clinicians and policymakers on the management and palliative care of women diagnosed with invasive cervical cancer. ASCO convened a multidisciplinary, multinational panel of cancer control, medical and radiation oncology, health economic, obstetric and gynecologic, and palliative care experts to produce recommendations reflecting resource-tiered settings. A systematic review of literature from 1966 to 2015 failed to yield sufficiently strong quality evidence to support basic- and limited-resource setting recommendations; a formal consensus-based process was used to develop recommendations. A modified ADAPTE process was also used to adapt recommendations from existing guidelines. Five existing sets of guidelines were identified and reviewed, and adapted recommendations form the evidence base. Eight systematic reviews, along with cost-effectiveness analyses, provided indirect evidence to inform the consensus process, which resulted in agreement of 75% or greater. Clinicians and planners should strive to provide access to the most effective evidence-based antitumor and palliative care interventions. If a woman cannot access these within her own or neighboring country or region, she may need to be treated with lower-tier modalities, depending on capacity and resources for surgery, chemotherapy, radiation therapy, and supportive and palliative care. For women with early-stage cervical cancer in basic settings, cone biopsy or extrafascial hysterectomy may be performed. Fertility-sparing procedures or modified radical or radical hysterectomy may be additional options in nonbasic settings. Combinations of surgery, chemotherapy, and radiation therapy (including brachytherapy) should be used for women with stage IB to IVA disease, depending on available resources. Pain control is a vital component of palliative care. Additional information is available at www.asco.org/rs-cervical-cancer-treatment-guideline and www.asco.org/guidelineswiki. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

Building Consensus for Change: Developing an Administrative and Management Structure in a Southern African University.

ERIC Educational Resources Information Center

Ingalls, Wayne B.

1995-01-01

The way in which the University of Botswana went about building the consensus necessary to develop a new administrative and management structure is described. The process began with a commission review to address increasing demand, and progressed to recommendations, governing council response, a task force for reorganization, and implementation.…

Here's Advice on Cutting Staff (From Those Who've Done It).

ERIC Educational Resources Information Center

Hill, T. Susan

1982-01-01

Using the experiences of individual school districts, such as the Yonkers (New York) Public Schools, the author provides advice on how a board should carry out a reduction in force (RIF). She stresses the need to develop a written RIF policy and recommends involving staff and the community in the policy development process. Issues the policy…

Strategies of Raising the Quality of Higher Education and Attaining Equality of Educational Opportunities

ERIC Educational Resources Information Center

Petrovskiy, Igor V.; Agapova, Elena N.

2016-01-01

The aim of the research is to develop the policy and strategy recommendations to increase the quality of higher education in Russian Federation. The study examines the significance of equal educational opportunities and the influence of this factor on the educational systems of developing countries. Transformational processes in the domain of…

Committee on the Future of Arizona Community Colleges: Report on the Charrette.

ERIC Educational Resources Information Center

Arizona Community Coll. Presidents Council, Phoenix.

From September 4 to 6, 1996, the Committee on the Future of Arizona Community Colleges conducted a charrette, or structured decision-making process designed to develop consensus, to provide recommendations for improving Arizona's community colleges. In developing the charrette, the Committee issued a request for ideas in March 1996 and selected 79…

Summary of the National Advisory Committee on Immunization (NACI) Statement on Seasonal Influenza Vaccine for 2016-2017.

PubMed

Gemmill, I; Zhao, L; Cochrane, L

2016-09-01

Influenza is a respiratory infection caused primarily by influenza A and B viruses. Vaccination is the most effective way to prevent influenza and its complications. The National Advisory Committee on Immunization (NACI) provides recommendations regarding seasonal influenza vaccines annually to the Public Health Agency of Canada (the Agency). To summarize the NACI recommendations regarding the use of seasonal influenza vaccines for the 2016-2017 influenza season. Annual influenza vaccine recommendations are developed by NACI's Influenza Working Group for consideration and approval by NACI, based on NACI's evidence-based process for developing recommendations, and include a consideration of the burden of influenza illness and the target populations for vaccination; efficacy and effectiveness, immunogenicity and safety of influenza vaccines; vaccine schedules; and other aspects of influenza immunization. These recommendations are published annually on the Agency's website in the NACI Advisory Committee Statement: Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine (the Statement). The annual NACI seasonal influenza vaccine recommendations have been updated for the 2016-2017 influenza season to include adults with neurologic or neurodevelopment conditions among the groups for whom influenza vaccination is particularly recommended; to include the new high-dose, trivalent inactivated influenza vaccine for use in adults 65 years of age and over; to recommend that egg-allergic individuals may also be vaccinated against influenza using the low ovalbumin-containing live attenuated influenza vaccine (LAIV) licensed for use in Canada (NACI has previously recommended that egg-allergic individuals may be vaccinated using inactivated influenza vaccines); and to remove the preferential recommendation for the use of LAIV in children 2-17 years of age. Two addenda to the 2016-2017 Statement address these new LAIV recommendations. NACI continues to recommend annual influenza vaccination for all individuals aged six months and older, with particular focus on people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk and others as indicated.

Identifying strengths and weaknesses of Quality Management Unit University of Sumatera Utara software using SCAMPI C

NASA Astrophysics Data System (ADS)

Gunawan, D.; Amalia, A.; Rahmat, R. F.; Muchtar, M. A.; Siregar, I.

2018-02-01

Identification of software maturity level is a technique to determine the quality of the software. By identifying the software maturity level, the weaknesses of the software can be observed. As a result, the recommendations might be a reference for future software maintenance and development. This paper discusses the software Capability Level (CL) with case studies on Quality Management Unit (Unit Manajemen Mutu) University of Sumatera Utara (UMM-USU). This research utilized Standard CMMI Appraisal Method for Process Improvement class C (SCAMPI C) model with continuous representation. This model focuses on activities for developing quality products and services. The observation is done in three process areas, such as Project Planning (PP), Project Monitoring and Control (PMC), and Requirements Management (REQM). According to the measurement of software capability level for UMM-USU software, turns out that the capability level for the observed process area is in the range of CL1 and CL2. Planning Project (PP) is the only process area which reaches capability level 2, meanwhile, PMC and REQM are still in CL 1 or in performed level. This research reveals several weaknesses of existing UMM-USU software. Therefore, this study proposes several recommendations for UMM-USU to improve capability level for observed process areas.

Integrating Evidence Within and Across Evidence Streams Using Qualitative Methods

EPA Science Inventory

There is high demand in environmental health for adoption of a structured process that evaluates and integrates evidence while making decisions transparent. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework holds promise to address this deman...

Developing Representative Michigan Truck Configurations for Bridge Load Rating

DOT National Transportation Integrated Search

2018-02-28

The objective of this study is to recommend a rating process representative of Michigan load effects for legal and extended permit vehicles. For this study, high fidelity WIM data from 20 Michigan sites were analyzed. Using vehicle weight and configu...

Diffusion of Mass Media Messages among Brazilian Farmers.

ERIC Educational Resources Information Center

Schneider, Ivo A.; Fett, John H.

1978-01-01

Reports on a study designed to discover the nature of the flow of messages about recommended agricultural practices first introduced through the mass media in a developing country, and to explore the role opinion leaders plan in the process. (GW)

Research notes : recycling roads and roofs.

DOT National Transportation Integrated Search

2010-06-01

One objective of the larger study is to develop recommendations for a design process for selecting the grade of virgin asphalt binder for HMAC mixtures containing RAP or RAS, or combinations of RAP and RAS, such that the blended binder meets the desi...

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis.

PubMed

Coates, Laura C; Kavanaugh, Arthur; Mease, Philip J; Soriano, Enrique R; Laura Acosta-Felquer, Maria; Armstrong, April W; Bautista-Molano, Wilson; Boehncke, Wolf-Henning; Campbell, Willemina; Cauli, Alberto; Espinoza, Luis R; FitzGerald, Oliver; Gladman, Dafna D; Gottlieb, Alice; Helliwell, Philip S; Husni, M Elaine; Love, Thorvardur J; Lubrano, Ennio; McHugh, Neil; Nash, Peter; Ogdie, Alexis; Orbai, Ana-Maria; Parkinson, Andrew; O'Sullivan, Denis; Rosen, Cheryl F; Schwartzman, Sergio; Siegel, Evan L; Toloza, Sergio; Tuong, William; Ritchlin, Christopher T

2016-05-01

To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA). GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire. Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves. © 2016, American College of Rheumatology.

Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

PubMed Central

Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

2015-01-01

Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

41 CFR 101-6.2109 - How does the Administrator receive and respond to comments?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 6... transmits a State process recommendation for a program selected under § 101-6.2106. (b)(1) The single point... and entities where there is no State process recommendation. (2) If a State process recommendation is...

Developing core outcome measurement sets for clinical trials: OMERACT filter 2.0.

PubMed

Boers, Maarten; Kirwan, John R; Wells, George; Beaton, Dorcas; Gossec, Laure; d'Agostino, Maria-Antonietta; Conaghan, Philip G; Bingham, Clifton O; Brooks, Peter; Landewé, Robert; March, Lyn; Simon, Lee S; Singh, Jasvinder A; Strand, Vibeke; Tugwell, Peter

2014-07-01

Lack of standardization of outcome measures limits the usefulness of clinical trial evidence to inform health care decisions. This can be addressed by agreeing on a minimum core set of outcome measures per health condition, containing measures relevant to patients and decision makers. Since 1992, the Outcome Measures in Rheumatology (OMERACT) consensus initiative has successfully developed core sets for many rheumatologic conditions, actively involving patients since 2002. Its expanding scope required an explicit formulation of its underlying conceptual framework and process. Literature searches and iterative consensus process (surveys and group meetings) of stakeholders including patients, health professionals, and methodologists within and outside rheumatology. To comprehensively sample patient-centered and intervention-specific outcomes, a framework emerged that comprises three core "Areas," namely Death, Life Impact, and Pathophysiological Manifestations; and one strongly recommended Resource Use. Through literature review and consensus process, core set development for any specific health condition starts by identifying at least one core "Domain" within each of the Areas to formulate the "Core Domain Set." Next, at least one applicable measurement instrument for each core Domain is identified to formulate a "Core Outcome Measurement Set." Each instrument must prove to be truthful (valid), discriminative, and feasible. In 2012, 96% of the voting participants (n=125) at the OMERACT 11 consensus conference endorsed this model and process. The OMERACT Filter 2.0 explicitly describes a comprehensive conceptual framework and a recommended process to develop core outcome measurement sets for rheumatology likely to be useful as a template in other areas of health care. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations.

PubMed

Louis, Edouard; Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan

2015-08-01

The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients' access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. © European Crohn’s and Colitis Organisation 2015.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations

PubMed Central

Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan

2015-01-01

Introduction: The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients’ access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Methods: Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. Results: A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Conclusions: Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. PMID:25987349

The Environmental Protection Agency's Safety Standards for Disposal of Spent Nuclear Fuel: Potential Path Forward in Response to the Report of the Blue Ribbon Commission on America's Nuclear Future - 13388

DOE Office of Scientific and Technical Information (OSTI.GOV)

Forinash, Betsy; Schultheisz, Daniel; Peake, Tom

2013-07-01

Following the decision to withdraw the Yucca Mountain license application, the Department of Energy created a Blue Ribbon Commission (BRC) on America's Nuclear Future, tasked with recommending a national strategy to manage the back end of the nuclear fuel cycle. The BRC issued its final report in January 2012, with recommendations covering transportation, storage and disposal of spent nuclear fuel (SNF); potential reprocessing; and supporting institutional measures. The BRC recommendations on disposal of SNF and high-level waste (HLW) are relevant to the U.S. Environmental Protection Agency (EPA), which shares regulatory responsibility with the Nuclear Regulatory Commission (NRC): EPA issues 'generallymore » applicable' performance standards for disposal repositories, which are then implemented in licensing. For disposal, the BRC endorses developing one or more geological repositories, with siting based on an approach that is adaptive, staged and consent-based. The BRC recommends that EPA and NRC work cooperatively to issue generic disposal standards-applying equally to all sites-early in any siting process. EPA previously issued generic disposal standards that apply to all sites other than Yucca Mountain. However, the BRC concluded that the existing regulations should be revisited and revised. The BRC proposes a number of general principles to guide the development of future regulations. EPA continues to review the BRC report and to assess the implications for Agency action, including potential regulatory issues and considerations if EPA develops new or revised generic disposal standards. This review also involves preparatory activities to define potential process and public engagement approaches. (authors)« less

Dietary behaviors related to cancer prevention among pre-adolescents and adolescents: the gap between recommendations and reality.

PubMed

Holman, Dawn M; White, Mary C

2011-06-01

Diet is thought to play an important role in cancer risk. This paper summarizes dietary recommendations for cancer prevention and compares these recommendations to the dietary behaviors of U.S. youth ages 8-18. We identified cancer prevention-related dietary recommendations from key health organizations and assessed dietary consumption patterns among youth using published statistics from the National Health and Nutrition Examination Survey, the national Youth Risk Behavior Survey, and other supplemental sources. Cancer prevention guidelines recommend a diet rich in fruits, vegetables, and whole grains, recommend limiting sugary foods and beverages, red and processed meats, sodium, and alcohol, and recommend avoiding foods contaminated with carcinogens. However, youth typically do not meet the daily recommendations for fruit, vegetable, or whole grain consumption and are over-consuming energy-dense, sugary and salty foods. A large discrepancy exists between expert recommendations about diet and cancer and actual dietary practices among young people and points to the need for more research to better promote the translation of science into practice. Future research should focus on developing and evaluating policies and interventions at the community, state and national levels for aligning the diets of youth with the evolving scientific evidence regarding cancer prevention.

OARSI Clinical Trials Recommendations: Design, conduct, and reporting of clinical trials for knee osteoarthritis.

PubMed

McAlindon, T E; Driban, J B; Henrotin, Y; Hunter, D J; Jiang, G-L; Skou, S T; Wang, S; Schnitzer, T

2015-05-01

The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct, and reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After the members voted we calculated the median score among the nine members of the working group who completed the score. The document includes 25 recommendations regarding randomization, blocking and stratification, blinding, enhancing accuracy of patient-reported outcomes (PRO), selecting a study population and index knee, describing interventions, patient-reported and physical performance measures, structural outcome measures, biochemical biomarkers, and reporting recommendations. In summary, the working group identified 25 recommendations that represent the current best practices regarding clinical trials that target symptom or structure modification among individuals with knee OA. These updated recommendations incorporate novel technologies (e.g., magnetic resonance imaging (MRI)) and strategies to address the heterogeneity of knee OA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Strengthening the Reporting of Observational Studies in Epidemiology—Nutritional Epidemiology (STROBE-nut): An Extension of the STROBE Statement

PubMed Central

Hawwash, Dana; Ocké, Marga C.; Berg, Christina; Forsum, Elisabet; Sonestedt, Emily; Wirfält, Elisabet; Åkesson, Agneta; Kolsteren, Patrick; Byrnes, Graham; De Keyzer, Willem; Van Camp, John; Slimani, Nadia; Cevallos, Myriam; Egger, Matthias; Huybrechts, Inge

2016-01-01

Background Concerns have been raised about the quality of reporting in nutritional epidemiology. Research reporting guidelines such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can improve quality of reporting in observational studies. Herein, we propose recommendations for reporting nutritional epidemiology and dietary assessment research by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology—Nutritional Epidemiology (STROBE-nut). Methods and Findings Recommendations for the reporting of nutritional epidemiology and dietary assessment research were developed following a systematic and consultative process, coordinated by a multidisciplinary group of 21 experts. Consensus on reporting guidelines was reached through a three-round Delphi consultation process with 53 external experts. In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist. Conclusion When used appropriately, reporting guidelines for nutritional epidemiology can contribute to improve reporting of observational studies with a focus on diet and health. PMID:27270749

The Automated Array Assembly Task of the Low-cost Silicon Solar Array Project, Phase 2

NASA Technical Reports Server (NTRS)

Coleman, M. G.; Grenon, L.; Pastirik, E. M.; Pryor, R. A.; Sparks, T. G.

1978-01-01

An advanced process sequence for manufacturing high efficiency solar cells and modules in a cost-effective manner is discussed. Emphasis is on process simplicity and minimizing consumed materials. The process sequence incorporates texture etching, plasma processes for damage removal and patterning, ion implantation, low pressure silicon nitride deposition, and plated metal. A reliable module design is presented. Specific process step developments are given. A detailed cost analysis was performed to indicate future areas of fruitful cost reduction effort. Recommendations for advanced investigations are included.

Delivery of optimized inpatient anticoagulation therapy: consensus statement from the anticoagulation forum.

PubMed

Nutescu, Edith A; Wittkowsky, Ann K; Burnett, Allison; Merli, Geno J; Ansell, Jack E; Garcia, David A

2013-05-01

To provide recommendations for optimized anticoagulant therapy in the inpatient setting and outline broad elements that need to be in place for effective management of anticoagulant therapy in hospitalized patients; the guidelines are designed to promote optimization of patient clinical outcomes while minimizing the risks for potential anticoagulation-related errors and adverse events. The medical literature was reviewed using MEDLINE (1946-January 2013), EMBASE (1980-January 2013), and PubMed (1947-January 2013) for topics and key words including, but not limited to, standards of practice, national guidelines, patient safety initiatives, and regulatory requirements pertaining to anticoagulant use in the inpatient setting. Non-English-language publications were excluded. Specific MeSH terms used include algorithms, anticoagulants/administration and dosage/adverse effects/therapeutic use, clinical protocols/standards, decision support systems, drug monitoring/methods, humans, inpatients, efficiency/ organizational, outcome and process assessment (health care), patient care team/organization and administration, program development/standards, quality improvement/organization and administration, thrombosis/ drug therapy, thrombosis/prevention and control, risk assessment/standards, patient safety/standards, and risk management/methods. Because of this document's scope, the medical literature was searched using a variety of strategies. When possible, recommendations are supported by available evidence; however, because this paper deals with processes and systems of care, high-quality evidence (eg, controlled trials) is unavailable. In these cases, recommendations represent the consensus opinion of all authors and are endorsed by the Board of Directors of the Anticoagulation Forum, an organization dedicated to optimizing anticoagulation care. The board is composed of physicians, pharmacists, and nurses with demonstrated expertise and experience in the management of patients receiving anticoagulation therapy. Recommendations for delivering optimized inpatient anticoagulation therapy were developed collaboratively by the authors and are summarized in 8 key areas: (1) process, (2) accountability, (3) integration, (4) standards of practice, (5) provider education and competency, (6) patient education, (7) care transitions, and (8) outcomes. Recommendations are intended to inform the development of coordinated care systems containing elements with demonstrated benefit in improvement of anticoagulation therapy outcomes. Recommendations for delivering optimized inpatient anticoagulation therapy are intended to apply to all clinicians involved in the care of hospitalized patients receiving anticoagulation therapy. Anticoagulants are high-risk medications associated with a significant rate of medication errors among hospitalized patients. Several national organizations have introduced initiatives to reduce the likelihood of patient harm associated with the use of anticoagulants. Health care organizations are under increasing pressure to develop systems to ensure the safe and effective use of anticoagulants in the inpatient setting. This document provides consensus guidelines for anticoagulant therapy in the inpatient setting and serves as a companion document to prior guidelines relevant for outpatients.

Proceedings of the 19th Annual Software Engineering Workshop

NASA Technical Reports Server (NTRS)

1994-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of applications software. The goals of the SEL are: (1) to understand the software development process in the GSFC environment; (2) to measure the effects of various methodologies, tools, and models on this process; and (3) to identify and then to apply successful development practices. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that include this document.

Data to action: using formative research to develop intervention programs to increase physical activity in adolescent girls.

PubMed

Young, Deborah Rohm; Johnson, Carolyn C; Steckler, Allan; Gittelsohn, Joel; Saunders, Ruth P; Saksvig, Brit I; Ribisl, Kurt M; Lytle, Leslie A; McKenzie, Thomas L

2006-02-01

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls' stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed.

Assessment of the NASA Flight Assurance Review Program

NASA Technical Reports Server (NTRS)

Holmes, J.; Pruitt, G.

1983-01-01

The NASA flight assurance review program to develop minimum standard guidelines for flight assurance reviews was assessed. Documents from NASA centers and NASA headquarters to determine current design review practices and procedures were evaluated. Six reviews were identified for the recommended minimum. The practices and procedures used at the different centers to incorporate the most effective ones into the minimum standard review guidelines were analyzed and guidelines for procedures, personnel and responsibilies, review items/data checklist, and feedback and closeout were defined. The six recommended reviews and the minimum standards guidelines developed for flight assurance reviews are presented. Observations and conclusions for further improving the NASA review and quality assurance process are outlined.

Recommended approach to software development, revision 3

NASA Technical Reports Server (NTRS)

Landis, Linda; Waligora, Sharon; Mcgarry, Frank; Pajerski, Rose; Stark, Mike; Johnson, Kevin Orlin; Cover, Donna

1992-01-01

Guidelines for an organized, disciplined approach to software development that is based on studies conducted by the Software Engineering Laboratory (SEL) since 1976 are presented. It describes methods and practices for each phase of a software development life cycle that starts with requirements definition and ends with acceptance testing. For each defined life cycle phase, guidelines for the development process and its management, and for the products produced and their reviews are presented.

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

PubMed Central

Lentine, Krista L.; Kasiske, Bertram L.; Levey, Andrew S.; Adams, Patricia L.; Alberú, Josefina; Bakr, Mohamed A.; Gallon, Lorenzo; Garvey, Catherine A.; Guleria, Sandeep; Li, Philip Kam-Tao; Segev, Dorry L.; Taler, Sandra J.; Tanabe, Kazunari; Wright, Linda; Zeier, Martin G.; Cheung, Michael; Garg, Amit X.

2017-01-01

Abstract The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a “proof-in-concept” risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided. In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109. PMID:28742762

Assessment of a Hospital Palliative Care Unit (HPCU) for Cancer Patients; A Conceptual Framework.

PubMed

Rouhollahi, Mohammad Reza; Saghafinia, Masoud; Zandehdel, Kazem; Motlagh, Ali Ghanbari; Kazemian, Ali; Mohagheghi, Mohammad Ali; Tahmasebi, Mamak

2015-01-01

The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support). We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed. The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps. Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended.

Introduction of human papillomavirus (HPV) vaccination into national immunisation schedules in Europe: Results of the VENICE 2007 survey.

PubMed

King, L A; Lévy-Bruhl, D; O'Flanagan, D; Bacci, S; Lopalco, P L; Kudjawu, Y; Salmaso, S

2008-08-14

The European Union Member States are simultaneously considering introducing HPV vaccination into their national immunisation schedules. The Vaccine European New Integrated Collaboration Effort (VENICE) project aims to develop a collaborative European vaccination network. A survey was undertaken to describe the decision status and the decision-making process regarding the potential introduction of human papillomavirus (HPV) vaccination in to their national immunisation schedules. A web-based questionnaire was developed and completed online in 2007 by 28 countries participating in VENICE. As of 31 October 2007,five countries had decided to introduce HPV vaccination into the national immunisation schedule, while another seven had started the decision-making process with a recommendation favouring introduction. Varying target populations were selected by the five countries which had introduced the vaccination. Half of the surveyed countries had undertaken at least one ad hoc study to support the decision-making process. According to an update of the decision-status from January 2008, the number of countries which had made a decision or recommendation changed to 10 and 5 respectively. This survey demonstrates the rapidly evolving nature of HPV vaccine introduction in Europe and the existence of expertise and experience among EU Member States. The VENICE network is capable of following this process and supporting countries in making vaccine introduction decisions. A VENICE collaborative web-space is being developed as a European resource for the decision-making process for vaccine introduction.

Common Data Elements for Clinical Research in Friedreich Ataxia

PubMed Central

Lynch, David R.; Pandolfo, Massimo; Schulz, Jorg B.; Perlman, Susan; Delatycki, Martin B.; Payne, R. Mark; Shaddy, Robert; Fischbeck, Kenneth H.; Farmer, Jennifer; Kantor, Paul; Raman, Subha V.; Hunegs, Lisa; Odenkirchen, Joanne; Miller, Kristy; Kaufmann, Petra

2012-01-01

Background To reduce study start-up time, increase data sharing, and assist investigators conducting clinical studies, the National Institute of Neurological Disorders and Stroke embarked on an initiative to create common data elements for neuroscience clinical research. The Common Data Element Team developed general common data elements which are commonly collected in clinical studies regardless of therapeutic area, such as demographics. In the present project, we applied such approaches to data collection in Friedreich ataxia, a neurological disorder that involves multiple organ systems. Methods To develop Friedreich’s ataxia common data elements, Friedreich’s ataxia experts formed a working group and subgroups to define elements in: Ataxia and Performance Measures; Biomarkers; Cardiac and Other Clinical Outcomes; and Demographics, Laboratory Tests and Medical History. The basic development process included: Identification of international experts in Friedreich’s ataxia clinical research; Meeting via teleconference to develop a draft of standardized common data elements recommendations; Vetting of recommendations across the subgroups; Dissemination of recommendations to the research community for public comment. Results The full recommendations were published online in September 2011 at http://www.commondataelements.ninds.nih.gov/FA.aspx. The Subgroups’ recommendations are classified as core, supplemental or exploratory. Template case report forms were created for many of the core tests. Conclusions The present set of data elements should ideally lead to decreased initiation time for clinical research studies and greater ability to compare and analyze data across studies. Their incorporation into new and ongoing studies will be assessed in an ongoing fashion to define their utility in Friedreich’s ataxia. PMID:23239403

Automated Simulation For Analysis And Design

NASA Technical Reports Server (NTRS)

Cantwell, E.; Shenk, Tim; Robinson, Peter; Upadhye, R.

1992-01-01

Design Assistant Workstation (DAWN) software being developed to facilitate simulation of qualitative and quantitative aspects of behavior of life-support system in spacecraft, chemical-processing plant, heating and cooling system of large building, or any of variety of systems including interacting process streams and processes. Used to analyze alternative design scenarios or specific designs of such systems. Expert system will automate part of design analysis: reason independently by simulating design scenarios and return to designer with overall evaluations and recommendations.

Evaluation criteria for commercially oriented materials processing in space proposals

NASA Technical Reports Server (NTRS)

Moore, W. F.; Mcdowell, J. R.

1979-01-01

An approach and criteria for evaluating NASA funded experiments and demonstrations which have commercial potential were developed. Methods for insuring quick initial screening of commercial proposals are presented. Recommendations are given for modifying the current evaluation approach. New criteria for evaluating commercially orientated materials processing in space (MPS) proposals are introduced. The process for selection of qualified individuals to evaluate the phases of this approach and criteria is considered and guidelines are set for its implementation.

Methods of dental instrument processing, sterilization, and storage--a review.

PubMed

Thomas, Lisa P; Bebermeyer, Richard D; Dickinson, Sharon K

2005-10-01

A comprehensive instrument processing and sterilization program in the dental office is essential to ensure that the DHCP and the public are protected from disease transmission due to contaminated instruments/ devices. The Centers for Disease Control and Prevention and other organizations have made recommendations to help dental personnel with this aspect of patient care. By following the CDC's latest guidelines, the DHCP can develop an optimal program of dental instrument processing, sterilization and storage.

Social Network Supported Process Recommender System

PubMed Central

Ye, Yanming; Yin, Jianwei; Xu, Yueshen

2014-01-01

Process recommendation technologies have gained more and more attention in the field of intelligent business process modeling to assist the process modeling. However, most of the existing technologies only use the process structure analysis and do not take the social features of processes into account, while the process modeling is complex and comprehensive in most situations. This paper studies the feasibility of social network research technologies on process recommendation and builds a social network system of processes based on the features similarities. Then, three process matching degree measurements are presented and the system implementation is discussed subsequently. Finally, experimental evaluations and future works are introduced. PMID:24672309

Managing Institutional Image.

ERIC Educational Resources Information Center

Melchiori, Gerlinda S.

1990-01-01

A managerial process for enhancing the image and public reputation of a higher education institution is outlined. It consists of five stages: market research; data analysis and market positioning; communication of results and recommendations to the administration; development of a global image program; and impact evaluation. (MSE)

Meeting Kentucky's Transportation needs and priorities : citizens' perceptions and recommendations.

DOT National Transportation Integrated Search

2005-08-01

This study was designed to (1) consider the role of public input in the transportation planning process; (2) obtain citizen perceptions of system needs and develop priorities in the state of Kentucky; and (3) use that experience (and the experiences ...

Recommendations for elaboration, transcultural adaptation and validation process of tests in Speech, Hearing and Language Pathology.

PubMed

Pernambuco, Leandro; Espelt, Albert; Magalhães, Hipólito Virgílio; Lima, Kenio Costa de

2017-06-08

to present a guide with recommendations for translation, adaptation, elaboration and process of validation of tests in Speech and Language Pathology. the recommendations were based on international guidelines with a focus on the elaboration, translation, cross-cultural adaptation and validation process of tests. the recommendations were grouped into two Charts, one of them with procedures for translation and transcultural adaptation and the other for obtaining evidence of validity, reliability and measures of accuracy of the tests. a guide with norms for the organization and systematization of the process of elaboration, translation, cross-cultural adaptation and validation process of tests in Speech and Language Pathology was created.

Reusing Information Management Services for Recommended Decadal Study Missions to Facilitate Aerosol and Cloud Studies

NASA Technical Reports Server (NTRS)

Kempler, Steve; Alcott, Gary; Lynnes, Chris; Leptoukh, Greg; Vollmer, Bruce; Berrick, Steve

2008-01-01

NASA Earth Sciences Division (ESD) has made great investments in the development and maintenance of data management systems and information technologies, to maximize the use of NASA generated Earth science data. With information management system infrastructure in place, mature and operational, very small delta costs are required to fully support data archival, processing, and data support services required by the recommended Decadal Study missions. This presentation describes the services and capabilities of the Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) and the reusability for these future missions. The GES DISC has developed a series of modular, reusable data management components currently in use. They include data archive and distribution (Simple, Scalable, Script-based, Science [S4] Product Archive aka S4PA), data processing (S4 Processor for Measurements aka S4PM), data search (Mirador), data browse, visualization, and analysis (Giovanni), and data mining services. Information management system components are based on atmospheric scientist inputs. Large development and maintenance cost savings can be realized through their reuse in future missions.

Guidelines for the Pharmacotherapy of Schizophrenia in Adults.

PubMed

Remington, Gary; Addington, Donald; Honer, William; Ismail, Zahinoor; Raedler, Thomas; Teehan, Michael

2017-09-01

The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia.

A Brief History of Evolving Diagnostics and Therapy for Gonorrhea: Lessons Learned.

PubMed

Hook, Edward W; Kirkcaldy, Robert D

2018-04-05

Progressively decreasing susceptibility of Neisseria gonorrhoeae to the antibiotics recommended for treatment has raised concerns about the public health threat of antibiotic resistant gonorrhea. This is not a new process and the organism has reliably developed resistance to all modern antibiotics used for treatment since the dawn of the antibiotic era. The history of changing recommendations for gonorrhea therapy however is complex and has been influenced by diagnostic test methods and surveillance. Understanding the impact of these influences may provide insights into current approaches to address this re-emerging public health challenge. We reviewed available literature on gonococcal susceptibility to therapeutic agents since the 1930s, changing methods for gonorrhea diagnosis, and public health recommendations for gonorrhea treatment. The literature review was supplemented by qualitative interviews with senior investigators who helped to shape gonorrhea management strategies over the past 50 years. The process of development of antimicrobial resistance to the antibiotics widely used for treatment appears to be an inexorable process. Many currently voiced concerns are similar to those raised in the past. The public health threat of increasing antimicrobial resistance by N. gonorrhoeae has been amplified as a result of a smaller pipeline introducing new drugs for gonorrhea treatment. Improved methods for gonorrhea diagnosis have also repeatedly influenced appreciation of the burden of disease caused by N. gonorrhoeae. U.S. Public Health Service leadership has also shaped and improved the management of this important public health problem.

Descriptive Study Analyzing Discrepancies in a Software Development Project Change Request (CR) Assessment Process and Recommendations for Process Improvements

NASA Technical Reports Server (NTRS)

Cunningham, Kenneth J.

2002-01-01

The Change Request (CR) assessment process is essential in the display development cycle. The assessment process is performed to ensure that the changes stated in the description of the CR match the changes in the actual display requirements. If a discrepancy is found between the CR and the requirements, the CR must be returned to the originator for corrections. Data will be gathered from each of the developers to determine the type of discrepancies and the amount of time spent assessing each CR. This study will determine the most common types of discrepancies and the amount of time spent assessing those issues. The results of the study will provide a foundation for future improvements as well as a baseline for future studies.

A multifaceted knowledge translation strategy can increase compliance with guideline recommendations for mechanical bowel preparation.

PubMed

Eskicioglu, Cagla; Pearsall, Emily; Victor, J Charles; Aarts, Mary-Anne; Okrainec, Allan; McLeod, Robin S

2015-01-01

The successful transfer of evidence into clinical practice is a slow and haphazard process. We report the outcome of a 5-year knowledge translation (KT) strategy to increase adherence with a clinical practice guideline (CPG) for mechanical bowel preparation (MBP) for elective colorectal surgery patients. A locally tailored CPG recommending MBP practices was developed. Data on MBP practices were collected at six University of Toronto hospitals before CPG implementation as well as after two separate KT strategies. KT strategy #1 included development of the CPG, education by opinion leaders, reminder cards, and presentations of data. KT strategy #2 included selection of hospital champions, development of communities of practice, education, reminder cards, electronic updates, pre-printed standardized orders, and audit and feedback. A total of 744 patients (400 males, 344 females, mean age 57.0) were included. Compliance increased from 58.6 to 70.4% after KT strategy #1 and to 81.1% after KT strategy #2 (p < 0.001). Using a tailored KT strategy, increased compliance was observed with CPG recommendations over time suggesting that a longitudinal KT strategy is required to increase and sustain compliance with recommendations. Furthermore, different strategies may be required at different times (i.e., educational sessions initially and reminders and standardized orders to maintain adherence).

Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part I.

PubMed

Saavedra Salinas, Miguel Ángel; Barrera Cruz, Antonio; Cabral Castañeda, Antonio Rafael; Jara Quezada, Luis Javier; Arce-Salinas, C Alejandro; Álvarez Nemegyei, José; Fraga Mouret, Antonio; Orozco Alcalá, Javier; Salazar Páramo, Mario; Cruz Reyes, Claudia Verónica; Andrade Ortega, Lilia; Vera Lastra, Olga Lidia; Mendoza Pinto, Claudia; Sánchez González, Antonio; Cruz Cruz, Polita Del Rocío; Morales Hernández, Sara; Portela Hernández, Margarita; Pérez Cristóbal, Mario; Medina García, Gabriela; Hernández Romero, Noé; Velarde Ochoa, María Del Carmen; Navarro Zarza, José Eduardo; Portillo Díaz, Verónica; Vargas Guerrero, Angélica; Goycochea Robles, María Victoria; García Figueroa, José Luis; Barreira Mercado, Eduardo; Amigo Castañeda, Mary Carmen

2015-01-01

Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Communication of Psychiatric Risk in 22q11.2 Deletion Syndrome: A Pilot Project.

PubMed

Hart, Sarah J; Schoch, Kelly; Shashi, Vandana; Callanan, Nancy

2016-02-01

Individuals with 22q11.2 deletion syndrome (22q11.2DS) have an increased chance of developing a psychiatric disorder. While parents of children affected by 22q11.2DS typically receive counseling about risk for non-psychiatric health concerns, genetic counselors may be reluctant to discuss psychiatric risk. Further education of genetic counselors may be necessary to encourage discussion of psychiatric risk with these families. The goal of this project was to develop recommendations for genetic counselors to provide psychiatric risk information to families affected by 22q11.2DS. The recommendations were developed by synthesizing resources in the literature about risk communication. These recommendations were refined following an online focus group meeting with five health care professionals who were recruited for participation from 22q11.2DS clinics across the U.S.A. The focus group data revealed three themes related to discussion of psychiatric risk: 1) Stepwise approach, 2) Discussing treatment options and reducing risks, and 3) Addressing stigma. These recommendations may be used as a foundation for a future clinical protocol to encourage discussion about the risk for psychiatric illness at an earlier point in the diagnostic process for 22q11.2DS and to provide improved information, support and resources to affected families.

Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline

PubMed Central

Chuang, Linus T.; Temin, Sarah; Camacho, Rolando; Dueñas-Gonzalez, Alfonso; Feldman, Sarah; Gultekin, Murat; Gupta, Vandana; Horton, Susan; Jacob, Graciela; Kidd, Elizabeth A.; Lishimpi, Kennedy; Nakisige, Carolyn; Nam, Joo-Hyun; Ngan, Hextan Yuen Sheung; Small, William; Thomas, Gillian; Berek, Jonathan S.

2016-01-01

Purpose To provide evidence-based, resource-stratified global recommendations to clinicians and policymakers on the management and palliative care of women diagnosed with invasive cervical cancer. Methods ASCO convened a multidisciplinary, multinational panel of cancer control, medical and radiation oncology, health economic, obstetric and gynecologic, and palliative care experts to produce recommendations reflecting resource-tiered settings. A systematic review of literature from 1966 to 2015 failed to yield sufficiently strong quality evidence to support basic- and limited-resource setting recommendations; a formal consensus-based process was used to develop recommendations. A modified ADAPTE process was also used to adapt recommendations from existing guidelines. Results Five existing sets of guidelines were identified and reviewed, and adapted recommendations form the evidence base. Eight systematic reviews, along with cost-effectiveness analyses, provided indirect evidence to inform the consensus process, which resulted in agreement of 75% or greater. Recommendations Clinicians and planners should strive to provide access to the most effective evidence-based antitumor and palliative care interventions. If a woman cannot access these within her own or neighboring country or region, she may need to be treated with lower-tier modalities, depending on capacity and resources for surgery, chemotherapy, radiation therapy, and supportive and palliative care. For women with early-stage cervical cancer in basic settings, cone biopsy or extrafascial hysterectomy may be performed. Fertility-sparing procedures or modified radical or radical hysterectomy may be additional options in nonbasic settings. Combinations of surgery, chemotherapy, and radiation therapy (including brachytherapy) should be used for women with stage IB to IVA disease, depending on available resources. Pain control is a vital component of palliative care. Additional information is available at www.asco.org/rs-cervical-cancer-treatment-guideline and www.asco.org/guidelineswiki. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines. PMID:28717717

Development of high temperature containerless processing equipment and the design and evaluation of associated systems required for microgravity materials processing and property measurements

NASA Technical Reports Server (NTRS)

Rey, Charles A.

1991-01-01

The development of high temperature containerless processing equipment and the design and evaluation of associated systems required for microgravity materials processing and property measurements are discussed. Efforts were directed towards the following task areas: design and development of a High Temperature Acoustic Levitator (HAL) for containerless processing and property measurements at high temperatures; testing of the HAL module to establish this technology for use as a positioning device for microgravity uses; construction and evaluation of a brassboard hot wall Acoustic Levitation Furnace; construction and evaluation of a noncontact temperature measurement (NCTM) system based on AGEMA thermal imaging camera; construction of a prototype Division of Amplitude Polarimetric Pyrometer for NCTM of levitated specimens; evaluation of and recommendations for techniques to control contamination in containerless materials processing chambers; and evaluation of techniques for heating specimens to high temperatures for containerless materials experimentation.

Development of high temperature containerless processing equipment and the design and evaluation of associated systems required for microgravity materials processing and property measurements

NASA Astrophysics Data System (ADS)

Rey, Charles A.

1991-03-01

The development of high temperature containerless processing equipment and the design and evaluation of associated systems required for microgravity materials processing and property measurements are discussed. Efforts were directed towards the following task areas: design and development of a High Temperature Acoustic Levitator (HAL) for containerless processing and property measurements at high temperatures; testing of the HAL module to establish this technology for use as a positioning device for microgravity uses; construction and evaluation of a brassboard hot wall Acoustic Levitation Furnace; construction and evaluation of a noncontact temperature measurement (NCTM) system based on AGEMA thermal imaging camera; construction of a prototype Division of Amplitude Polarimetric Pyrometer for NCTM of levitated specimens; evaluation of and recommendations for techniques to control contamination in containerless materials processing chambers; and evaluation of techniques for heating specimens to high temperatures for containerless materials experimentation.

Apollo experience report: Apollo lunar surface experiments package data processing system

NASA Technical Reports Server (NTRS)

Eason, R. L.

1974-01-01

Apollo Program experience in the processing of scientific data from the Apollo lunar surface experiments package, in which computers and associated hardware and software were used, is summarized. The facility developed for the preprocessing of the lunar science data is described, as are several computer facilities and programs used by the Principal Investigators. The handling, processing, and analyzing of lunar science data and the interface with the Principal Investigators are discussed. Pertinent problems that arose in the development of the data processing schemes are discussed so that future programs may benefit from the solutions to the problems. The evolution of the data processing techniques for lunar science data related to recommendations for future programs of this type.

The Challenges of Credible Thermal Protection System Reliability Quantification

NASA Technical Reports Server (NTRS)

Green, Lawrence L.

2013-01-01

The paper discusses several of the challenges associated with developing a credible reliability estimate for a human-rated crew capsule thermal protection system. The process of developing such a credible estimate is subject to the quantification, modeling and propagation of numerous uncertainties within a probabilistic analysis. The development of specific investment recommendations, to improve the reliability prediction, among various potential testing and programmatic options is then accomplished through Bayesian analysis.

ISS Payload Human Factors

NASA Technical Reports Server (NTRS)

Ellenberger, Richard; Duvall, Laura; Dory, Jonathan

2016-01-01

The ISS Payload Human Factors Implementation Team (HFIT) is the Payload Developer's resource for Human Factors. HFIT is the interface between Payload Developers and ISS Payload Human Factors requirements in SSP 57000. ? HFIT provides recommendations on how to meet the Human Factors requirements and guidelines early in the design process. HFIT coordinates with the Payload Developer and Astronaut Office to find low cost solutions to Human Factors challenges for hardware operability issues.

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline

PubMed Central

Jeronimo, Jose; Castle, Philip E.; Temin, Sarah; Denny, Lynette; Gupta, Vandana; Kim, Jane J.; Luciani, Silvana; Murokora, Daniel; Ngoma, Twalib; Qiao, Youlin; Quinn, Michael; Sankaranarayanan, Rengaswamy; Sasieni, Peter; Schmeler, Kathleen M.; Shastri, Surendra S.

2017-01-01

Purpose To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. Methods ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Results Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Recommendations Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed. Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki. It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines. PMID:29094101

Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers

PubMed Central

WALLCRAFT, JAN; AMERING, MICHAELA; FREIDIN, JULIAN; DAVAR, BHARGAVI; FROGGATT, DIANE; JAFRI, HUSSAIN; JAVED, AFZAL; KATONTOKA, SYLVESTER; RAJA, SHOBA; RATAEMANE, SOLOMON; STEFFEN, SIGRID; TYANO, SAM; UNDERHILL, CHRISTPHER; WAHLBERG, HENRIK; WARNER, RICHARD; HERRMAN, HELEN

2011-01-01

WPA President M. Maj established the Task Force on Best Practice in Working with Service Users and Carers in 2008, chaired by H. Herrman. The Task Force had the remit to create recommendations for the international mental health community on how to develop successful partnership working. The work began with a review of literature on service user and carer involvement and partnership. This set out a range of considerations for good practice, including choice of appropriate terminology, clarifying the partnership process and identifying and reducing barriers to partnership working. Based on the literature review and on the shared knowledge in the Task Force, a set of ten recommendations for good practice was developed. These recommendations were the basis for a worldwide consultation of stakeholders with expertise as service users, families and carers, and the WPA Board and Council. The results showed a strong consensus across the international mental health community on the ten recommendations, with the strongest agreement coming from service users and carers. This general consensus gives a basis for Task Force plans to seek support for activities to promote shared work worldwide to identify best practice examples and create a resource to assist others to begin successful collaboration. PMID:21991284

Management of bleeding following major trauma: an updated European guideline

PubMed Central

2010-01-01

Introduction Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. Methods The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. Results Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. Conclusions This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients. PMID:20370902

The evolution of standards for naturally occurring fluorides: an example of scientific due process.

PubMed Central

Clark, N; Corbin, S

1983-01-01

In three quarters of a century of observation and research, the effects of fluoride on dental caries and on general bodily health have been well documented. An expanding data base has allowed a firming up of the guidance and standards for appropriate and safe levels of naturally occurring fluorides for human consumption. Over time, through specific recommendations, the maximum fluoride concentrations deemed appropriate have been altered, but by a process of considered adjustment. Although the Public Health Service has been responsible for the formalization of many of the recommended standards, those recommendations have been based on research from many fronts. In the most recent reconsideration of the standards for natural fluoride, the most exhaustive and thoroughly documented review to date was done, incorporating review by representatives from State, Federal, and private programs. Although the specific example of the development of standards for natural fluoride is used, it should be illustrative of similar processes that are constantly underway in regard to substances and factors with a potential impact on the public's health. Expansion of the data base through research and scientific inquiry will lay the foundation for future reconsideration of the standards for naturally occurring fluorides. PMID:6828638

The Internal Medicine of the 21st century: Organizational and operational standards.

PubMed

Casariego-Vales, E; Zapatero-Gaviria, A; Elola-Somoza, F J

2017-12-01

The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

On-board processing concepts for future satellite communications systems

NASA Technical Reports Server (NTRS)

Brandon, W. T. (Editor); White, B. E. (Editor)

1980-01-01

The initial definition of on-board processing for an advanced satellite communications system to service domestic markets in the 1990's is discussed. An exemplar system with both RF on-board switching and demodulation/remodulation baseband processing is used to identify important issues related to system implementation, cost, and technology development. Analyses of spectrum-efficient modulation, coding, and system control techniques are summarized. Implementations for an RF switch and baseband processor are described. Among the major conclusions listed is the need for high gain satellites capable of handling tens of simultaneous beams for the efficient reuse of the 2.5 GHz 30/20 frequency band. Several scanning beams are recommended in addition to the fixed beams. Low power solid state 20 GHz GaAs FET power amplifiers in the 5W range and a general purpose digital baseband processor with gigahertz logic speeds and megabits of memory are also recommended.

Guideline for primary care management of headache in adults

PubMed Central

Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

2015-01-01

Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

Report of the Fermilab ILC Citizens' Task Force

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

Fermi National Accelerator Laboratory convened the ILC Citizens' Task Force to provide guidance and advice to the laboratory to ensure that community concerns and ideas are included in all public aspects of planning and design for a proposed future accelerator, the International Linear Collider. In this report, the members of the Task Force describe the process they used to gather and analyze information on all aspects of the proposed accelerator and its potential location at Fermilab in northern Illinois. They present the conclusions and recommendations they reached as a result of the learning process and their subsequent discussions and deliberations.more » While the Task Force was charged to provide guidance on the ILC, it became clear during the process that the high cost of the proposed accelerator made a near-term start for the project at Fermilab unlikely. Nevertheless, based on a year of extensive learning and dialogue, the Task Force developed a series of recommendations for Fermilab to consider as the laboratory develops all successor projects to the Tevatron. The Task Force recognizes that bringing a next-generation particle physics project to Fermilab will require both a large international effort and the support of the local community. While the Task Force developed its recommendations in response to the parameters of a future ILC, the principles they set forth apply directly to any large project that may be conceived at Fermilab, or at other laboratories, in the future. With this report, the Task Force fulfills its task of guiding Fermilab from the perspective of the local community on how to move forward with a large-scale project while building positive relationships with surrounding communities. The report summarizes the benefits, concerns and potential impacts of bringing a large-scale scientific project to northern Illinois.« less

Assessing and managing multiple risks in a changing world-The Roskilde recommendations.

PubMed

Selck, Henriette; Adamsen, Peter B; Backhaus, Thomas; Banta, Gary T; Bruce, Peter K H; Burton, G Allen; Butts, Michael B; Boegh, Eva; Clague, John J; Dinh, Khuong V; Doorn, Neelke; Gunnarsson, Jonas S; Hauggaard-Nielsen, Henrik; Hazlerigg, Charles; Hunka, Agnieszka D; Jensen, John; Lin, Yan; Loureiro, Susana; Miraglia, Simona; Munns, Wayne R; Nadim, Farrokh; Palmqvist, Annemette; Rämö, Robert A; Seaby, Lauren P; Syberg, Kristian; Tangaa, Stine R; Thit, Amalie; Windfeld, Ronja; Zalewski, Maciej; Chapman, Peter M

2017-01-01

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk-Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological context for assessments in human-modified systems; 8) assess risks and benefits to humans and the ecosystem and consider unintended consequences of management actions; 9) avoid excessive conservatism or possible underprotection resulting from sole reliance on binary, numerical benchmarks; and 10) develop adaptive risk-management and regulatory goals based on ranges of uncertainty. Environ Toxicol Chem 2017;36:7-16. © 2016 SETAC. © 2016 SETAC.

National Advisory Groups and their role in immunization policy-making processes in European countries.

PubMed

Nohynek, H; Wichmann, O; D Ancona, F

2013-12-01

During the twenty-first century, the development of national immunization programmes (NIP) has matured into robust processes where evidence-based methodologies and frameworks have increasingly been adopted. A key role in the decision-making and recommending processes is played by National Immunization Technical Advisory Groups (NITAGs). In a survey performed among European Union member states, Norway and Iceland, in February 2013, 85% of the 27 responding countries reported having established a NITAG, and of these, 45% have formal frameworks in place for the systematic development of vaccination recommendations. Independent of whether a formal framework is in place, common key factors are addressed by all NITAGs and also in countries without NITAGs. The four main factors addressed by all were: disease burden in the country, severity of the disease, vaccine effectiveness or efficacy, and vaccine safety at population level. Mathematical modelling and cost-effectiveness analyses are still not common tools. Differences in the relative weighting of these key factors, differences in data or assumptions on country-specific key factors, and differences in existing vaccination systems and financing, are likely to be reasons for differences in NITAG recommendations, and eventually NIPs, across Europe. Even if harmonization of NIPs is presently not a reasonable aim, systematic reviews and the development of mathematical/economic models could be performed at supranational level, thus sharing resources and easing the present work-load of NITAGs. Nevertheless, it has been argued that harmonization would ease central purchase of vaccines, thus reducing the price and increasing access to new vaccines. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Using qualitative methods for attribute development for discrete choice experiments: issues and recommendations.

PubMed

Coast, Joanna; Al-Janabi, Hareth; Sutton, Eileen J; Horrocks, Susan A; Vosper, A Jane; Swancutt, Dawn R; Flynn, Terry N

2012-06-01

Attribute generation for discrete choice experiments (DCEs) is often poorly reported, and it is unclear whether this element of research is conducted rigorously. This paper explores issues associated with developing attributes for DCEs and contrasts different qualitative approaches. The paper draws on eight studies, four developed attributes for measures, and four developed attributes for more ad hoc policy questions. Issues that have become apparent through these studies include the following: the theoretical framework for random utility theory and the need for attributes that are neither too close to the latent construct nor too intrinsic to people's personality; the need to think about attribute development as a two-stage process involving conceptual development followed by refinement of language to convey the intended meaning; and the difficulty in resolving tensions inherent in the reductiveness of condensing complex and nuanced qualitative findings into precise terms. The comparison of alternative qualitative approaches suggests that the nature of data collection will depend both on the characteristics of the question (its sensitivity, for example) and the availability of existing qualitative information. An iterative, constant comparative approach to analysis is recommended. Finally, the paper provides a series of recommendations for improving the reporting of this element of DCE studies. Copyright © 2011 John Wiley & Sons, Ltd.

The Process and Impact of the Infant/Toddler Credential as Professional Development: Reflections from Multiple Perspectives and Recommendations for Policy

ERIC Educational Resources Information Center

Chen, Jennifer J.; Martin, Arlene; Erdosi-Mehaffey, Valeria

2017-01-01

Early childhood educators worldwide all strive to improve the quality of care and education for young children through sustainable pathways. One such pathway is professional development (PD). In the United States, ongoing PD has been recognized as critical to enhancing practitioners' professional competence. Situated within the broader context of…

Implementing a High Performance Work Place in the Distribution and Logistics Industry: Recommendations for Leadership & Team Member Development

ERIC Educational Resources Information Center

McCann, Laura Harding

2012-01-01

Leadership development and employee engagement are two elements critical to the success of organizations. In response to growth opportunities, our Distribution and Logistics company set on a course to implement High Performance Work Place to meet the leadership and employee engagement needs, and to find methods for improving work processes. This…

Analysis of Human Resource Development and Utilization in Nigeria, Summary and Conclusions.

ERIC Educational Resources Information Center

Education and World Affairs, New York, NY.

This report is a second synthesis of the observations and recommendations of the Education and Human Resource Development Committee's Nigerian Project Task Force, which have been in the process of formulation since early 1965. A summary report, this paper does not include substantiation of all points: it is meant to present an overview of the Task…

The Practice of Health Program Evaluation.

PubMed

Lewis, Sarah R

2017-11-01

The Practice of Health Program Evaluation provides an overview of the evaluation process for public health programs while diving deeper to address select advanced concepts and techniques. The book unfolds evaluation as a three-phased process consisting of identification of evaluation questions, data collection and analysis, and dissemination of results and recommendations. The text covers research design, sampling methods, as well as quantitative and qualitative approaches. Types of evaluation are also discussed, including economic assessment and systems research as relative newcomers. Aspects critical to conducting a successful evaluation regardless of type or research design are emphasized, such as stakeholder engagement, validity and reliability, and adoption of sound recommendations. The book encourages evaluators to document their approach by developing an evaluation plan, a data analysis plan, and a dissemination plan, in order to help build consensus throughout the process. The evaluative text offers a good bird's-eye view of the evaluation process, while offering guidance for evaluation experts on how to navigate political waters and advocate for their findings to help affect change.

Basic emotion processing and the adolescent brain: Task demands, analytic approaches, and trajectories of changes.

PubMed

Del Piero, Larissa B; Saxbe, Darby E; Margolin, Gayla

2016-06-01

Early neuroimaging studies suggested that adolescents show initial development in brain regions linked with emotional reactivity, but slower development in brain structures linked with emotion regulation. However, the increased sophistication of adolescent brain research has made this picture more complex. This review examines functional neuroimaging studies that test for differences in basic emotion processing (reactivity and regulation) between adolescents and either children or adults. We delineated different emotional processing demands across the experimental paradigms in the reviewed studies to synthesize the diverse results. The methods for assessing change (i.e., analytical approach) and cohort characteristics (e.g., age range) were also explored as potential factors influencing study results. Few unifying dimensions were found to successfully distill the results of the reviewed studies. However, this review highlights the potential impact of subtle methodological and analytic differences between studies, need for standardized and theory-driven experimental paradigms, and necessity of analytic approaches that are can adequately test the trajectories of developmental change that have recently been proposed. Recommendations for future research highlight connectivity analyses and non-linear developmental trajectories, which appear to be promising approaches for measuring change across adolescence. Recommendations are made for evaluating gender and biological markers of development beyond chronological age. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Basic emotion processing and the adolescent brain: Task demands, analytic approaches, and trajectories of changes

PubMed Central

Del Piero, Larissa B.; Saxbe, Darby E.; Margolin, Gayla

2016-01-01

Early neuroimaging studies suggested that adolescents show initial development in brain regions linked with emotional reactivity, but slower development in brain structures linked with emotion regulation. However, the increased sophistication of adolescent brain research has made this picture more complex. This review examines functional neuroimaging studies that test for differences in basic emotion processing (reactivity and regulation) between adolescents and either children or adults. We delineated different emotional processing demands across the experimental paradigms in the reviewed studies to synthesize the diverse results. The methods for assessing change (i.e., analytical approach) and cohort characteristics (e.g., age range) were also explored as potential factors influencing study results. Few unifying dimensions were found to successfully distill the results of the reviewed studies. However, this review highlights the potential impact of subtle methodological and analytic differences between studies, need for standardized and theory-driven experimental paradigms, and necessity of analytic approaches that are can adequately test the trajectories of developmental change that have recently been proposed. Recommendations for future research highlight connectivity analyses and nonlinear developmental trajectories, which appear to be promising approaches for measuring change across adolescence. Recommendations are made for evaluating gender and biological markers of development beyond chronological age. PMID:27038840

European Psychiatric Association (EPA) guidance on quality assurance in mental healthcare.

PubMed

Gaebel, W; Großimlinghaus, I; Heun, R; Janssen, B; Johnson, B; Kurimay, T; Montellano, P; Muijen, M; Munk-Jorgensen, P; Rössler, W; Ruggeri, M; Thornicroft, G; Zielasek, J

2015-03-01

To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance. We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding). Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level). There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels. Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Canadian Consensus Conference on Osteoporosis, 2006 Update

PubMed Central

Brown, Jacques P.; Fortier, Michel

2016-01-01

Objective To provide guidelines for the health care provider on the diagnosis and clinical management of postmenopausal osteoporosis. Outcomes Strategies for identifying and evaluating high-risk individuals, the use of bone mineral density (BMD) and bone turnover markers in assessing diagnosis and response to management, and recommendations regarding nutrition, physical activity, and the selection of pharmacologic therapy to prevent and manage osteoporosis. Evidence MEDLINE and the Cochrane database were searched for articles in English on subjects related to osteoporosis diagnosis, prevention, and management from March 2001 to April 2005. The authors critically reviewed the evidence and developed the recommendations according to the Journal of Obstetrics and Gynaecology Canada’s methodology and consensus development process. Values The quality of evidence is rated using the criteria described in the report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this report. Sponsors The development of this consensus guideline was supported by unrestricted educational grants from Berlex Canada Inc., Lilly Canada, Merck Frosst, Novartis, Novogen, Novo Nordisk, Proctor and Gamble, Schering Canada, and Wyeth Canada. PMID:16626523

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma.

PubMed

Wall, Christopher J; Lynch, Joan; Harris, Ian A; Richardson, Martin D; Brand, Caroline; Lowe, Adrian J; Sugrue, Michael

2010-03-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

International Collegium of Rehabilitative Audiology (ICRA) recommendations for the construction of multilingual speech tests. ICRA Working Group on Multilingual Speech Tests.

PubMed

Akeroyd, Michael A; Arlinger, Stig; Bentler, Ruth A; Boothroyd, Arthur; Dillier, Norbert; Dreschler, Wouter A; Gagné, Jean-Pierre; Lutman, Mark; Wouters, Jan; Wong, Lena; Kollmeier, Birger

2015-01-01

To provide guidelines for the development of two types of closed-set speech-perception tests that can be applied and interpreted in the same way across languages. The guidelines cover the digit triplet and the matrix sentence tests that are most commonly used to test speech recognition in noise. They were developed by a working group on Multilingual Speech Tests of the International Collegium of Rehabilitative Audiology (ICRA). The recommendations are based on reviews of existing evaluations of the digit triplet and matrix tests as well as on the research experience of members of the ICRA Working Group. They represent the results of a consensus process. The resulting recommendations deal with: Test design and word selection; Talker characteristics; Audio recording and stimulus preparation; Masking noise; Test administration; and Test validation. By following these guidelines for the development of any new test of this kind, clinicians and researchers working in any language will be able to perform tests whose results can be compared and combined in cross-language studies.

Electronic fetal monitoring: family medicine obstetrics.

PubMed

Rodney, John R M; Huntley, Benjamin J F; Rodney, Wm Macmillan

2012-03-01

Electronic fetal monitoring assesses fetal health during the prenatal and intrapartum process. Intermittent auscultation does not detect key elements of fetal risk, such as beat-to-beat variability. Family medicine obstetric fellowships have contributed new knowledge to this process by articulating a method of analysis that builds on evidence-based recommendations from the American College of Obstetrics and Gynecology as well as the National Institute of Child Health and Development. This article summarizes the development, interpretation, and management of electronic fetal heart rate patterns and tracings. Copyright © 2012 Elsevier Inc. All rights reserved.

Computer generated animation and movie production at LARC: A case study

NASA Technical Reports Server (NTRS)

Gates, R. L.; Matthews, C. G.; Vonofenheim, W. H.; Randall, D. P.; Jones, K. H.

1984-01-01

The process of producing computer generated 16mm movies using the MOVIE.BYU software package developed by Brigham Young University and the currently available hardware technology at the Langley Research Center is described. A general overview relates the procedures to a specific application. Details are provided which describe the data used, preparation of a storyboard, key frame generation, the actual animation, title generation, filming, and processing/developing the final product. Problems encountered in each of these areas are identified. Both hardware and software problems are discussed along with proposed solutions and recommendations.

Evolving the ECSS Standards and their Use: Experience Based on Industrial Case Studies

NASA Astrophysics Data System (ADS)

Feldt, R.; Ahmad, E.; Raza, B.; Hult, E.; Nordebäck, T.

2009-05-01

This paper introduces two case studies conducted at two Swedish companies developing software for the space industry. The overall goal of the project is to evaluate if current use of ECSS is cost efficient and if there are ways to make the process leaner while maintaining quality. The case studies reported on here focused on how the ECSS standard was used by the companies and how that affected software development processes and software quality. This paper describes the results and recommendations based on identified challenges.

Spacelab data analysis and interactive control study

NASA Technical Reports Server (NTRS)

Tarbell, T. D.; Drake, J. F.

1980-01-01

The study consisted of two main tasks, a series of interviews of Spacelab users and a survey of data processing and display equipment. Findings from the user interviews on questions of interactive control, downlink data formats, and Spacelab computer software development are presented. Equipment for quick look processing and display of scientific data in the Spacelab Payload Operations Control Center (POCC) was surveyed. Results of this survey effort are discussed in detail, along with recommendations for NASA development of several specific display systems which meet common requirements of many Spacelab experiments.

Nutrition for healthy term infants, six to 24 months: An overview

PubMed Central

Critch, Jeffrey N

2014-01-01

Nutrition for Healthy Term Infants is a joint statement by Health Canada, the Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada. It was republished in September 2012, with recommendations on infant feeding from birth to six months of age. The statement was most recently updated in April 2014, with recommendations for feeding older infants and young children from six to 24 months of age. The present practice point outlines the statement development process and principles of feeding, with specific recommendations for clinicians. Health professionals who counsel families on nutrition in infants and young children are advised to read the statement in its entirety because discussion in the longer document expands on and clarifies advice summarized in the principles and recommendations given here. The complete statement is available on Health Canada’s website: www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php. PMID:25587235

Seismology software: state of the practice

NASA Astrophysics Data System (ADS)

Smith, W. Spencer; Zeng, Zheng; Carette, Jacques

2018-05-01

We analyzed the state of practice for software development in the seismology domain by comparing 30 software packages on four aspects: product, implementation, design, and process. We found room for improvement in most seismology software packages. The principal areas of concern include a lack of adequate requirements and design specification documents, a lack of test data to assess reliability, a lack of examples to get new users started, and a lack of technological tools to assist with managing the development process. To assist going forward, we provide recommendations for a document-driven development process that includes a problem statement, development plan, requirement specification, verification and validation (V&V) plan, design specification, code, V&V report, and a user manual. We also provide advice on tool use, including issue tracking, version control, code documentation, and testing tools.

Seismology software: state of the practice

NASA Astrophysics Data System (ADS)

Smith, W. Spencer; Zeng, Zheng; Carette, Jacques

2018-02-01

We analyzed the state of practice for software development in the seismology domain by comparing 30 software packages on four aspects: product, implementation, design, and process. We found room for improvement in most seismology software packages. The principal areas of concern include a lack of adequate requirements and design specification documents, a lack of test data to assess reliability, a lack of examples to get new users started, and a lack of technological tools to assist with managing the development process. To assist going forward, we provide recommendations for a document-driven development process that includes a problem statement, development plan, requirement specification, verification and validation (V&V) plan, design specification, code, V&V report, and a user manual. We also provide advice on tool use, including issue tracking, version control, code documentation, and testing tools.

The Hyper Suprime-Cam software pipeline

NASA Astrophysics Data System (ADS)

Bosch, James; Armstrong, Robert; Bickerton, Steven; Furusawa, Hisanori; Ikeda, Hiroyuki; Koike, Michitaro; Lupton, Robert; Mineo, Sogo; Price, Paul; Takata, Tadafumi; Tanaka, Masayuki; Yasuda, Naoki; AlSayyad, Yusra; Becker, Andrew C.; Coulton, William; Coupon, Jean; Garmilla, Jose; Huang, Song; Krughoff, K. Simon; Lang, Dustin; Leauthaud, Alexie; Lim, Kian-Tat; Lust, Nate B.; MacArthur, Lauren A.; Mandelbaum, Rachel; Miyatake, Hironao; Miyazaki, Satoshi; Murata, Ryoma; More, Surhud; Okura, Yuki; Owen, Russell; Swinbank, John D.; Strauss, Michael A.; Yamada, Yoshihiko; Yamanoi, Hitomi

2018-01-01

In this paper, we describe the optical imaging data processing pipeline developed for the Subaru Telescope's Hyper Suprime-Cam (HSC) instrument. The HSC Pipeline builds on the prototype pipeline being developed by the Large Synoptic Survey Telescope's Data Management system, adding customizations for HSC, large-scale processing capabilities, and novel algorithms that have since been reincorporated into the LSST codebase. While designed primarily to reduce HSC Subaru Strategic Program (SSP) data, it is also the recommended pipeline for reducing general-observer HSC data. The HSC pipeline includes high-level processing steps that generate coadded images and science-ready catalogs as well as low-level detrending and image characterizations.

Patient perspective workshop: moving towards OMERACT guidelines for choosing or developing instruments to measure patient-reported outcomes.

PubMed

Kirwan, John R; Fries, James F; Hewlett, Sarah E; Osborne, Richard H; Newman, Stanton; Ciciriello, Sabina; van de Laar, Mart A; Dures, Emma; Minnock, Patricia; Heiberg, Turid; Sanderson, Tessa C; Flurey, Caroline A; Leong, Amy L; Montie, Pamela; Richards, Pam

2011-08-01

The workshop Choosing or Developing Instruments held at the Outcome Measures in Rheumatology (OMERACT) 10 meeting was designed to help participants think about the underlying methods of instrument development. Conference pre-reading material and 3 brief introductory presentations elaborated the issues, and participants broke into discussion groups before reconvening to share insights, engage in a more general discussion of the issues, and vote on recommendations. Tradeoffs between using current imperfect measures and the long and complex process of developing new instruments were considered, together with the need for rigor in patient-reported outcome (PRO) instrument development. The main considerations for PRO instrument development were listed and a research agenda for action produced. As part of the agenda for action, it is recommended that researchers and patient partners work together to tackle these issues, and that OMERACT bring forward proposals for acceptable instrument development protocols that would meet an enhanced "Truth" statement in the OMERACT Filter.

Nursing considerations to complement the Surviving Sepsis Campaign guidelines.

PubMed

Aitken, Leanne M; Williams, Ged; Harvey, Maurene; Blot, Stijn; Kleinpell, Ruth; Labeau, Sonia; Marshall, Andrea; Ray-Barruel, Gillian; Moloney-Harmon, Patricia A; Robson, Wayne; Johnson, Alexander P; Lan, Pang Nguk; Ahrens, Tom

2011-07-01

To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis. Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus. We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding. Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia, and the role of therapeutic end points. Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care.

Guidelines for the Practice of Adaptive Diabetes Education for Visually Impaired Persons.

ERIC Educational Resources Information Center

Berkowitz, Kathy

1993-01-01

This article presents guidelines developed by the American Association of Diabetes Educators concerning adaptive diabetes education for visually impaired persons (ADEVIP). The article discusses definitions, values, and assumptions; recommended professional educational background; role delineation; and process and content of ADEVIP. (DB)

Student Assessment in Portugal: Academic Practice and Bologna Policy

ERIC Educational Resources Information Center

Sin, Cristina; Manatos, Maria

2014-01-01

This paper investigates institutional policies and academic practices of student assessment in four Portuguese higher education institutions (HEIs) in the wake of European policy developments driven by the Bologna Process. Specifically, it examines the correspondence between European policy recommendations related to student assessment (promotion…

The Development of Curricula/Programs for Indian and Metis People.

ERIC Educational Resources Information Center

Whyte, Kenn

1982-01-01

Discusses various multicultural education programs in Canada, recommending an understanding and appreciation of cultural heritage, analysis of contemporary conditions, and flexibility, variability, and greater control by minority groups of educational processes. Available: Department of Educational Foundations, 5-109 Education North, University of…

Computerized Financial Reporting Based on GAAP.

ERIC Educational Resources Information Center

Tikkanen, Stan; Liljeberg, Burt

1983-01-01

Describes the statewide computerized system developed in Minnesota following the 1976 enactment of the Uniform Financial Accounting and Reporting Standards (UFARS) law. UFARS includes provisions for an advisory council responsible for recommending accounting and reporting procedures, and seven data processing centers to serve all 560 Minnesota…

Report on Collaborative Facilities Projects.

ERIC Educational Resources Information Center

California Community Colleges, Sacramento. Office of the Chancellor.

California's community colleges develop their own requests in concert with their district five-year master plan. They then submit those requests to the State Chancellor's Office for review. This document discusses the current process of submitting proposals for collaborative facilities projects, and outlines and discusses five recommendations for…

Integrating Climate Change into Habitat Conservation Plans Under the U.S. Endangered Species Act

NASA Astrophysics Data System (ADS)

Bernazzani, Paola; Bradley, Bethany A.; Opperman, Jeffrey J.

2012-06-01

Habitat Conservation Plans (HCPs) under the Endangered Species Act (ESA) are an important mechanism for the acquisition of land and the management of terrestrial and aquatic ecosystems. HCPs have become a vital means of protecting endangered and threatened species and their habitats throughout the United States, particularly on private land. The scientific consensus that climate is changing and that these changes will impact the viability of species has not been incorporated into the conservation strategies of recent HCPs, rendering plans vulnerable biologically. In this paper we review the regulatory context for incorporating climate change into HCPs and analyze the extent to which climate change is linked to management actions in a subset of large HCPs. We conclude that most current plans do not incorporate climate change into conservation actions, and so we provide recommendations for integrating climate change into the process of HCP development and implementation. These recommendations are distilled from the published literature as well as the practice of conservation planning and are structured to the specific needs of HCP development and implementation. We offer nine recommendations for integrating climate change into the HCP process: (1) identify species at-risk from climate change, (2) explore new strategies for reserve design, (3) increase emphasis on corridors, linkages, and connectivity, (4) develop anticipatory adaptation measures, (5) manage for diversity, (6) consider assisted migration, (7) include climate change in scenarios of water management, (8) develop future-oriented management actions, and (9) increase linkages between the conservation strategy and adaptive management/monitoring programs.

Integrating climate change into habitat conservation plans under the U.S. endangered species act.

PubMed

Bernazzani, Paola; Bradley, Bethany A; Opperman, Jeffrey J

2012-06-01

Habitat Conservation Plans (HCPs) under the Endangered Species Act (ESA) are an important mechanism for the acquisition of land and the management of terrestrial and aquatic ecosystems. HCPs have become a vital means of protecting endangered and threatened species and their habitats throughout the United States, particularly on private land. The scientific consensus that climate is changing and that these changes will impact the viability of species has not been incorporated into the conservation strategies of recent HCPs, rendering plans vulnerable biologically. In this paper we review the regulatory context for incorporating climate change into HCPs and analyze the extent to which climate change is linked to management actions in a subset of large HCPs. We conclude that most current plans do not incorporate climate change into conservation actions, and so we provide recommendations for integrating climate change into the process of HCP development and implementation. These recommendations are distilled from the published literature as well as the practice of conservation planning and are structured to the specific needs of HCP development and implementation. We offer nine recommendations for integrating climate change into the HCP process: (1) identify species at-risk from climate change, (2) explore new strategies for reserve design, (3) increase emphasis on corridors, linkages, and connectivity, (4) develop anticipatory adaptation measures, (5) manage for diversity, (6) consider assisted migration, (7) include climate change in scenarios of water management, (8) develop future-oriented management actions, and (9) increase linkages between the conservation strategy and adaptive management/monitoring programs.

COINS: A composites information database system

NASA Technical Reports Server (NTRS)

Siddiqi, Shahid; Vosteen, Louis F.; Edlow, Ralph; Kwa, Teck-Seng

1992-01-01

An automated data abstraction form (ADAF) was developed to collect information on advanced fabrication processes and their related costs. The information will be collected for all components being fabricated as part of the ACT program and include in a COmposites INformation System (COINS) database. The aim of the COINS development effort is to provide future airframe preliminary design and fabrication teams with a tool through which production cost can become a deterministic variable in the design optimization process. The effort was initiated by the Structures Technology Program Office (STPO) of the NASA LaRC to implement the recommendations of a working group comprised of representatives from the commercial airframe companies. The principal working group recommendation was to re-institute collection of composite part fabrication data in a format similar to the DOD/NASA Structural Composites Fabrication Guide. The fabrication information collection form was automated with current user friendly computer technology. This work in progress paper describes the new automated form and features that make the form easy to use by an aircraft structural design-manufacturing team.

Integrating values and consumer involvement in guidelines with the patient at the center: article 8 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Kelson, Marcia; Akl, Elie A; Bastian, Hilda; Cluzeau, Françoise; Curtis, J Randall; Guyatt, Gordon; Montori, Victor M; Oliver, Sandy; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence. They are also realizing the need to involve consumers of healthcare (patients, caregivers, and the public) and integrate their values and preferences in clinical guideline development. This is the eighth of a series of 14 articles that were prepared to advise guideline developers in respiratory and other diseases. It focuses on where to find information about consumer values and preferences, at what points in the guideline development process to integrate their values and preferences, and why. In this review, we addressed the following questions: (1) What do we mean by "consumers"? (2) Why integrate the values and preferences of consumers of healthcare (patients, caregivers, and the public) into clinical practice guidelines? (3) What are the sources of information on consumer values? (4) When and how should consumer values and preferences be integrated into chronic obstructive pulmonary disease guideline recommendations? We defined consumers as patients, caregivers, and members of the public, excluding groups that may also be identified as consumers of guidelines including health professionals, providers, and commissioners of services. We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on available evidence, supplemented by a rapid appraisal of a selection of qualitative studies, experience of what guideline developers are doing, and workshop discussions. A clear distinction needs to be made between the use of information on consumer values and preferences by guideline developers, and the direct involvement of consumers in guideline development processes. Sources of information on consumer values include the research literature and direct elicitation of values both from organizations representing consumer interests and from individuals. To complement the identification of consumer values, there are a range of methods for involving consumers at all stages of guideline development, from consultation to direct membership of guideline development groups. Evidence-based guidelines need to consider explicitly the values and preferences of all relevant stakeholders (including those of consumers) and to provide opportunities for patients, caregivers, and the public to engage in the processes that consider and integrate those values into the development of guideline recommendations.

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline.

PubMed

Jeronimo, Jose; Castle, Philip E; Temin, Sarah; Denny, Lynette; Gupta, Vandana; Kim, Jane J; Luciani, Silvana; Murokora, Daniel; Ngoma, Twalib; Qiao, Youlin; Quinn, Michael; Sankaranarayanan, Rengaswamy; Sasieni, Peter; Schmeler, Kathleen M; Shastri, Surendra S

2017-10-01

To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki.It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines.

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2013 CFR

2013-07-01

... processing. These include: Certain bulky wastes (e.g., combustible demolition and construction debris, tree... WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-2 Recommended procedures: Design. (a) In addition to the residential and commercial wastes...

Follow-up intervals in patients with Cushing's disease: recommendations from a panel of experienced pituitary clinicians.

PubMed

Geer, Eliza B; Ayala, Alejandro; Bonert, Vivien; Carmichael, John D; Gordon, Murray B; Katznelson, Laurence; Manuylova, Ekaterina; Shafiq, Ismat; Surampudi, Vijaya; Swerdloff, Ronald S; Broder, Michael S; Cherepanov, Dasha; Eagan, Marianne; Lee, Jackie; Said, Qayyim; Neary, Maureen P; Biller, Beverly M K

2017-08-01

Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing's disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after ("second round") an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: "agreement" if no more than two responses were outside a 2 week window around the median response; "disagreement" if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8-24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.

Architecture and data processing alternatives for Tse computer. Volume 1: Tse logic design concepts and the development of image processing machine architectures

NASA Technical Reports Server (NTRS)

Rickard, D. A.; Bodenheimer, R. E.

1976-01-01

Digital computer components which perform two dimensional array logic operations (Tse logic) on binary data arrays are described. The properties of Golay transforms which make them useful in image processing are reviewed, and several architectures for Golay transform processors are presented with emphasis on the skeletonizing algorithm. Conventional logic control units developed for the Golay transform processors are described. One is a unique microprogrammable control unit that uses a microprocessor to control the Tse computer. The remaining control units are based on programmable logic arrays. Performance criteria are established and utilized to compare the various Golay transform machines developed. A critique of Tse logic is presented, and recommendations for additional research are included.

Data to Action

PubMed Central

Rohm Young, Deborah; Johnson, Carolyn C.; Steckler, Allan; Gittelsohn, Joel; Saunders, Ruth P.; Saksvig, Brit I.; Ribisl, Kurt M.; Lytle, Leslie A.; McKenzie, Thomas L.

2008-01-01

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls’ stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed. PMID:16397162

Steering operational synergies in terrestrial observation networks: opportunity for advancing Earth system dynamics modelling

NASA Astrophysics Data System (ADS)

Baatz, Roland; Sullivan, Pamela L.; Li, Li; Weintraub, Samantha R.; Loescher, Henry W.; Mirtl, Michael; Groffman, Peter M.; Wall, Diana H.; Young, Michael; White, Tim; Wen, Hang; Zacharias, Steffen; Kühn, Ingolf; Tang, Jianwu; Gaillardet, Jérôme; Braud, Isabelle; Flores, Alejandro N.; Kumar, Praveen; Lin, Henry; Ghezzehei, Teamrat; Jones, Julia; Gholz, Henry L.; Vereecken, Harry; Van Looy, Kris

2018-05-01

Advancing our understanding of Earth system dynamics (ESD) depends on the development of models and other analytical tools that apply physical, biological, and chemical data. This ambition to increase understanding and develop models of ESD based on site observations was the stimulus for creating the networks of Long-Term Ecological Research (LTER), Critical Zone Observatories (CZOs), and others. We organized a survey, the results of which identified pressing gaps in data availability from these networks, in particular for the future development and evaluation of models that represent ESD processes, and provide insights for improvement in both data collection and model integration. From this survey overview of data applications in the context of LTER and CZO research, we identified three challenges: (1) widen application of terrestrial observation network data in Earth system modelling, (2) develop integrated Earth system models that incorporate process representation and data of multiple disciplines, and (3) identify complementarity in measured variables and spatial extent, and promoting synergies in the existing observational networks. These challenges lead to perspectives and recommendations for an improved dialogue between the observation networks and the ESD modelling community, including co-location of sites in the existing networks and further formalizing these recommendations among these communities. Developing these synergies will enable cross-site and cross-network comparison and synthesis studies, which will help produce insights around organizing principles, classifications, and general rules of coupling processes with environmental conditions.

Recent progress in utilization planning for Space Station Freedom

NASA Technical Reports Server (NTRS)

Bartoe, John-David F.; Thiringer, Peter S.

1991-01-01

The progress made in utilization planning for the redesigned Space Station Freedom (SSF) concept is described. Consideration is given to the SSF user capabilities, the strategic planning process, the strategic planning organizations, and the Consolidated Operations and Utilization Plan (COUP, which will be released in January 1993) as well as to the COUP development process and implementation. The process by which the COUP will be produced was exercised in the international Multilateral Strategic and Tactical Integration Process (MUSTIP) simulation. The paper describes the MUSTIP simulation and its activities along with MUSTIP findings and recommendations.

TrustRank: a Cold-Start tolerant recommender system

NASA Astrophysics Data System (ADS)

Zou, Haitao; Gong, Zhiguo; Zhang, Nan; Zhao, Wei; Guo, Jingzhi

2015-02-01

The explosive growth of the World Wide Web leads to the fast advancing development of e-commerce techniques. Recommender systems, which use personalised information filtering techniques to generate a set of items suitable to a given user, have received considerable attention. User- and item-based algorithms are two popular techniques for the design of recommender systems. These two algorithms are known to have Cold-Start problems, i.e., they are unable to effectively handle Cold-Start users who have an extremely limited number of purchase records. In this paper, we develop TrustRank, a novel recommender system which handles the Cold-Start problem by leveraging the user-trust networks which are commonly available for e-commerce applications. A user-trust network is formed by friendships or trust relationships that users specify among them. While it is straightforward to conjecture that a user-trust network is helpful for improving the accuracy of recommendations, a key challenge for using user-trust network to facilitate Cold-Start users is that these users also tend to have a very limited number of trust relationships. To address this challenge, we propose a pre-processing propagation of the Cold-Start users' trust network. In particular, by applying the personalised PageRank algorithm, we expand the friends of a given user to include others with similar purchase records to his/her original friends. To make this propagation algorithm scalable to a large amount of users, as required by real-world recommender systems, we devise an iterative computation algorithm of the original personalised TrustRank which can incrementally compute trust vectors for Cold-Start users. We conduct extensive experiments to demonstrate the consistently improvement provided by our proposed algorithm over the existing recommender algorithms on the accuracy of recommendations for Cold-Start users.

Evaluation of the acceptability, feasibility and effectiveness of two methods of involving patients with disability in developing clinical guidelines: study protocol of a randomized pragmatic pilot trial.

PubMed

Lamontagne, Marie-Eve; Perreault, Kadija; Gagnon, Marie-Pierre

2014-04-10

Despite growing interest in the importance of, and challenges associated with the involvement of patient and population (IPP) in the process of developing and adapting clinical practice guidelines (CPGs), there is a lack of knowledge about the best method to use. This is especially problematic in the field of rehabilitation, where individuals with disabilities might face many barriers to their involvement in the guideline development and adaptation process. The goal of this pilot trial is to document the acceptability, feasibility and effectiveness of two methods of involving patients with a disability (traumatic brain injury) in CPG development. A single-blind, randomized, crossover pragmatic trial will be performed with 20 patients with traumatic brain injury (TBI). They will be randomized into two groups, and each will try two alternative methods of producing recommendations; a discussion group (control intervention) and a Wiki, a webpage that can be modified by those who have access to it (experimental intervention). The participants will rate the acceptability of the two methods, and feasibility will be assessed using indicators such as the number of participants who accessed and completed the two methods, and the number of support interventions required. Twenty experts, blinded to the method of producing the recommendations, will independently rate the recommendations produced by the participants for clarity, accuracy, appropriateness and usefulness. Our trial will allow for the use of optimal IPP methods in a larger project of adapting guidelines for the rehabilitation of individuals with TBI. Ultimately the results will inform the science of CPG development and contribute to the growing knowledge about IPP in rehabilitation settings. Clinical trial KT Canada 87776.

Development of permissible exposure limits: the California experience.

PubMed

Cohen, Richard; Steinmaus, Craig; Quinlan, Patricia; Ku, Robert; Cooper, Michael; Roberts, Tim

2006-01-01

The California OSHA Airborne Contaminant Advisory Committee reviewed several hundred substances and recommended occupational exposure limits with the intent of worker and employer protection. The model used offers important benefits. First, by allowing open meetings, the process was transparent, and input could be offered by concerned stakeholders. Second, the process was data-driven and, therefore, less susceptible to bias and error. Third, by incorporating members with backgrounds in toxicology, epidemiology, risk assessment, occupational medicine, and industrial hygiene, the process fostered a thorough and diverse assessment of substances.

Space Transportation Avionics Technology Symposium. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1990-01-01

The focus of the symposium was to examine existing and planned avionics technology processes and products and to recommend necessary changes for strengthening priorities and program emphases. Innovative changes in avionics technology development and design processes, identified during the symposium, are needed to support the increasingly complex, multi-vehicle, integrated, autonomous space-based systems. Key technology advances make such a major initiative viable at this time: digital processing capabilities, integrated on-board test/checkout methods, easily reconfigurable laboratories, and software design and production techniques.

Long-term care information systems: an overview of the selection process.

PubMed

Nahm, Eun-Shim; Mills, Mary Etta; Feege, Barbara

2006-06-01

Under the current Medicare Prospective Payment System method and the ever-changing managed care environment, the long-term care information system is vital to providing quality care and to surviving in business. system selection process should be an interdisciplinary effort involving all necessary stakeholders for the proposed system. The system selection process can be modeled following the Systems Developmental Life Cycle: identifying problems, opportunities, and objectives; determining information requirements; analyzing system needs; designing the recommended system; and developing and documenting software.

Space Transportation Avionics Technology Symposium. Volume 2: Conference Proceedings

NASA Technical Reports Server (NTRS)

1990-01-01

The focus of the symposium was to examine existing and planned avionics technology processes and products and to recommend necessary changes for strengthening priorities and program emphases. Innovative changes in avionics technology development and design processes are needed to support the increasingly complex, multi-vehicle, integrated, autonomous space-based systems. Key technology advances make such a major initiative viable at this time: digital processing capabilities, integrated on-board test/checkout methods, easily reconfigurable laboratories, and software design and production techniques.

Resilience Analysis of Face Slopes and Internal Dumps and Causes of their Instability at “Mugunsky” Opencast Coal Mine

NASA Astrophysics Data System (ADS)

Zagibalov, A. V.; Okhotin, A. L.; Volokhov, A. V.

2017-10-01

The paper deals with the problems of initiation and consequences of landslide processes registered in the internal dumps at Mugunsky lignite opencast mine. Water cutting at the internal dump base, availability of clay rocks in the dump bottom, and the bottom incline towards the working face are revealed to be the sources of the landslide process. Some measures are recommended to prevent deformation processes that are possible to take place in the run of mine development.

Science and Observation Recommendations for Future NASA Carbon Cycle Research

NASA Technical Reports Server (NTRS)

McClain, Charles R.; Collatz, G. J.; Kawa, S. R.; Gregg, W. W.; Gervin, J. C.; Abshire, J. B.; Andrews, A. E.; Behrenfeld, M. J.; Demaio, L. D.; Knox, R. G.

2002-01-01

Between October 2000 and June 2001, an Agency-wide planning, effort was organized by elements of NASA Goddard Space Flight Center (GSFC) to define future research and technology development activities. This planning effort was conducted at the request of the Associate Administrator of the Office of Earth Science (Code Y), Dr. Ghassem Asrar, at NASA Headquarters (HQ). The primary points of contact were Dr. Mary Cleave, Deputy Associate Administrator for Advanced Planning at NASA HQ (Headquarters) and Dr. Charles McClain of the Office of Global Carbon Studies (Code 970.2) at GSFC. During this period, GSFC hosted three workshops to define the science requirements and objectives, the observational and modeling requirements to meet the science objectives, the technology development requirements, and a cost plan for both the science program and new flight projects that will be needed for new observations beyond the present or currently planned. The plan definition process was very intensive as HQ required the final presentation package by mid-June 2001. This deadline was met and the recommendations were ultimately refined and folded into a broader program plan, which also included climate modeling, aerosol observations, and science computing technology development, for contributing to the President's Climate Change Research Initiative. This technical memorandum outlines the process and recommendations made for cross-cutting carbon cycle research as presented in June. A separate NASA document outlines the budget profiles or cost analyses conducted as part of the planning effort.

The Impacts of the Annual Professional Performance Review in New York State: Science Teachers' and Administrators' Perspectives

NASA Astrophysics Data System (ADS)

Mintz, Jessica A.

The goal of this study was to investigate New York State’s Annual Professional Performance Review (APPR) from the perspectives of secondary science teachers and their administrators. Examining their perceptions through interviews was insightful due to the subjects’ proximity to the teaching and learning processes. Five science teacher/administrator pairs from selected school districts were interviewed; all had varied ranges of experience and content certifications. The study also investigated the unintended consequences the teachers and administrators experienced using the APPR system. This phenomenological research study lays the groundwork for making policy recommendations for science teacher evaluations. The goal was to examine teacher and administrator perceptions, the clarity and practicality of teacher evaluation reforms, as well as how motivational theory might incentivize teacher change through future reform efforts. Provisional coding was used in this study based upon prior research. The list of codes was generated using motivational theories applied to the design of teacher evaluation policy and reform implementation constructs. Although the science teachers agreed with the importance of being evaluated, they generally viewed aspects of the process of quantifying their effectiveness as unclear, unfair, and flawed. The science teachers indicated that student variations in ability and performance were not considered when APPR was established. The science teachers recommended that the focus of teacher evaluations should be on content specific professional development. They proposed the establishment of peer review systems, teacher collaboration networks, and self-reflection documentation as means to improve their science teaching practices. The administrators agreed that accountability was important, however, holding individual teachers accountable for student outcomes was not reliably measured through the APPR process. They recommended other forms of evaluative measures that would focus on professional development instead of an evaluative effectiveness score. Their recommendations involved. creating more time for science administrators to be teacher leaders rather than evaluators. The administrators proposed three main recommendations: 1) decreasing the number of formal observations and replacing them with frequent informal classroom visits; 2) peer-peer observations utilizing instructional rounds; and 3) educator involvement in the creation of improved science teacher evaluation, with implicit trust in the administrators to exert local control.

Policy and science in children's health and environment: recommendations from the PINCHE project.

PubMed

van den Hazel, Peter; Zuurbier, Moniek; Bistrup, Marie Louise; Busby, Chris; Fucic, Aleksandra; Koppe, Janna G; Lundqvist, Christofer; Ronchetti, Roberto; ten Tusscher, Gavin

2006-10-01

Policy recommendations result from the discussions and analysis of the present situation in environment and health. Such analysis was performed in PINCHE. This led to recommendations based on the scientific literature. In the field of children's environmental health the policy process will follow more or less fixed rules, but this process is still at an early level of development. The link between science and policy still faces many challenges. Scientific assessment of environmental risk must recognize and tackle the problems of data sets, variability of human and environmental systems, the range, spatial and temporal diffusion of potential health effects and many biases and confounding factors. The PINCHE network recommends a general improvement of the supporting scientific fields in environment and health. Assessments from epidemiology or toxicology should play a key role in influencing science-policy decisions in programmes that are intended to inform the public policy process. Scientific committees at a local level could play a role. The relation between health and environment needs to be better incorporated in training and education. There is a need for harmonization of data production and use. The priorities in PINCHE focus on the most important issues. A classification of low, medium or high priority for action was used to describe a range of different environmental stressors. PINCHE provided recommendations to reduce exposure for children. Exposure reduction is not always linked to improved health in the short term, but it will reduce the body burden of accumulating chemicals in children. A strategic choice is reduction of exposure of children to compounds by changing production techniques or by increasing the distance of child specific settings to sources. The contribution of all players in the production, distribution and use of scientific knowledge in the field of children's environmental health is necessary.

The Physician Recommendation Coding System (PhyReCS): A Reliable and Valid Method to Quantify the Strength of Physician Recommendations During Clinical Encounters

PubMed Central

Scherr, Karen A.; Fagerlin, Angela; Williamson, Lillie D.; Davis, J. Kelly; Fridman, Ilona; Atyeo, Natalie; Ubel, Peter A.

2016-01-01

Background Physicians’ recommendations affect patients’ treatment choices. However, most research relies on physicians’ or patients’ retrospective reports of recommendations, which offer a limited perspective and have limitations such as recall bias. Objective To develop a reliable and valid method to measure the strength of physician recommendations using direct observation of clinical encounters. Methods Clinical encounters (n = 257) were recorded as part of a larger study of prostate cancer decision making. We used an iterative process to create the 5-point Physician Recommendation Coding System (PhyReCS). To determine reliability, research assistants double-coded 50 transcripts. To establish content validity, we used one-way ANOVAs to determine whether relative treatment recommendation scores differed as a function of which treatment patients received. To establish concurrent validity, we examined whether patients’ perceived treatment recommendations matched our coded recommendations. Results The PhyReCS was highly reliable (Krippendorf’s alpha =. 89, 95% CI [.86, .91]). The average relative treatment recommendation score for each treatment was higher for individuals who received that particular treatment. For example, the average relative surgery recommendation score was higher for individuals who received surgery versus radiation (mean difference = .98, SE = .18, p < .001) or active surveillance (mean difference = 1.10, SE = .14, p < .001). Patients’ perceived recommendations matched coded recommendations 81% of the time. Conclusion The PhyReCS is a reliable and valid way to capture the strength of physician recommendations. We believe that the PhyReCS would be helpful for other researchers who wish to study physician recommendations, an important part of patient decision making. PMID:27343015

The Physician Recommendation Coding System (PhyReCS): A Reliable and Valid Method to Quantify the Strength of Physician Recommendations During Clinical Encounters.

PubMed

Scherr, Karen A; Fagerlin, Angela; Williamson, Lillie D; Davis, J Kelly; Fridman, Ilona; Atyeo, Natalie; Ubel, Peter A

2017-01-01

Physicians' recommendations affect patients' treatment choices. However, most research relies on physicians' or patients' retrospective reports of recommendations, which offer a limited perspective and have limitations such as recall bias. To develop a reliable and valid method to measure the strength of physician recommendations using direct observation of clinical encounters. Clinical encounters (n = 257) were recorded as part of a larger study of prostate cancer decision making. We used an iterative process to create the 5-point Physician Recommendation Coding System (PhyReCS). To determine reliability, research assistants double-coded 50 transcripts. To establish content validity, we used 1-way analyses of variance to determine whether relative treatment recommendation scores differed as a function of which treatment patients received. To establish concurrent validity, we examined whether patients' perceived treatment recommendations matched our coded recommendations. The PhyReCS was highly reliable (Krippendorf's alpha = 0.89, 95% CI [0.86, 0.91]). The average relative treatment recommendation score for each treatment was higher for individuals who received that particular treatment. For example, the average relative surgery recommendation score was higher for individuals who received surgery versus radiation (mean difference = 0.98, SE = 0.18, P < 0.001) or active surveillance (mean difference = 1.10, SE = 0.14, P < 0.001). Patients' perceived recommendations matched coded recommendations 81% of the time. The PhyReCS is a reliable and valid way to capture the strength of physician recommendations. We believe that the PhyReCS would be helpful for other researchers who wish to study physician recommendations, an important part of patient decision making. © The Author(s) 2016.

Evaluating pet foods: how confident are you when you recommend a commercial pet food?

PubMed

Zicker, Steven C

2008-08-01

The safety, adequacy, and efficacy of pet foods are important considerations for veterinarians and consumers. Manufacturers of pet foods in the United States are required to comply with multiple regulations from a variety of governmental and state agencies to market foods in the public sector. However, consumers and veterinarians may not be aware of the multiple systems in place that help ensure the safety and adequacy of foods for their pets. Since the veterinarian occupies a key role to make recommendations to consumers regarding pet foods, it is the purpose of this article to review the processes of pet food manufacturing, as well as the processes that have been developed to help ensure safety and adequacy of pet foods in the United States.

Pneumococcal conjugate vaccine: economic issues of the introduction of a new childhood vaccine.

PubMed

Ray, G Thomas

2002-06-01

In February 2000, a pneumococcal conjugate vaccine was licensed for use in the USA. This vaccine has been shown to be effective in reducing pneumococcal disease, and has been recommended for universal use in infants. However, pneumococcal conjugate vaccine is by far the most expensive child vaccine series routinely administered in the USA, alone accounting for over 40% of the total purchase price of vaccines for the recommended childhood schedule. This article reviews the existing efficacy and economic studies of pneumococcal conjugate vaccine and discusses the process by which routine use of pneumococcal conjugate vaccine was introduced and the role economic analysis played in that process. Some of the scientific and funding issues relating to its use in both the industrialized and developing world are also discussed.

Effective Strategies for Global Health Research, Training and Clinical Care: A Narrative Review

PubMed Central

Walker, Rebekah J.; Campbell, Jennifer A.; Egede, Leonard E.

2015-01-01

The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical care. Global health program development should be completed within the framework of a larger institutional commitment or partnership. Support from leadership in the university or NGO, and an engaged local community are both integral to success and sustainability of efforts. It is also important for program development to engage local partners from the onset, jointly exploring issues and developing goals and objectives. Evaluation is a recommended way to determine if goals are being met, and should include considerations of sustainability, partnership building, and capacity. Global health research programs should consider details regarding the research process, context of research, partnerships, and community relationships. Training for global health should involve mentorship, pre-departure preparation of students, and elements developed to increase impact. Clinical care programs should focus on collaboration, sustainability, meeting local needs, and appropriate process considerations. PMID:25716404

The past and future of fish consumption: Can supplies meet healthy eating recommendations?

PubMed

Thurstan, Ruth H; Roberts, Callum M

2014-12-15

In many developed countries fish and shellfish are increasingly promoted as healthy alternatives to other animal protein. We analysed how much fish was available to UK and global populations after accounting for processing losses, and compared this to recommended levels of fish consumption. In 2012, UK domestic fish landings per capita fell 81% below the recommended intake, although declines were masked by increased imports and aquaculture from the 1970s onwards. Global wild fish supply per capita declined by 32% from its peak in 1970. However, overall fish supplies per capita increased by 10% over the same period due to rapidly expanding aquaculture production. Whilst aquaculture has so far prevented a downturn in global fish supplies, many developed nations continue to aspire to consume more fish than they produce. Until demand is balanced with sustainable methods of production governments should consider carefully the social and environmental implications of greater fish consumption. Copyright © 2014 Elsevier Ltd. All rights reserved.

Improving the Effectiveness of Electronic Health Record-Based Referral Processes

PubMed Central

2012-01-01

Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted “socio-technical” approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication. PMID:22973874

Recommendations for involving the family in developmental care of the NICU baby

PubMed Central

Craig, J W; Glick, C; Phillips, R; Hall, S L; Smith, J; Browne, J

2015-01-01

Family involvement is a key to realize the potential for long-lasting positive effects on physical, cognitive and psychosocial development of all babies, including those in the neonatal intensive care unit (NICU). Family-centered developmental care (FCDC) recognizes the family as vital members of the NICU health-care team. As such, families are integrated into decision-making processes and are collaborators in their baby's care. Through standardized use of FCDC principles in the NICU, a foundation is constructed to enhance the family's lifelong relationship with their child and optimize development of the baby. Recommendations are made for supporting parental roles as caregivers of their babies in the NICU, supporting NICU staff participation in FCDC and creating NICU policies that support this type of care. These recommendations are designed to meet the basic human needs of all babies, the special needs of hospitalized babies and the needs of families who are coping with the crisis of having a baby in the NICU. PMID:26597804

S3-guideline "helicobacter pylori and gastroduodenal ulcer disease" of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e. V., German society for rheumatology, AWMF-registration-no. 021 / 001.

PubMed

Fischbach, W; Malfertheiner, P; Hoffmann, J C; Bolten, W; Bornschein, J; Götze, O; Höhne, W; Kist, M; Koletzko, S; Labenz, J; Layer, P; Miehlke, St; Morgner, A; Peitz, U; Preiss, J; Prinz, C; Rosien, U; Schmidt, W; Schwarzer, A; Suerbaum, St; Timmer, A; Treiber, G; Vieth, M

2009-12-01

This guideline updates a prior consensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE), and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based S 3 level consensus guideline and has also implemented grading criteria according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics, and therapy were taken into account.

Preparation of Faculty Members and Students to Be Citizen Leaders and Pharmacy Advocates

PubMed Central

Janke, Kristin K.; Boyle, Cynthia J.; Gianutsos, Gerald; Lindsey, Cameron C.; Moczygemba, Leticia R.; Whalen, Karen

2013-01-01

To identify characteristics and quality indicators of best practices for leadership and advocacy development in pharmacy education, a national task force on leadership development in pharmacy invited colleges and schools to complete a phone survey to characterize the courses, processes, and noteworthy practices for leadership and advocacy development at their institution. The literature was consulted to corroborate survey findings and identify additional best practices. Recommendations were derived from the survey results and literature review, as well as from the experience and expertise of task force members. Fifty-four institutions provided information about lecture-based and experiential curricular and noncurricular components of leadership and advocacy development. Successful programs have a supportive institutional culture, faculty and alumni role models, administrative and/or financial support, and a cocurricular thread of activities. Leadership and advocacy development for student pharmacists is increasingly important. The recommendations and suggestions provided can facilitate leadership and advocacy development at other colleges and schools of pharmacy. PMID:24371344

Preparation of faculty members and students to be citizen leaders and pharmacy advocates.

PubMed

Ross, Leigh Ann; Janke, Kristin K; Boyle, Cynthia J; Gianutsos, Gerald; Lindsey, Cameron C; Moczygemba, Leticia R; Whalen, Karen

2013-12-16

To identify characteristics and quality indicators of best practices for leadership and advocacy development in pharmacy education, a national task force on leadership development in pharmacy invited colleges and schools to complete a phone survey to characterize the courses, processes, and noteworthy practices for leadership and advocacy development at their institution. The literature was consulted to corroborate survey findings and identify additional best practices. Recommendations were derived from the survey results and literature review, as well as from the experience and expertise of task force members. Fifty-four institutions provided information about lecture-based and experiential curricular and noncurricular components of leadership and advocacy development. Successful programs have a supportive institutional culture, faculty and alumni role models, administrative and/or financial support, and a cocurricular thread of activities. Leadership and advocacy development for student pharmacists is increasingly important. The recommendations and suggestions provided can facilitate leadership and advocacy development at other colleges and schools of pharmacy.

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

PubMed

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores.

Future research needs associated with the assessment of potential human health risks from exposure to toxic ambient air pollutants.

PubMed Central

Möller, L; Schuetzle, D; Autrup, H

1994-01-01

This paper presents key conclusions and future research needs from a Workshop on the Risk Assessment of Urban Air, Emissions, Exposure, Risk Identification, and Quantification, which was held in Stockholm during June 1992 by 41 participants from 13 countries. Research is recommended in the areas of identification and quantification of toxics in source emissions and ambient air, atmospheric transport and chemistry, exposure level assessment, the development of improved in vitro bioassays, biomarker development, the development of more accurate epidemiological methodologies, and risk quantification techniques. Studies are described that will be necessary to assess and reduce the level of uncertainties associated with each step of the risk assessment process. International collaborative research efforts between industry and government organizations are recommended as the most effective way to carry out this research. PMID:7529703

Recommendations of the wwPDB NMR Validation Task Force

PubMed Central

Montelione, Gaetano T.; Nilges, Michael; Bax, Ad; Güntert, Peter; Herrmann, Torsten; Richardson, Jane S.; Schwieters, Charles; Vranken, Wim F.; Vuister, Geerten W.; Wishart, David S.; Berman, Helen M.; Kleywegt, Gerard J.; Markley, John L.

2013-01-01

As methods for analysis of biomolecular structure and dynamics using nuclear magnetic resonance spectroscopy (NMR) continue to advance, the resulting 3D structures, chemical shifts, and other NMR data are broadly impacting biology, chemistry, and medicine. Structure model assessment is a critical area of NMR methods development, and is an essential component of the process of making these structures accessible and useful to the wider scientific community. For these reasons, the Worldwide Protein Data Bank (wwPDB) has convened an NMR Validation Task Force (NMR-VTF) to work with the wwPDB partners in developing metrics and policies for biomolecular NMR data harvesting, structure representation, and structure quality assessment. This paper summarizes the recommendations of the NMR-VTF, and lays the groundwork for future work in developing standards and metrics for biomolecular NMR structure quality assessment. PMID:24010715

CAEP 2016 Academic Symposium on Education Scholarship: Training our Future Clinician Educators in Emergency Medicine.

PubMed

Woods, Robert A; Artz, Jennifer D; Carrière, Benoit; Field, Simon; Huffman, James; Dong, Sandy L; Bhanji, Farhan; Yiu, Stella; Smith, Sheila; Mengual, Rose; Hicks, Chris; Frank, Jason

2017-05-01

To develop consensus recommendations for training future clinician educators (CEs) in emergency medicine (EM). A panel of EM education leaders was assembled from across Canada and met regularly by teleconference over the course of 1 year. Recommendations for CE training were drafted based on the panel's experience, a literature review, and a survey of current and past EM education leaders in Canada. Feedback was sought from attendees at the Canadian Association of Emergency Physicians (CAEP) annual academic symposium. Recommendations were distributed to the society's Academic Section for further feedback and updated by a consensus of the expert panel. Recommendations were categorized for one of three audiences: 1) Future CEs; 2) Academic departments and divisions (AD&D) that support training to fulfill their education leadership goals; and 3) The CAEP Academic Section. Advanced medical education training is recommended for any emergency physician or resident who pursues an education leadership role. Individuals should seek out mentorship in making decisions about career opportunities and training options. AD&D should regularly perform a needs assessment of their future CE needs and identify and encourage potential individuals who fulfill education leadership roles. AD&D should develop training opportunities at their institution, provide support to complete this training, and advocate for the recognition of education scholarship in their institutional promotions process. The CAEP Academic Section should support mentorship of future CEs on a national scale. These recommendations serve as a framework for training and supporting the next generation of Canadian EM medical educators.

Impact of Ada and object-oriented design in the flight dynamics division at Goddard Space Flight Center

NASA Technical Reports Server (NTRS)

Waligora, Sharon; Bailey, John; Stark, Mike

1995-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of applications software. The goals of the SEL are (1) to understand the software development process in the GSFC environment; (2) to measure the effects of various methodologies, tools, and models on this process; and (3) to identify and then to apply successful development practices. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that includes this document.

77 FR 55192 - New England Fishery Management Council (NEFMC); Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

... 25-27, 2012 to consider actions affecting New England fisheries in the exclusive economic zone (EEZ... findings and recommendations concerning the use of socio-cultural information in the NEFMC process. Three... will cover initial development of Atlantic herring fishery specifications for the upcoming fishing...

Cognitive Requirements for Small Unit Leaders in Military Operations in Urban Terrain

DTIC Science & Technology

1998-09-01

operations specifically. A cognitive task analysis , based on in depth interviews with subject matter experts (n=7), was conducted to expose the...process. The findings of the cognitive task analysis guided the development of training recommendations, particularly the need for a scenario based

Guiding Students to Answers: Query Recommendation

ERIC Educational Resources Information Center

Yilmazel, Ozgur

2011-01-01

This paper reports on a guided navigation system built on the textbook search engine developed at Anadolu University to support distance education students. The search engine uses Turkish Language specific language processing modules to enable searches over course material presented in Open Education Faculty textbooks. We implemented a guided…

75 FR 71787 - Occupational Information Development Advisory Panel Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-24

... recommendations will relate to our disability programs in the following areas: medical and vocational analysis of... medical-vocational adjudication policies and processes. Agenda: The Panel will meet on Wednesday, December... business. Those interested in providing testimony in person at the meeting or via teleconference should...

American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.

PubMed

Hochberg, Marc C; Altman, Roy D; April, Karine Toupin; Benkhalti, Maria; Guyatt, Gordon; McGowan, Jessie; Towheed, Tanveer; Welch, Vivian; Wells, George; Tugwell, Peter

2012-04-01

To update the American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) and develop new recommendations for hand OA. A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. Systematic evidence-based literature reviews were conducted by a working group at the Institute of Population Health, University of Ottawa, and updated by ACR staff to include additions to bibliographic databases through December 31, 2010. The Grading of Recommendations Assessment, Development and Evaluation approach, a formal process to rate scientific evidence and to develop recommendations that are as evidence based as possible, was used by a Technical Expert Panel comprised of various stakeholders to formulate the recommendations for the use of nonpharmacologic and pharmacologic modalities for OA of the hand, hip, and knee. Both “strong” and “conditional” recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self management programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA. These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA. Copyright © 2012 by the American College of Rheumatology.

An Analytical Impact Assessment Framework for Wildlife to Inform the Siting and Permitting of Wind Energy Facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schwartz, Jesse D.M.

In the United States overall electrical generation capacity is expected to increase by 10-25 gigawatts (GW) per year to meet increases in demand. Wind energy is a key component of state and federal renewable energy standards, and central to the Department of Energy’s 20% by 2030 wind production goals. Increased wind energy development may present increased resource conflict with avian wildlife, and environmental permitting has been identified as a potential obstacle to expansion in the sector. ICF developed an analytical framework to help applicants and agencies examine potential impacts in support of facility siting and permitting. A key objective ofmore » our work was to develop a framework that is scalable from the local to the national level, and one that is generalizable across the different scales at which biological communities operate – from local influences to meta-populations. The intent was to allow natural resource managers to estimate the cumulative impacts of turbine strikes and habitat changes on long-term population performance in the context of a species demography, genetic potential, and life history. We developed three types of models based on our literature review and participation in the scientific review processes. First, the conceptual model was developed as a general description of the analytical framework. Second, we developed the analytical framework based on the relationships between concepts, and the functions presented in the scientific literature. Third, we constructed an application of the model by parameterizing the framework using data from and relevant to the Altamont Pass Wind Resource Area (APWRA), and an existing golden eagle population model. We developed managed source code, database create statements, and written documentation to allow for the reproduction of each phase of the analysis. ICF identified a potential template adaptive management system in the form of the US Fish & Wildlife Service (USFWS) Adaptive Harvest Management (AHM) program, and developed recommendations for the structure and function of a similar wind-facility related program. We provided a straw-man implementation of the analytical framework based on assumptions for APWRA-wide golden eagle fatalities, and presented a statistical examination of the model performance. APWRA-wide fatality rates appear substantial at all scales examined from the local APWRA population to the Bird Conservation Region. Documented fatality rates significantly influenced population performance in terms of non-territorial non-breeding birds. Breeder, Juvenile, Subadult, and Adult abundance were mostly unaffected by Baseline APWRA-wide fatality rates. However, increased variability in fatality rates would likely have impacts on long-term population performance, and would result in a substantially larger loss of resources. We developed four recommendations for future study. First, we recommend establishment of concept experts through the existing system of non-profits, regulatory agencies, academia, and industry in the wind energy sector. Second, we recommend the development of a central or distributed shared data repository, and establish guidelines for data sharing and transparency. Third, we recommend development a forum and process for model selection at the local and national level. Last, we recommend experimental implementation of the prescribed system at broader scales, and refinement the expectations for modeling and adaptive management.« less