Do Community Recommendations Improve Metadata?

NASA Astrophysics Data System (ADS)

Gordon, S.; Habermann, T.; Jones, M. B.; Leinfelder, B.; Mecum, B.; Powers, L. A.; Slaughter, P.

2016-12-01

Complete documentation of scientific data is the surest way to facilitate discovery and reuse. What is complete metadata? There are many metadata recommendations from communities like the OGC, FGDC, NASA, and LTER, that can provide data documentation guidance for discovery, access, use and understanding. Often, the recommendations that communities develop are for a particular metadata dialect. Two examples of this are the LTER Completeness recommendation for EML and the FGDC Data Discovery recommendation for CSDGM. Can community adoption of a recommendation ensure that what is included in the metadata is understandable to the scientific community and beyond? By applying quantitative analysis to different LTER and USGS metadata collections in DataOne and ScienceBase, we show that community recommendations can improve the completeness of collections over time. Additionally, by comparing communities in DataOne that use the EML and CSDGM dialects, but have not adopted the recommendations to the communities that have, the positive effects of recommendation adoption on documentation completeness can be measured.

Quality of cancer care in Spain: recommendations of a patients' jury.

PubMed

Arrighi, E; Blancafort, S; Jovell, A J; Navarro Rubio, M D

2015-05-01

The aim of the study was to evaluate quality of cancer care in Spain through patient's views, experiences and perceptions; with the purpose of making recommendations to improve cancer care. A modified citizen's jury was organised with the participation of 30 members and four experts as witnesses. For 1 day jurors representing 13 of 17 Spanish Autonomous Communities were met to make recommendations for improving the quality of cancer care in Spain. Concerns were identified regarding care fragmentation, test delays, duplications and poor social and emotional support. Some recommendations highlighted the need to improve the access to psycho-oncology care as well as support in social care and counselling, addressing patients to specific care. Some strategies proposed by the jury included a 24-h call centre, continuity in palliative care and appropriate follow-up and support after the end of therapy. In conclusion, the experience of cancer should include access to multiple specialists, effective coordination of care, accurate information about the disease and treatment options, and timely attention to symptoms and psychosocial needs. © 2014 John Wiley & Sons Ltd.

SoRS: Social recommendation using global rating reputation and local rating similarity

NASA Astrophysics Data System (ADS)

Qian, Fulan; Zhao, Shu; Tang, Jie; Zhang, Yanping

2016-11-01

Recommendation is an important and also challenging problem in online social networks. It needs to consider not only users' personalized interests, but also social relations between users. Indeed, in practice, users are often inclined to accept recommendations from friends or opinion leaders (users with high reputations). In this paper, we present a novel recommendation framework, social recommendation using global rating reputation and local rating similarity, which combine user reputation and social similarity based on ratings. User reputation can be obtained by iteratively calculating the correlation of historical ratings of user and intrinsic qualities of items. We view the user reputation as the user's global influence and the similarity based on rating of social relation as the user's local influence, introduce it in the basic social recommender model. Thus users with high reputation have a strong influence on the others, and on the other hand, the effect of a user with low reputation has been weakened. The recommendation accuracy of proposed framework can be improved by effectively removing nature noise because of less rigorous user ratings and strengthening the effect of user influence with high reputation. We also improve the similarity based on ratings by avoiding the high similarity with the less common ratings between friends. We evaluate our approach on three datasets including Movielens, Epinions and Douban. Empirical results demonstrate that proposed framework achieves significant improvements on recommendation accuracy. User reputation and local similarity which are both based on ratings have a lot of helpful in improvement of prediction accuracy. The reputation also can help to improve the recommendation precision with the small training sets.

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From the American College of Physicians.

PubMed

Qaseem, Amir; Barry, Michael J; Humphrey, Linda L; Forciea, Mary Ann

2017-02-21

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on oral pharmacologic treatment of type 2 diabetes in adults. This guideline serves as an update to the 2012 ACP guideline on the same topic. This guideline is endorsed by the American Academy of Family Physicians. This guideline is based on a systematic review of randomized, controlled trials and observational studies published through December 2015 on the comparative effectiveness of oral medications for type 2 diabetes. Evaluated interventions included metformin, thiazolidinediones, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Study quality was assessed, data were extracted, and results were summarized qualitatively on the basis of the totality of evidence identified by using several databases. Evaluated outcomes included intermediate outcomes of hemoglobin A1c, weight, systolic blood pressure, and heart rate; all-cause mortality; cardiovascular and cerebrovascular morbidity and mortality; retinopathy, nephropathy, and neuropathy; and harms. This guideline grades the recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The target audience for this guideline includes all clinicians, and the target patient population includes adults with type 2 diabetes. ACP recommends that clinicians prescribe metformin to patients with type 2 diabetes when pharmacologic therapy is needed to improve glycemic control. (Grade: strong recommendation; moderate-quality evidence). ACP recommends that clinicians consider adding either a sulfonylurea, a thiazolidinedione, an SGLT-2 inhibitor, or a DPP-4 inhibitor to metformin to improve glycemic control when a second oral therapy is considered. (Grade: weak recommendation; moderate-quality evidence.) ACP recommends that clinicians and patients select among medications after discussing benefits, adverse effects, and costs.

A Geospatial Data Recommender System based on Metadata and User Behaviour

NASA Astrophysics Data System (ADS)

Li, Y.; Jiang, Y.; Yang, C. P.; Armstrong, E. M.; Huang, T.; Moroni, D. F.; Finch, C. J.; McGibbney, L. J.

2017-12-01

Earth observations are produced in a fast velocity through real time sensors, reaching tera- to peta- bytes of geospatial data daily. Discovering and accessing the right data from the massive geospatial data is like finding needle in the haystack. To help researchers find the right data for study and decision support, quite a lot of research focusing on improving search performance have been proposed including recommendation algorithm. However, few papers have discussed the way to implement a recommendation algorithm in geospatial data retrieval system. In order to address this problem, we propose a recommendation engine to improve discovering relevant geospatial data by mining and utilizing metadata and user behavior data: 1) metadata based recommendation considers the correlation of each attribute (i.e., spatiotemporal, categorical, and ordinal) to data to be found. In particular, phrase extraction method is used to improve the accuracy of the description similarity; 2) user behavior data are utilized to predict the interest of a user through collaborative filtering; 3) an integration method is designed to combine the results of the above two methods to achieve better recommendation Experiments show that in the hybrid recommendation list, the all the precisions are larger than 0.8 from position 1 to 10.

A Checklist for Improving Teacher Morale.

ERIC Educational Resources Information Center

Stedt, Joe D.; Fraser, Hugh W.

1984-01-01

The Behavioral Morale Checklist (BMC) for assessing and improving teacher moral is described and reprinted. A criterion-referenced instrument, the BMC, defines morale in terms of behavior observable by administrators and includes recommended adjustments for principals to improve morale. (MJL)

The influence of evaluation recommendations on instrumental and conceptual uses: A preliminary analysis.

PubMed

Bourgeois, Isabelle; Whynot, Jane

2018-06-01

Evaluation recommendations are sometimes included in evaluation reports to highlight specific actions to be taken to improve a program or to make other changes to its operational context. This preliminary study sought to examine evaluation recommendations drawn from 25 evaluation reports published by Canadian federal government departments and agencies, in order to examine the evaluation issues covered and the focus of the recommendations. Our results show that in keeping with policy requirements, the evaluation recommendations focused on program relevance, effectiveness and efficiency and economy. Furthermore, a significant number of recommendations also focused on the implementation of more rigorous performance measurement strategies. The focus of the recommendations did not vary by publication date, recommendation type, and organizational sector. The findings also show that for the most part, the management responses produced as part of the broader evaluation process support the recommendations included in the report and identify specific timelines for implementation. Copyright © 2018 Elsevier Ltd. All rights reserved.

A qualitative exploration of the major challenges facing pharmacovigilance in Saudi Arabia.

PubMed

Aljadhey, Hisham; Mahmoud, Mansour A; Alshammari, Thamir M; Al-Dhaeefi, Mohammed; Le Louet, Herve; Perez-Gutthann, Susana; Pitts, Peter J

2015-09-01

To explore the challenges facing pharmacovigilance in Saudi Arabia and formulate recommendations to improve it from the perspective of healthcare professionals in Saudi Arabia. This was a qualitative study of 4 focus group discussions with pharmacists, physicians, and academicians held under the auspices of the King Saud University School of Pharmacy and the Center for Medicine in the Public Interest, Riyadh, Saudi Arabia. A total of 29 eligible healthcare professionals were invited to participate in the discussion. The predefined themes of the study were the current practice and major challenges facing pharmacovigilance in regulatory bodies, hospitals, the community, and academia, as well as recommendations to improve pharmacovigilance practice.  Of the 29 participants invited, 27 attended the discussion. Challenges facing regulatory bodies included complicated adverse drug reactions (ADR) reporting forms, lack of feedback on ADRs submitted to the Saudi Food and Drug Authority, lack of decisions from the local authority to withdraw medications, and lack of data on pharmacovigilance. The challenges to pharmacovigilance in hospitals included the lack of knowledge of the significance of ADR reporting, workload, blaming culture, and lack of collaboration between regulatory bodies and hospitals. However, challenges facing pharmaceutical industries included the lack of drug manufacturers in Saudi Arabia and lack of interest in pharmacovigilance. Recommendations to improve pharmacovigilance included the need for communication, stronger regulatory requirements, the need for research, the need for unified ADRs reporting, and continuous education and training.  The study has identified the challenges facing pharmacovigilance in Saudi Arabia and made certain recommendations to overcome them. These recommendations might be helpful for regulatory bodies to enhance spontaneous reporting and promote pharmacovigilance.

Local action on outdoor air pollution to improve public health.

PubMed

Vardoulakis, Sotiris; Kettle, Rachel; Cosford, Paul; Lincoln, Paul; Holgate, Stephen; Grigg, Jonathan; Kelly, Frank; Pencheon, David

2018-06-01

The National Institute for Health and Care Excellence, jointly with Public Health England, have developed a guideline on outdoor air pollution and its links to health. The guideline makes recommendations on local interventions that can help improve air quality and prevent a range of adverse health outcomes associated with road-traffic-related air pollution. The guideline was based on a rigorous assessment of the scientific evidence by an independent advisory committee, with input from public health professionals and other professional groups. The process included systematics reviews of the literature, expert testimonies and stakeholder consultation. The guideline includes recommendations for local planning, clean air zones, measures to reduce emissions from public sector transport services, smooth driving and speed reduction, active travel, and awareness raising. The guideline recommends taking a number of actions in combination, because multiple interventions, each producing a small benefit, are likely to act cumulatively to produce significant change. These actions are likely to bring multiple public health benefits, in addition to air quality improvements.

Evidence-based management of systemic sclerosis: Navigating recommendations and guidelines.

PubMed

Pellar, Russell Edward; Pope, Janet Elizabeth

2017-06-01

Systemic sclerosis (SSc) is a rare heterogeneous connective tissue disease. Recommendations addressing the major issues in the management of SSc including screening and treatment of organ complications are needed. The updated European League Against Rheumatism/European Scleroderma Trial and Research (EULAR/EUSTAR) and the British Society of Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines were compared and contrasted. The updated EULAR/EUSTAR guidelines focus specifically on the management of SSc features and include data on newer therapeutic modalities and mention a research agenda. These recommendations are pharmacologic, with few guidelines regarding investigations and non-pharmacologic management. Recommendations from BSR/BHPR are similar to the organ manifestations mentioned in the EULAR/EUSTAR recommendations, and expand on several domains of treatment, including general measures, non-pharmacologic treatment, cardiac involvement, calcinosis, and musculoskeletal features. The guidelines usually agree with one another. Limitations include the lack of guidance for combination or second-line therapy, algorithmic suggestions, the absence of evidence-based recommendations regarding the treatment of specific complications (i.e., gastric antral ectasia and erectile dysfunction). Consensus for when to treat interstitial lung disease in SSc is lacking. There are differences between Europe and North American experts due to access and indications for certain therapies. Care gaps in SSc have been demonstrated so the EULAR/EUSTAR and BSR/BHP guidelines can promote best practices. Certain complications warrant active investigation to further improve outcomes in SSc and future updates of these recommendations. Care gaps in SSc have been demonstrated so the EULAR/EUSTAR and BSR/BHP guidelines can promote best practices. Certain complications warrant active investigation to further improve outcomes in SSc. Copyright © 2017 Elsevier Inc. All rights reserved.

Waivers for Mental Disorders in the Aviation Components of the Armed Services: Recommendations for Improving Evidence-Based Decisions and Aviator Return to Duty

DTIC Science & Technology

2016-03-02

mental health disorder , especially for attention deficit / hyperactivity disorder . In the Army’s waiver guide, the information required for...necessary for Attention Deficit / Hyperactivity Disorder and any disorder where aviators will be flying while on approved psychotropic medications, including...USAARL Report No. 2016-11 Waivers for Mental Disorders in the Aviation Components of the Armed Services: Recommendations for Improving Evidence

Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review

PubMed Central

Brand, Sarah L.; Thompson Coon, Jo; Fleming, Lora E.; Carroll, Lauren; Bethel, Alison; Wyatt, Katrina

2017-01-01

Background Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and “burnout” at work than staff in other sectors. There is a growing call for the ‘triple aim’ of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom’s (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff. Objectives This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing. Methods A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours. Results Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local staff needs that have extensive choice of activities to participate in (three studies). Only five of the interventions included substantial involvement and engagement of leadership and efforts aimed at up-skilling the leadership of staff to support staff health and wellbeing. Incorporation of more of the recommendations did not appear to be related to effectiveness. The heterogeneity of study designs, populations and outcomes excluded a meta-analysis. All studies were deemed by their authors to be at least partly effective. Two studies reported statistically significant improvement in objectively measured physical health (BMI) and eight in subjective mental health. Six studies reported statistically significant positive changes in subjectively assessed health behaviours. Conclusions This systematic review identified 11 studies which incorporate at least one of the Boorman recommendations and provides evidence that whole-system healthy workplace interventions can improve health and wellbeing and promote healthier behaviours in healthcare staff. PMID:29200422

Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review.

PubMed

Brand, Sarah L; Thompson Coon, Jo; Fleming, Lora E; Carroll, Lauren; Bethel, Alison; Wyatt, Katrina

2017-01-01

Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and "burnout" at work than staff in other sectors. There is a growing call for the 'triple aim' of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom's (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff. This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing. A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours. Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local staff needs that have extensive choice of activities to participate in (three studies). Only five of the interventions included substantial involvement and engagement of leadership and efforts aimed at up-skilling the leadership of staff to support staff health and wellbeing. Incorporation of more of the recommendations did not appear to be related to effectiveness. The heterogeneity of study designs, populations and outcomes excluded a meta-analysis. All studies were deemed by their authors to be at least partly effective. Two studies reported statistically significant improvement in objectively measured physical health (BMI) and eight in subjective mental health. Six studies reported statistically significant positive changes in subjectively assessed health behaviours. This systematic review identified 11 studies which incorporate at least one of the Boorman recommendations and provides evidence that whole-system healthy workplace interventions can improve health and wellbeing and promote healthier behaviours in healthcare staff.

Multidisciplinary Team Meetings appear to be effective in Inflammatory Bowel Disease Management: An audit of process and outcomes.

PubMed

Ferman, Mutaz; Lim, Amanda H; Hossain, Monowar; Siow, Glenn W; Andrews, Jane M

2018-05-14

Multidisciplinary team meetings (MDTMs) have proven efficacy in cancer management. Whilst widely implemented in inflammatory bowel disease (IBD) care, their value is yet to be investigated. We reviewed the performance of MDTMs for IBD patients. Retrospective review of MDTMs from March 2013 to July 2016. Each patient's first MDTM was considered. Data collected included: report production and location, disease factors, recommendation(s), implementation and barriers to implementation. The MDTM process was considered successful when at least top-level recommendations were implemented within 6 months. MDTM attendance included IBD gastroenterologist, surgeons, radiologist, nurses, dieticians, psychologists and clinical trial staff. Initial MDTM encounters for 166 patients were reviewed: 86 females; mean age 40 years; 140 (84.3%) with Crohn's disease; mean disease duration 10.8 years (interquartile range 15 years). Electronic reports were filed for all patients; hard copies in 84%. In 151/166 episodes, all (n=127) or top-line (n=24) recommendations were implemented, although there was a delay beyond 6 months in 5. Of 146 patients with a successful MDTM, 85 (58.2%) were in clinical remission at last review (median follow-up 27 months). Amongst patients with unsuccessful MDTMs (n=13), only 2 (15.4%) were in clinical remission at follow-up. Barriers to implementation included patients declining recommendations and loss to follow-up. The majority of MDTM encounters were successful from both a process and clinical outcome perspective. System opportunities to improve the process include ensuring 100% reports are available and addressing implementation delays. Patient factors to address include improved engagement and understanding reasons for declining recommendations. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Creating a State-Wide Virtual Health Library: The Michigan Experience.

ERIC Educational Resources Information Center

Brenneise, Harvey

The AccessMichigan Electronic Community Health Information Initiative (AMECHII) is a response to a recommendation of the Michigan Information Technology Commission Report recommending improved access to high-quality health care information for all Michigan stakeholders. This project is multi-type, including public, general academic, academic…

Report of the National Advisory Commission on Health Manpower. Volume 1.

ERIC Educational Resources Information Center

National Advisory Commission on Health Manpower, Washington, DC.

In 1966, the President established the National Advisory Commission on Health Manpower to "develop appropriate recommendations for action by government or by private institutions, organizations, or individuals for improving the availability and utilization of health manpower." Recommendations include: (1) federal funds to encourage…

7 CFR 958.47 - Research and development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... development projects, and marketing promotion including paid advertising, designed to assist, improve, or... the promotion and advertising of onions may utilize an identifying mark which shall be made available... § 958.46; (2) Its recommendation as to any research projects; and (3) Its recommendation as to promotion...

Making our offices universally accessible: guidelines for physicians

PubMed Central

Jones, K E; Tamari, I E

1997-01-01

OBJECTIVE: To develop recommendations for office-based physicians who wish to make their offices accessible to all patients. OPTIONS: Include taking steps to make offices more accessible, or not; offices may be accessible to varying degrees. OUTCOMES: Outcomes of accessibility involve patient-care, economic, ethical and legal issues. Stakeholders in these outcomes include patients, physicians, government and society. EVIDENCE: Data were obtained from a series of searches of MEDLINE, CINAHL and Healthstar (previously Health) databases for articles on disability and family medicine, primary (health) care and family practice, and on access and offices, and health services accessibility, and from a telephone survey of 50 stakeholders. VALUES: A high value was placed on services to persons with disabilities and on stakeholder input. Universal accessibility was valued as an overall goal; improved accessibility was also highly valued. BENEFITS, HARMS AND COSTS: Benefits to patients include improved access to care as guaranteed by the Canada Health Act and in keeping with provincial Human Rights Codes. Benefits to physicians include contact with a broader patient population and freedom from fear of litigation. Costs of improved accessibility vary depending on individual circumstances and on whether an office is being built or renovated; some improvement costs are minimal. RECOMMENDATIONS: All physicians should take measures to improve practice accessibility. Improved access should be considered in each of the following areas: transportation and entrance to the facility, entrance to the office, waiting rooms, rest rooms, examination rooms, general building features and other features. VALIDATION: No similar guidelines exist. To assess the content validity of these guidelines, the authors had a draft document reviewed by 18 stakeholders. All specific recommendations met the minimum criterion of adherence to current legislation, including national and provincial building codes. The specific recommendations are endorsed by the Canadian Paraplegic Association (national and Ontario offices), the DisAbled Women's Network (Ontario) and the Centre for Independent Living (Toronto). SPONSORS: Development of these guidelines was supported in part by the Department of Family and Community Medicine, Toronto Hospital, Toronto, Ont. PMID:9068570

Improved Information and Educational Messages on Outer Packaging of Micronutrient Powders Distributed in Indonesia Increase Caregiver Knowledge and Adherence to Recommended Use.

PubMed

Sutrisna, Aang; Vossenaar, Marieke; Poonawala, Alia; Mallipu, Agnes; Izwardy, Doddy; Menon, Ravi; Tumilowicz, Alison

2018-06-08

The objective of this study was to examine the influence of improved information and educational messages on outer packaging of a micronutrient powder (MNP), locally known as “ Taburia ”, on knowledge and adherence to recommended use. A community-based cluster randomized controlled trial was conducted among 1149 caregivers and their children aged 6⁻36 months. Caregiver⁻child dyads were randomized by their villages to receive 30 sachets of Taburia with the: (i) original outer packaging; (ii) improved outer packaging; or (iii) improved outer packaging combined with cooking demonstrations. Adherence to Taburia use was assessed through caregiver interviews and observation of unused sachets during home visits; “high” adherence was defined as consuming 13⁻17 sachets in the previous month. Data collection included surveys and focus groups discussions. The majority of caregivers (>80%) preferred the improved packaging because it was more attractive and contained more comprehensive information. Caregivers who received the improved packaging had better knowledge regarding the recommended use of Taburia ( p < 0.001) and higher adherence with the prescribed use of Taburia (43% with “high” adherence) ( p < 0.001) than those who received the original packaging (29% with “high” adherence). Caregivers who participated in cooking demonstrations generally had better knowledge regarding the benefits of Taburia and recommended use, but this did not lead to higher adherence to recommended use. “Underconsumption” of Taburia (≤7 sachets) was much less prevalent than “overconsumption” (≥23 sachets), and original packaging users were more likely to consume Taburia daily instead of every two days as recommended. We conclude that the design of the outer packaging and comprehensiveness of information provided are important influencers of recommended MNP use by caregivers.

Assessing the impact of the U.S. Endangered Species Act recovery planning guidelines on managing threats for listed species.

PubMed

Troyer, Caitlin M; Gerber, Leah R

2015-10-01

The Endangered Species Act (ESA) of the United States was enacted in 1973 to prevent the extinction of species. Recovery plans, required by 1988 amendments to the ESA, play an important role in organizing these efforts to protect and recover species. To improve the use of science in the recovery planning process, the Society for Conservation Biology (SCB) commissioned an independent review of endangered species recovery planning in 1999. From these findings, the SCB made key recommendations for how management agencies could improve the recovery planning process, after which the U.S. Fish and Wildlife Service and the National Marine Fisheries Service redrafted their recovery planning guidelines. One important recommendation called for recovery plans to make threats a primary focus, including organizing and prioritizing recovery tasks for threat abatement. We sought to determine the extent to which results from the SCB study were incorporated into these new guidelines and whether the SCB recommendations regarding threats manifested in recovery plans written under the new guidelines. Recovery planning guidelines generally incorporated the SCB recommendations, including those for managing threats. However, although recent recovery plans have improved in their treatment of threats, many fail to adequately incorporate threat monitoring. This failure suggests that developing clear guidelines for monitoring should be an important priority in improving ESA recovery planning. © 2015 Society for Conservation Biology.

Railroad safety program, volume 1

NASA Technical Reports Server (NTRS)

1985-01-01

Since 1981, the Federal Railroad Administration (FRA) has annually prepared a National Inspection Plan (NIP) whose purpose is to summarize regional efforts to improve railroad transportation safety. The research concluded on the following tasks including the problems, conclusions and recommendations associated with these tasks is summarized: (1) the preparation of the 1983 NIP, with recommended procedures for improving future NIPs; (2) the development of an outline for the 1984 NIP, including a methodology for the allocation of inspection resources and other specialized regional activities; (3) the management and development of the 1984 NIP; and (4) the development of an instruction manual to be used in the preparation of future NIPs.

Quality improvement in neurology residency programs. Report of the Quality Improvement Committee of the Association of University Professors of Neurology.

PubMed

Bradley, W G; Daube, J; Mendell, J R; Posner, J; Richman, D; Troost, B T; Swift, T R

1997-11-01

The neurology residency programs in the United States are facing a crisis of quality. The Association of University Professors of Neurology (AUPN) approved the Quality Improvement Committee to examine this situation and make recommendations, which have been accepted by the AUPN. The recommendations are (1) that the educational goals of neurology residency training be dissociated from patient-care needs in academic medical centers and (2) that minimum levels of quality be applied to residents in neurology residency programs and to these programs themselves. These minimum criteria should include minimum educational criteria for entry into the program, minimum criteria for advancement from one year to the next in the program, and minimum criteria for performance of the graduates of neurology residency programs for program accreditation. The implementation of these recommendations will require a shift of funding of the care of indigent patients from the graduate medical education budget to direct patient-care sources. These recommendations will significantly improve the quality of neurologists and neurologic care in the United States.

Defense Nuclear Enterprise: DOD Has Established Processes for Implementing and Tracking Recommendations to Improve Leadership, Morale, and Operations

DTIC Science & Technology

2016-07-14

and (2) track the implementation of these recommendations and measure the effectiveness of the actions it has taken to address them. We briefed the... effectiveness of actions taken, we reviewed key documents, including the reports of the nuclear enterprise reviews, Strategic Command’s action plan, DOD...Federal Government—including assessing and responding to risk, using and effectively communicating quality information, and performing monitoring

Student Motivation, Attitude, and Approach to Learning: Notes from a Novice Teacher.

ERIC Educational Resources Information Center

Vivaldo-Lima, Eduardo

2001-01-01

Describes what young professors can do considering student motivation, learning styles, and instructional effectiveness to improve student learning. Lists recommendations from experts on how to improve student learning. Includes 25 references. (Author/YDS)

Consensus recommendations for the postmortem diagnosis of Alzheimer's disease. The National Institute on Aging, and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease.

PubMed

1997-01-01

This report summarizes the consensus recommendations of a panel of neuropathologists from the United States and Europe to improve the postmortem diagnostic criteria for Alzheimer's disease. The recommendations followed from a two-day workshop sponsored by the National Institute on Aging (NIA) and the Ronald and Nancy Reagan Institute of the Alzheimer's Association to reassess the original NIA criteria for the postmortem diagnosis of Alzheimer's disease published in 1985. The consensus recommendations for improving the neuropathological criteria for the postmortem diagnosis of Alzheimer's disease are reported here, and the "position papers" by members of the Working Group that accompany this report elaborate on the research findings and concepts upon which these recommendations were based. Further, commentaries by other experts in the field also are included here to provide additional perspectives on these recommendations. Finally, it is anticipated that future meetings of the Working Group will reassess these recommendations and the implementation of postmortem diagnostic criteria for Alzheimer's disease.

Deaf Education Services in Southern Regions of Vietnam: A Survey of Teacher Perceptions and Recommendations

ERIC Educational Resources Information Center

Nelson, Lauri H.

2015-01-01

Purpose: This survey study explored teacher perceptions regarding services for children who are deaf or hard of hearing in southern regions of Vietnam, including educational successes and challenges, the availability and use of hearing technology, and teacher recommendations for improving child outcomes. Method: Using a cross-sectional survey…

To Strengthen Quality in Higher Education. Summary Recommendations of the National Commission on Higher Education Issues.

ERIC Educational Resources Information Center

National Commission in Higher Education Issues, Washington, DC.

Recommendations for improving educational quality and strengthening public confidence in American higher education are offered, based on the deliberations of the National Commission on Higher Education, which existed for 1 year and held four meetings. Areas of concern include: setting priorities for the institution and strengthening administrative…

The Donaldson Review and Scottish Baccalaureates--A Model for Implementation in Schools

ERIC Educational Resources Information Center

Ritchie, Margaret R.; Keith, David; Jones, Deuan; Ramnarine, Sabrina; Spiers, Andrew

2012-01-01

In January 2011, a review about teacher education in Scotland included 50 recommendations designed to improve the learning of young people in Scotland. A feature of the recommendations was enhancement of teacher education via new national initiatives and strengthened partnerships between schools, local authorities and universities. The Scottish…

Assessing the Use of Media Reporting Recommendations by the World Health Organization in Suicide News Published in the Most Influential Media Sources in China, 2003-2015.

PubMed

Chu, Xin; Zhang, Xingyi; Cheng, Peixia; Schwebel, David C; Hu, Guoqing

2018-03-05

Public media reports about suicide are likely to influence the population's suicidal attempts and completed suicides. Irresponsible reports might trigger copycat suicidal behaviors, while responsible reports may help reduce suicide rates. The World Health Organization (WHO) released recommendations to encourage responsible suicide reports in 2008. However, little is known about whether these recommendations are reflected in the suicide news for most countries, including China. In this study, we assessed the responsibility of suicide stories published in the most influential newspaper and Internet media sources in China from 2003 to 2015, using the media reporting recommendations by the World Health Organization (WHO). In total, 3965 and 1836 eligible stories from newspaper and Internet-based media, respectively, were included in the study. Newspapers and Internet-based media performed similarly in applying WHO recommendations to report suicide news. Three recommendations were applied in over 88% of suicide stories. However, four recommendations were seldom applied, including offering information about where to seek help and linking the suicide event to mental disorders. Government and the journalism industry should work together to improve media reporting of news about suicide in China.

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.

Transparency in a Pediatric Quality Improvement Collaborative: A Passionate Journey by NPC-QIC Clinicians and Parents.

PubMed

Lihn, Stacey L; Kugler, John D; Peterson, Laura E; Lannon, Carole M; Pickles, Diane; Beekman, Robert H

2015-01-01

Transparency-sharing data or information about outcomes, processes, protocols, and practices-may be the most powerful driver of health care improvement. In this special article, the development and growth of transparency within the National Pediatric Cardiology Quality Improvement Collaborative is described. The National Pediatric Cardiology Quality Improvement Collaborative transparency journey is guided by equal numbers of clinicians and parents of children with congenital heart disease working together in a Transparency Work Group. Activities are organized around four interrelated levels of transparency (individual, organizational, collaborative, and system), each with a specified purpose and aim. A number of Transparency Work Group recommendations have been operationalized. Aggregate collaborative performance is now reported on the public-facing web site. Specific information that the Transparency Work Group recommends centers provide to parents has been developed and published. Almost half of National Pediatric Cardiology Quality Improvement Collaborative centers participated in a pilot of transparently sharing their outcomes achieved with one another. Individual centers have also begun successfully implementing recommended transparency activities. Despite progress, barriers to full transparency persist, including health care organization concerns about potential negative effects of disclosure on reputation and finances, and lack of reliable definitions, data, and reporting standards for fair comparisons of centers. The National Pediatric Cardiology Quality Improvement Collaborative's transparency efforts have been a journey that continues, not a single goal or destination. Balanced participation of clinicians and parents has been a critical element of the collaborative's success on this issue. Plans are in place to guide implementation of additional transparency recommendations across all four levels, including extension of the activities beyond the collaborative to support transparency efforts in national cardiology and cardiac surgery societies. © 2015 Wiley Periodicals, Inc.

Group visits for chronic illness management: implementation challenges and recommendations.

PubMed

Jones, Katherine R; Kaewluang, Napatsawan; Lekhak, Nirmala

2014-01-01

The group visit approach to improve chronic illness self-management appears promising in terms of selected outcomes, but little information is available about best ways to organize and implement group visits. This literature review of 84 articles identified group visit implementation challenges, including lack of a group visit billing code, inadequate administrative support and resources, difficult participant recruitment and retention, and logistical issues such as space and scheduling. Recommendations for future implementation initiatives were also abstracted from the literature. Patients and providers can benefit from well-planned and well-conducted group visits. These benefits include greater patient and provider satisfaction, reduced overall utilization, improved clinical outcomes, and greater provider efficiency and productivity.

The APOSTEL recommendations for reporting quantitative optical coherence tomography studies.

PubMed

Cruz-Herranz, Andrés; Balk, Lisanne J; Oberwahrenbrock, Timm; Saidha, Shiv; Martinez-Lapiscina, Elena H; Lagreze, Wolf A; Schuman, Joel S; Villoslada, Pablo; Calabresi, Peter; Balcer, Laura; Petzold, Axel; Green, Ari J; Paul, Friedemann; Brandt, Alexander U; Albrecht, Philipp

2016-06-14

To develop consensus recommendations for reporting of quantitative optical coherence tomography (OCT) study results. A panel of experienced OCT researchers (including 11 neurologists, 2 ophthalmologists, and 2 neuroscientists) discussed requirements for performing and reporting quantitative analyses of retinal morphology and developed a list of initial recommendations based on experience and previous studies. The list of recommendations was subsequently revised during several meetings of the coordinating group. We provide a 9-point checklist encompassing aspects deemed relevant when reporting quantitative OCT studies. The areas covered are study protocol, acquisition device, acquisition settings, scanning protocol, funduscopic imaging, postacquisition data selection, postacquisition data analysis, recommended nomenclature, and statistical analysis. The Advised Protocol for OCT Study Terminology and Elements recommendations include core items to standardize and improve quality of reporting in quantitative OCT studies. The recommendations will make reporting of quantitative OCT studies more consistent and in line with existing standards for reporting research in other biomedical areas. The recommendations originated from expert consensus and thus represent Class IV evidence. They will need to be regularly adjusted according to new insights and practices. © 2016 American Academy of Neurology.

System Safety in an IT Service Organization

NASA Astrophysics Data System (ADS)

Parsons, Mike; Scutt, Simon

Within Logica UK, over 30 IT service projects are considered safetyrelated. These include operational IT services for airports, railway infrastructure asset management, nationwide radiation monitoring and hospital medical records services. A recent internal audit examined the processes and documents used to manage system safety on these services and made a series of recommendations for improvement. This paper looks at the changes and the challenges to introducing them, especially where the service is provided by multiple units supporting both safety and non-safety related services from multiple locations around the world. The recommendations include improvements to service agreements, improved process definitions, routine safety assessment of changes, enhanced call logging, improved staff competency and training, and increased safety awareness. Progress is reported as of today, together with a road map for implementation of the improvements to the service safety management system. A proposal for service assurance levels (SALs) is discussed as a way forward to cover the wide variety of services and associated safety risks.

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

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.

Trends in dietary patterns and compliance with World Health Organization recommendations: a cross-country analysis.

PubMed

Mazzocchi, Mario; Brasili, Cristina; Sandri, Elisa

2008-05-01

To investigate time patterns of compliance with nutrient goals recommended by the World Health Organization (WHO). A single aggregated indicator of distance from the key WHO recommendations for a healthy diet is built using FAOSTAT intake data, bounded between 0 (maximum possible distance from goals) and 1 (perfect adherence). Two hypotheses are tested for different country groupings: (1) whether adherence has improved over time; and (2) whether cross-country disparities in terms of diet healthiness have decreased. One hundred and forty-nine countries, including 26 countries belonging to the Organisation for Economic Co-operation and Development (OECD) and 115 developing countries (including 43 least developed countries), with yearly data over the period 1961-2002. The Recommendation Compliance Index (RCI) shows significant improvements in adherence to WHO goals for both developing and especially OECD countries. The latter group of countries show the highest levels of the RCI and the largest increase over time, especially between 1981 and 2002. No improvement is detected for least developed countries. A reduction in disparities (convergence of the RCI) is observed only within the OECD grouping. Adherence to healthy eating guidelines depends on economic development. Diets are improving and converging in advanced economies, but developing and especially least developed countries are still far from meeting WHO nutrition goals. This confirms findings on the double burden of malnutrition and suggests that economic drivers are more relevant than socio-cultural factors in determining the healthiness of diets.

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

Doctrinal Guidelines for Quantitative Vulnerability Assessments of Infrastructure-Related Risks. Volume I

DTIC Science & Technology

2011-12-01

Services; Nuclear Reactors, Materials, and Waste; Information Technology; Communications ; Postal and Shipping; Transportation Systems; and Government...Materials, and Waste; Information Technology; Communications ; Postal and Shipping; Transportation Systems; and Government Facilities). 4 National...recommendations for best practices, including outreach and communications ; and e) Recommend how DHS can improve its risk analyses and how those analyses can

Defining a standard set of patient-centered outcomes for men with localized prostate cancer.

PubMed

Martin, Neil E; Massey, Laura; Stowell, Caleb; Bangma, Chris; Briganti, Alberto; Bill-Axelson, Anna; Blute, Michael; Catto, James; Chen, Ronald C; D'Amico, Anthony V; Feick, Günter; Fitzpatrick, John M; Frank, Steven J; Froehner, Michael; Frydenberg, Mark; Glaser, Adam; Graefen, Markus; Hamstra, Daniel; Kibel, Adam; Mendenhall, Nancy; Moretti, Kim; Ramon, Jacob; Roos, Ian; Sandler, Howard; Sullivan, Francis J; Swanson, David; Tewari, Ashutosh; Vickers, Andrew; Wiegel, Thomas; Huland, Hartwig

2015-03-01

Value-based health care has been proposed as a unifying force to drive improved outcomes and cost containment. To develop a standard set of multidimensional patient-centered health outcomes for tracking, comparing, and improving localized prostate cancer (PCa) treatment value. We convened an international working group of patients, registry experts, urologists, and radiation oncologists to review existing data and practices. The group defined a recommended standard set representing who should be tracked, what should be measured and at what time points, and what data are necessary to make meaningful comparisons. Using a modified Delphi method over a series of teleconferences, the group reached consensus for the Standard Set. We recommend that the Standard Set apply to men with newly diagnosed localized PCa treated with active surveillance, surgery, radiation, or other methods. The Standard Set includes acute toxicities occurring within 6 mo of treatment as well as patient-reported outcomes tracked regularly out to 10 yr. Patient-reported domains of urinary incontinence and irritation, bowel symptoms, sexual symptoms, and hormonal symptoms are included, and the recommended measurement tool is the Expanded Prostate Cancer Index Composite Short Form. Disease control outcomes include overall, cause-specific, metastasis-free, and biochemical relapse-free survival. Baseline clinical, pathologic, and comorbidity information is included to improve the interpretability of comparisons. We have defined a simple, easily implemented set of outcomes that we believe should be measured in all men with localized PCa as a crucial first step in improving the value of care. Measuring, reporting, and comparing identical outcomes across treatments and treatment centers will provide patients and providers with information to make informed treatment decisions. We defined a set of outcomes that we recommend being tracked for every man being treated for localized prostate cancer. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Tropospheric Airborne Meteorological Data Reporting (TAMDAR) Sensor Development

NASA Technical Reports Server (NTRS)

Daniels, Taumi S.; Tsoucalas, George; Anderson, Mark; Mulally, Daniel; Moninger, William; Mamrosh, Richard

2004-01-01

One of the recommendations of the National Aviation Weather Program Council was to expand and institutionalize the generation, dissemination, and use of automated pilot reports (PIREPS) to the full spectrum of the aviation community, including general aviation. In response to this and other similar recommendations, NASA initiated cooperative research into the development of an electronic pilot reporting capability (Daniels 2002). The ultimate goal is to develop a small low-cost sensor, collect useful meteorological observations below 25,000 ft., downlink the data in near real time, and use the data to improve weather forecasts. Primary users of the data include pilots, who are one targeted audience for the improved weather information that will result from the TAMDAR data. The weather data will be disseminated and used to improve aviation safety by providing pilots with enhanced weather situational awareness. In addition, the data will be used to improve the accuracy and timeliness of weather forecasts. Other users include air traffic controllers, flight service stations, and airline weather centers. Additionally, the meteorological data collected by TAMDAR is expected to have a significant positive impact on forecast accuracy for ground based applications.

ASCCP Colposcopy Standards: Risk-Based Colposcopy Practice.

PubMed

Wentzensen, Nicolas; Schiffman, Mark; Silver, Michelle I; Khan, Michelle J; Perkins, Rebecca B; Smith, Katie M; Gage, Julia C; Gold, Michael A; Conageski, Christine; Einstein, Mark H; Mayeaux, Edward J; Waxman, Alan G; Huh, Warner K; Massad, L Stewart

2017-10-01

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. This article describes the rationale, evidence, and recommendations related to risk-based colposcopy practice. Women referred to colposcopy have a wide range of underlying precancer risk, which can be estimated by referral screening tests including cytology and human papillomavirus testing, in conjunction with the colposcopic impression. Multiple targeted biopsies, at least 2 and up to 4, are recommended to improve detection of prevalent precancers. At the lowest end of the risk spectrum, untargeted biopsies are not recommended, and women with a completely normal colposcopic impression can be observed. At the highest end of the risk spectrum, immediate treatment is an alternative to biopsy confirmation. Assessing the risk of cervical precancer at the colposcopy visit allows for modification of colposcopy procedures consistent with a woman's risk. Implementation of these recommendations is expected to lead to improved detection of cervical precancers at colposcopy, while providing more reassurance of negative colposcopy results.

Recommendations to Support Nurses and Improve the Delivery of Oncology and Palliative Care in India.

PubMed

LeBaron, Virginia T; Palat, Gayatri; Sinha, Sudha; Chinta, Sanjeeva Kumari; Jamima, Beaulah John Battula; Pilla, Usha Lakshmi; Podduturi, Nireekshana; Shapuram, Yadamma; Vennela, Padma; Rapelli, Vineela; Lalani, Zahra; Beck, Susan L

2017-01-01

Nurses in India often practice in resource-constrained settings and care for cancer patients with high symptom burden yet receive little oncology or palliative care training. The aim of this study is to explore challenges encountered by nurses in India and offer recommendations to improve the delivery of oncology and palliative care. Qualitative ethnography. The study was conducted at a government cancer hospital in urban South India. Thirty-seven oncology/palliative care nurses and 22 others (physicians, social workers, pharmacists, patients/family members) who interact closely with nurses were included in the study. Data were collected over 9 months (September 2011- June 2012). Key data sources included over 400 hours of participant observation and 54 audio-recorded semi-structured interviews. Systematic qualitative analysis of field notes and interview transcripts identified key themes and patterns. Key concerns of nurses included safety related to chemotherapy administration, workload and clerical responsibilities, patients who died on the wards, monitoring family attendants, and lack of supplies. Many participants verbalized distress that they received no formal oncology training. Recommendations to support nurses in India include: prioritize safety, optimize role of the nurse and explore innovative models of care delivery, empower staff nurses, strengthen nurse leadership, offer relevant educational programs, enhance teamwork, improve cancer pain management, and engage in research and quality improvement projects. Strong institutional commitment and leadership are required to implement interventions to support nurses. Successful interventions must account for existing cultural and professional norms and first address safety needs of nurses. Positive aspects from existing models of care delivery can be adapted and integrated into general nursing practice.

A Framework for Measurement Feedback to Improve Decision-Making in Mental Health

PubMed Central

Chorpita, Bruce F.; Reay, William E.; Stelk, Wayne; Garland, Ann F.; Kutash, Krista; Mullican, Charlotte; Ringeisen, Heather

2009-01-01

The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field. PMID:20041342

Turbine generator evaluation for the Eesti-Energia Estonia and Baltic power plants. Export trade information

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

NONE

1995-12-01

The report evaluates the feasibility of 200 MW turbines and generators modernization in two Estonian power plants in order to improve performance and/or availability. This is Volume 1 and it includes the following: (1) scope; (2) evaluation approach; (3) summary of major recommendations; (4) performance tests descriptions; (5) current technology -- component description; (6) recommended studies; (7) recommendations; (8) district heating; (9) description of turbine K-200-130; (10) turbine evaluation results; (11) generator; (12) estimation of modernization costs.

Friend suggestion in social network based on user log

NASA Astrophysics Data System (ADS)

Kaviya, R.; Vanitha, M.; Sumaiya Thaseen, I.; Mangaiyarkarasi, R.

2017-11-01

Simple friend recommendation algorithms such as similarity, popularity and social aspects is the basic requirement to be explored to methodically form high-performance social friend recommendation. Suggestion of friends is followed. No tags of character were followed. In the proposed system, we use an algorithm for network correlation-based social friend recommendation (NC-based SFR).It includes user activities like where one lives and works. A new friend recommendation method, based on network correlation, by considering the effect of different social roles. To model the correlation between different networks, we develop a method that aligns these networks through important feature selection. We consider by preserving the network structure for a more better recommendations so that it significantly improves the accuracy for better friend-recommendation.

Adherence to Treatment in Hypertension.

PubMed

Villalva, Carlos Menéndez; Alvarez-Muiño, Xosé Luís López; Mondelo, Trinidad Gamarra; Fachado, Alfonso Alonso; Fernández, Joaquín Cubiella

2017-01-01

The lack of adherence to treatment in hypertension affects approximately 30 % of patients. The elderly, those with several co-morbidities, social isolation, low incomes or depressive symptoms are the most vulnerable to this problem. There is no ideal method to quantify the adherence to the treatment. Indirect methods are recommended in clinical practice. Any intervention strategy should not blame the patient and try a collaborative approach. It is recommended to involve the patient in decision-making. The clinical interview style must be patient-centered including motivational techniques. The improvement strategies that showed greater effectiveness in the compliance of hypertension treatment were: treatment simplification, appointment reminders systems, blood pressure self-monitoring, organizational improvements and nurse and pharmacists care. The combination of different interventions are recommended against isolated interventions.

International summit on the nutrition of adolescent girls and young women: consensus statement

PubMed Central

Krebs, Nancy; Bagby, Susan; Bhutta, Zulfiqar A.; Dewey, Kathryn; Fall, Caroline; Gregory, Fred; Hay, William; Rhuman, Lisa; Caldwell, Christine Wallace

2017-01-01

An international summit focusing on the difficult challenge of providing adequate nutrition for adolescent girls and young women in low‐ and middle‐income countries was held in Portland, Oregon in 2015. Sixty‐seven delegates from 17 countries agreed on a series of recommendations that would make progress toward improving the nutritional status of girls and young women in countries where their access to nutrition is compromised. Delegate recommendations include: (1) elevate the urgency of nutrition for girls and young women to a high international priority, (2) raise the social status of girls and young women in all regions of the world, (3) identify major knowledge gaps in the biology of adolescence that could be filled by robust research efforts, (4) and improve access to nutrient‐rich foods for girls and young women. Attention to these recommendations would improve the health of young women in all nations of the world. PMID:28722768

In-center hemodialysis attendance: patient perceptions of risks, barriers, and recommendations.

PubMed

Chenitz, Kara B; Fernando, Michael; Shea, Judy A

2014-04-01

Missed hemodialysis treatments lead to increased morbidity and mortality in the end-stage renal disease population. Little is known about why patients have difficulty attending their scheduled in-center dialysis treatments. Semistructured interviews with 15 adherent and 15 nonadherent hemodialysis patients were conducted to determine patients' attitudes about dialysis, health beliefs and risk perception regarding missed treatments, barriers and facilitators to hemodialysis attendance, and recommendations to improve the system to facilitate dialysis attendance. Average time on dialysis was 2.5 years for the nonadherent group and 7.3 years in the adherent group. In both groups, patients felt that dialysis is life-saving and a necessity. A substantial number of patients in both groups understood that missing hemodialysis treatments is dangerous and several patients could clearly communicate the risk of skipping. The most common barriers to hemodialysis were inadequate or unreliable transportation (mentioned in both groups) and a lack of motivation to get to dialysis or that dialysis is not a priority (typically mentioned by the nonadherent group). Facilitators to hemodialysis attendance included explanations from the health care team regarding the risk of skipping and relationships with other dialysis patients. Patient recommendations to improve dialysis attendance included continued education about the risk of poor attendance and more accessible transportation. Patients did not feel that home dialysis would improve adherence. Hemodialysis patients must adhere to a complex and burdensome regimen. Through the elucidation of barriers and facilitators to hemodialysis attendance and through specific patient recommendations, at least three interventions may be further investigated to improve hemodialysis attendance: Improvement of the transportation system, education and supportive encouragement from the health care team, and peer support mentorship. © 2014 International Society for Hemodialysis.

Improvement of Physical Therapist Assessment of Risk of Falls in the Hospital and Discharge Handover Through an Intervention to Modify Clinical Behavior.

PubMed

Thomas, Susie; Mackintosh, Shylie

2016-06-01

Discharge from the hospital is a high risk transition period for older adults at risk of falls. Guidelines relevant to physical therapists for managing this risk are well documented, but commonly not implemented. This project implemented an intervention to improve physical therapists' adherence to key guideline recommendations for managing risk of falls on discharge from one hospital. A pretest-posttest study design was undertaken and was underpinned by the Theoretical Domains Framework (TDF) to aid in the design of interventions to increase physical therapists' adherence to guideline recommendations and to identify barriers to these interventions. A multifaceted intervention was implemented, including the establishment of a governance committee, education sessions, development of a "pathway" to guide practice, modification of an existing standardized assessment proforma, development of standardized processes and indicators for handover, increasing availability of educational handouts, audit and feedback processes, and allocation of dedicated staffing to oversee falls prevention within the physical therapy department. There were significant improvements in physical therapist behavior leading to key guideline recommendations being met, including: the proportion of patients who were identified to be at risk of falls (6.3% preintervention versus 94.8% postintervention) prior to discharge, an increase in documentation of clinical handover at discharge (68.6% preintervention versus 90.9% postintervention), and improvement in the quality of this documented clinical handover (34.9% of case notes met 5 criteria preintervention versus 92.9% postintervention). The approach was resource intensive and consequently may be difficult to replicate at other sites. A multifaceted intervention underpinned by the TDF, designed to modify physical therapists' behavior to improve adherence to guideline recommendations for managing risk of falls on discharge from one hospital, was successful. © 2016 American Physical Therapy Association.

Policy recommendations for rare disease centres of expertise.

PubMed

Syed, Ahmed M; Camp, Rob; Mischorr-Boch, Christina; Houÿez, Francois; Aro, Arja R

2015-10-01

Rare diseases are a serious public health concern and are a priority in the EU. This study aims to develop policy recommendations for rare disease centres of expertise (CoEs) in order to improve standards and quality of care. A modified 3-round Delphi technique was used. Participants included rare diseases patients, carers, patient representatives and healthcare professionals (HCPs) from CoEs in two countries-Denmark and the UK. The results suggest the need to make improvements within current CoE environments, access to CoEs and the need for coordination and cooperation of services within and outside CoEs. It is recommended that CoEs are not overly 'medicalised', while at the same time they should be established as research facilities. The importance of including patient representatives in CoE performance management was also highlighted. Raising awareness and provision of appropriate training amongst non-specialist HCPs is seen as a priority for early and correct diagnosis and ensuring high quality care. Similarly, provision of targeted information about patients' illness and care was considered essential along with access to social assistance within CoEs. Policy recommendations were developed in areas previously recognised as having gaps. Their implementation is expected to strengthen and improve current care provision for rare disease patients. In member states where national plans and strategies are being developed, it is recommended to replicate the methodological approach used in this study as it has proven to be a helpful tool in rare disease centres of expertise policy development. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Evidence-based rehabilitation of mobility after stroke].

PubMed

Dohle, C; Tholen, R; Wittenberg, H; Quintern, J; Saal, S; Stephan, K M

2016-10-01

Approximately two thirds of stroke patients initially suffer from at least impaired mobility. Various rehabilitation concepts have been proposed. Based on the current literature, which rehabilitation methods can be recommended for improvement of gait, gait velocity, gait distance and balance? A systematic literature search was carried out for randomized clinical studies and reviews with clinically relevant outcome variables. Formulation of recommendations, separated for target variables and time after stroke. Restoration and improvement of gait function relies on a high number of repetitions of gait movements, which for more severely affected patients is preferentially machine-based. For improvement of gait velocity for less severely affected patients intensive gait training does not necessarily rely on mechanical support. Gait distance can be improved by aerobic endurance exercises with a cardiovascular effect, which have to be performed in a functional context. Improvement of balance should be achieved by intensive functional gait training. Additional stimulation techniques are only effective when included in a functionally relevant training program. These guidelines not only provide recommendations for action but also provide pathophysiological insights into functional restoration of stance and gait after stroke.

Strategies for Postsecondary Students in Developmental Education: A Practice Guide for College and University Administrators, Advisors, and Faculty. NCEE 2017-4011

ERIC Educational Resources Information Center

Bailey, Thomas; Bashford, Joanne; Boatman, Angela; Squires, John; Weiss, Michael; Doyle, William; Valentine, Jeffrey C.; LaSota, Robin; Polanin, Joshua R.; Spinney, Elizabeth; Wilson, Wesley; Yelde, Martha; Young, Sarah H.

2016-01-01

This practice guide presents six evidence-based recommendations for college and university faculty, administrators, and advisors working to improve the success of students academically underprepared for college. Each recommendation includes an overview of the practice, a summary of evidence used in support of the evidence rating, guidance on how…

Physician Manpower in Georgia: Report of the Task Force for Physician Manpower to the Georgia Comprehensive Health Planning Council.

ERIC Educational Resources Information Center

Georgia State Dept. of Public Health, Atlanta. Office of Comprehensive Health Planning.

This report is a result of a study of the state's physician manpower by representatives of the fields of medical education and professional practice in Georgia. Contents include introduction and principal findings, recommendations, and analysis of present supply of physicians and other data. Recommendations suggest improvement of the utilization…

Redefining Security. A Report by the Joint Security Commission

DTIC Science & Technology

1994-02-28

security policies. This report offers recommendations on developing new strategies for achieving security within our infor-mation systems, including...better, and we outline methods of improving government and industry personnel security poli- cies. We offer recommendations on developing new strategies ... strategies , sufficient funding, and management attention if our comput- ers and networks are to protect the confidentiality, integrity, and availability of

The new American Heart Association cardiopulmonary resuscitation guidelines: should children and adults have to share?

PubMed

Sherman, Mindy

2007-06-01

The latest American Heart Association guidelines for pediatric cardiopulmonary resuscitation (CPR) were published in December 2005. Changes from the 2000 guidelines were directed toward simplifying CPR. Infants, children, and adults now share the same recommendation for the initial compression:ventilation ratio. This is a significant change for pediatricians trained in the importance of a respiratory etiology of pediatric cardiopulmonary arrest. The present review will focus on the rationale behind these guideline changes. The new guidelines for single rescuer CPR include a compression:ventilation ratio of 30: 2 for both adult and pediatric victims. The impetus for this recommendation is based on recent appreciation for the deleterious effects of hyperventilation as well as an attempt to increase bystander delivery of CPR. The physiologic results of hyperventilation are discussed. The new pediatric basic life support guideline changes are underscored. Research representing the spectrum of opinions on the optimal compression:ventilation ratio, including compression-only CPR, is presented. Although based primarily on adult, animal, and computational models, the new compression:ventilation ratio, recommended for both initial pediatric and adult CPR, is a reasonable recommendation. The simplified CPR guidelines released in 2005 will hopefully contribute to improved bystander delivery of CPR and improved outcome.

Improving the Medical Curriculum in Predoctoral Dental Education: Recommendations From the American Association of Oral and Maxillofacial Surgeons Committee on Predoctoral Education and Training.

PubMed

Dennis, Matthew J; Bennett, Jeffrey D; DeLuke, Dean M; Evans, Erik W; Hudson, John W; Nattestad, Anders; Ness, Gregory M; Yeung, Allison

2017-02-01

Dental procedures are often performed on patients who present with some level of medical fragility. In many dental schools, the exercise of taking a medical history is all too often a transcription of information to the dental chart, with little emphasis on the presurgical risk assessment and the development of a treatment plan appropriate to the medical status of the dental patient. Changes in dentistry, driven by an increasingly medically complex population of dental patients, combined with treatment advances rooted in the biomedical sciences necessitate the adaptation of our dental education to include a stronger background in systemic health. Many predoctoral educators in the American Association of Oral and Maxillofacial Surgeons (AAOMS) have expressed concern about the medical preparedness of our dental students; therefore, the AAOMS and its Committee on Predoctoral Education and Training have provided recommendations for improving the medical curriculum in predoctoral dental education, including a strengthening of training in clinical medicine and biomedical sciences, with specific recommendations for improved training of our dental students and dental faculty. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records

PubMed Central

Chen, Jonathan H; Podchiyska, Tanya

2016-01-01

Objective: To answer a “grand challenge” in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com’s product recommender. Materials and Methods: EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender’s ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Results: Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10−10) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10−16). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. Discussion: Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from “correct” ones. Conclusions: Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. “interesting” suggestions). PMID:26198303

Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice

PubMed Central

Rogers, Jess; Manca, Donna; Lang-Robertson, Kelly; Bell, Stephanie; Salvalaggio, Ginetta; Greiver, Michelle; Korownyk, Christina; Klein, Doug; Carroll, June C.; Kahan, Mel; Meuser, Jamie; Buchman, Sandy; Barrett, Rebekah M.; Grunfeld, Eva

2014-01-01

Background The aim of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) randomized controlled trial is to improve the primary prevention of and screening for multiple conditions (diabetes, cardiovascular disease, cancer) and some of the associated lifestyle factors (tobacco use, alcohol overuse, poor nutrition, physical inactivity). In this article, we describe how we harmonized the evidence-based clinical practice guideline recommendations and patient tools to determine the content for the BETTER trial. Methods We identified clinical practice guidelines and tools through a structured literature search; we included both indexed and grey literature. From these guidelines, recommendations were extracted and integrated into knowledge products and outcome measures for use in the BETTER trial. End-users (family physicians, nurse practitioners, nurses and dieticians) were engaged in reviewing the recommendations and tools, as well as tailoring the content to the needs of the BETTER trial and family practice. Results In total, 3–5 high-quality guidelines were identified for each condition; from these, we identified high-grade recommendations for the prevention of and screening for chronic disease. The guideline recommendations were limited by conflicting recommendations, vague wording and different taxonomies for strength of recommendation. There was a lack of quality evidence for manoeuvres to improve the uptake of guidelines among patients with depression. We developed the BETTER clinical algorithms for the implementation plan. Although it was difficult to identify high-quality tools, 180 tools of interest were identified. Interpretation The intervention for the BETTER trial was built by integrating existing guidelines and tools, and working with end-users throughout the process to increase the intervention’s utility for practice. Trial registration: ISRCTN07170460 PMID:25077119

Knowledge and practices regarding iodine supplementation: A national survey of healthcare providers.

PubMed

Guess, Kimberly; Malek, Lenka; Anderson, Amanda; Makrides, Maria; Zhou, Shao J

2017-02-01

Little is known of healthcare providers' awareness and implementation of the National Health and Medical Research Council's recommendation regarding iodine supplementation during pre-conception, pregnancy and lactation. To assess knowledge and practices of Australian healthcare providers in relation to the National Health and Medical Research Council's iodine supplement recommendation. Obstetricians, gynaecologists, general practitioners, dietitians and midwives were recruited through their relevant professional bodies to participate in an online survey. The survey was completed by 396 healthcare providers Australia-wide. While 71% of healthcare providers' were aware of the National Health and Medical Research Council's recommendation for iodine supplementation, fewer were aware of the recommended dose (38%) or duration (44%). Seventy-three percent of healthcare providers recommended iodine supplements in pregnancy, 56% when planning pregnancy and 52% during lactation. The main reasons for not recommending iodine supplements included belief there was no need for iodine supplements due to mandatory iodine fortification of food (28%) and unawareness of the recommendation (25%). Awareness of the recommendation was positively associated with recommending iodine supplements while length of practice, time spent per consultation, age or area of practice were not associated with recommending iodine supplements. There is a need to improve healthcare providers' knowledge of and adherence to the National Health and Medical Research Council's iodine supplement recommendation. Strategies within antenatal and postnatal services, as well as public health initiatives, are required to improve the knowledge and practices of healthcare providers. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Rural emergency care 360°: mobilising healthcare professionals, decision-makers, patients and citizens to improve rural emergency care in the province of Quebec, Canada: a qualitative study protocol

PubMed Central

Fleet, Richard; Dupuis, Gilles; Fortin, Jean-Paul; Gravel, Jocelyn; Ouimet, Mathieu; Poitras, Julien; Légaré, France

2017-01-01

Introduction Emergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens. Our goal is to build recommendations for improving services by mobilising stakeholders interested in rural emergency care. With help and full engagement of stakeholders, we will (1) identify solutions for improving quality and performance in rural EDs; (2) formulate and prioritise recommendations; (3) transfer knowledge of the recommendations to rural EDs and support operationalisation and (4) assess knowledge transfer and explore further impacts of this participatory action research project. Methodology We will use a participatory action research approach. We will plan for a governance structure that includes all stakeholders’ representatives, so throughout this project, stakeholders are fully engaged at every step. Our sample will be 26 EDs in rural Quebec. We will conduct semistructured individual and focus group interviews with relevant and representative participants, including patients and citizens (estimated n=200). Interviews will be thematically analysed to extract potential solutions and other qualitative information. An expert panel (±15) will use an analysis grid to develop consensus recommendations from solutions suggested and will evaluate feasibility, impacts, costs, conditions for implementation and establish monitoring indicators. Recommendations will be transferred to stakeholders using tailored knowledge translation strategies (web platform, meetings and so on). Discussion and expected results This study will result in a comprehensive consensus list of feasible and high-priority recommendations enabling decision-makers in emergency care to implement improvements in rural emergency care in Quebec. Ethics and dissemination This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project number: MP 2017-009). The qualitative material will be kept confidential and the data will be presented in a way that respects confidentiality. The dissemination plan for the study includes publications in scientific and professional journals. We will also use social media to disseminate our findings and activities such as communications in public conferences. PMID:28819068

Utilizing Wisconsin Afterschool Programs to Increase Physical Activity in Youth.

PubMed

Cavanagh, Bradley D; Meinen, Amy

2015-10-01

Approximately 31.7% of children in the United States are overweight or obese. Interventions in the afterschool setting may help combat childhood obesity. Research exists on interventions in school settings, but a few data exist for interventions about afterschool programs. This study investigates increasing physical activity (PA) in Wisconsin afterschool programs. A literature review was used to develop key informant interviews. Utilizing a constant comparative method, interview data were coded and themes were identified. The themes, literature review, and expert opinions were used to formulate recommendations for improving PA in afterschool programs. Programs had success in utilizing different resources to improve PA. Key barriers to improving PA included grant-imposed academic restrictions, the need for provider education, fears of conflict and competitiveness, and a lack of understanding between health and sedentariness. There is a clear need for additional exploration into improving PA in Wisconsin afterschool programs. This study resulted in specific recommendations to increase PA in afterschool programming, including utilizing school wellness policies and staff professional development to improve PA in afterschool programs. © 2015, American School Health Association.

Environmental Issues in Managing Asthma

PubMed Central

Diette, Gregory B; McCormack, Meredith C; Hansel, Nadia N; Breysse, Patrick N; Matsui, Elizabeth C

2008-01-01

Management of asthma requires attention to environmental exposures both indoors and outdoors. Americans spend most of their time indoors, where they have a greater ability to modify their environment. The indoor environment contains both pollutants (eg, particulate matter, nitrogen dioxide, secondhand smoke, and ozone) and allergens from furred pets, dust mites, cockroaches, rodents, and molds. Indoor particulate matter consists of particles generated from indoor sources such as cooking and cleaning activities, and particles that penetrate from the outdoors. Nitrogen dioxide sources include gas stoves, furnaces, and fireplaces. Indoor particulate matter and nitrogen dioxide are linked to asthma morbidity. The indoor ozone concentration is mainly influenced by the outdoor ozone concentration. The health effects of indoor ozone exposure have not been well studied. In contrast, there is substantial evidence of detrimental health effects from secondhand smoke. Guideline recommendations are not specific for optimizing indoor air quality. The 2007 National Asthma Education and Prevention Program asthma guidelines recommend eliminating indoor smoking and improving the ventilation. Though the guidelines state that there is insufficient evidence to recommend air cleaners, air cleaners and reducing activities that generate indoor pollutants may be sound practical approaches for improving the health of individuals with asthma. The guidelines are more specific about allergen avoidance; they recommend identifying allergens to which the individual is immunoglobin E sensitized and employing a multifaceted, comprehensive strategy to reduce exposure. Outdoor air pollutants that impact asthma include particulate matter, ozone, nitrogen dioxide, and sulfur dioxide, and guidelines recommend that individuals with asthma avoid exertion outdoors when these pollutants are elevated. Outdoor allergens include tree, grass, and weed pollens, which vary in concentration by season. Recommendations to reduce exposure include staying indoors, keeping windows and doors closed, using air conditioning and perhaps high-efficiency particulate arrestor (HEPA) air filters, and thorough daily washing to remove allergens from one’s person. PMID:18426614

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.

PubMed

Qaseem, Amir; Wilt, Timothy J; McLean, Robert M; Forciea, Mary Ann

2017-04-04

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects. The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain. Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation). For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation). In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence).

Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol.

PubMed

Van Spall, Harriette G C; Shanbhag, Deepti; Gabizon, Itzhak; Ibrahim, Quazi; Graham, Ian D; Harlos, Karen; Haynes, R Brian; Connolly, Stuart J

2016-03-31

The uptake of Clinical Practice Guideline (CPG) recommendations that improve outcomes in heart failure (HF) remains suboptimal. We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations, those with clear evidence that benefits outweigh the risks. We will use American, Canadian and European HF guidelines as our reference. We will conduct a literature search in the databases of MEDLINE, EMBASE, HEALTHSTAR, CINAHL, Cochrane Library, Campbell Collaboration, Joanna Briggs Institute Evidence Based Practice, Centre for Reviews and Dissemination and Evidence Based Practice Centres. We will include prospective studies evaluating implementation interventions aimed at improving uptake of class I CPG recommendations in HF. We will extract data in duplicate. We will classify interventions according to their level of application (ie, provider, organisation, systems level) and common underlying characteristics (eg, education, decision-support, financial incentives) using the Cochrane Effective Practice and Organisation of Care Taxonomy. We will assess the impact of the intervention on adherence to the CPGs. Outcomes will include proportion of eligible patients who were: prescribed a CPG-recommended pharmacological treatment; referred for device consideration; provided self-care education at discharge; and provided left ventricular function assessment. We will include clinical outcomes such as hospitalisations, readmissions and mortality, if data is available. We will identify the common elements of successful and failing interventions, and examine the context in which they were applied, using the Process Redesign contextual framework. We will synthesise the results narratively and, if appropriate, will pool results for meta-analysis. In this review, we will assess the impact of implementation strategies and contextual factors on physician adherence to HF CPGs. We will explore why some interventions may succeed in one setting and fail in another. We will disseminate our findings through briefing reports, publications and presentations. CRD42015017155. 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/

Integrating Information Extraction Agents into a Tourism Recommender System

NASA Astrophysics Data System (ADS)

Esparcia, Sergio; Sánchez-Anguix, Víctor; Argente, Estefanía; García-Fornes, Ana; Julián, Vicente

Recommender systems face some problems. On the one hand information needs to be maintained updated, which can result in a costly task if it is not performed automatically. On the other hand, it may be interesting to include third party services in the recommendation since they improve its quality. In this paper, we present an add-on for the Social-Net Tourism Recommender System that uses information extraction and natural language processing techniques in order to automatically extract and classify information from the Web. Its goal is to maintain the system updated and obtain information about third party services that are not offered by service providers inside the system.

Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis

PubMed Central

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A.; Ward, David K.

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting. PMID:23613858

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

PubMed

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Surgical management of pancreatic necrosis: A practice management guideline from the Eastern Association for the Surgery of Trauma.

PubMed

Mowery, Nathan T; Bruns, Brandon R; MacNew, Heather G; Agarwal, Suresh; Enniss, Toby M; Khan, Mansoor; Guo, Weidun Alan; Cannon, Jeremy W; Lissauer, Matthew E; Duane, Therese M; Hildreth, Amy N; Pappas, Peter A; Gries, Lynn M; Kaiser, Meghann; Robinson, Bryce R H

2017-08-01

Pancreatic or peripancreatic tissue necrosis confers substantial morbidity and mortality. New modalities have created a wide variation in approaches and timing of interventions for necrotizing pancreatitis. As acute care surgery evolves, its practitioners are increasingly being called upon to manage these complex patients. A systematic review of the MEDLINE database using PubMed was performed. English language articles regarding pancreatic necrosis from 1980 to 2014 were included. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included operative timing, the use of adjuvant therapy and the type of operative repair. Grading of Recommendations, Assessment, Development and Evaluations methodology was applied to question development, outcome prioritization, evidence quality assessments, and recommendation creation. Eighty-eight studies were included and underwent full review. Increasing the time to surgical intervention had an improved outcome in each of the periods evaluated (72 hours, 12-14 days, 30 days) with a significant improvement in outcomes if surgery was delayed 30 days. The use of percutaneous and endoscopic procedures was shown to postpone surgery and potentially be definitive. The use of minimally invasive surgery for debridement and drainage has been shown to be safe and associated with reduced morbidity and mortality. Acute Care Surgeons are uniquely trained to care for those with pancreatic necrosis due their training in critical care and complex surgery with ongoing shock. In adult patients with pancreatic necrosis, we recommend that pancreatic necrosectomy be delayed until at least day 12. During the first 30 days of symptoms with infected necrotic collections, we conditionally recommend surgical debridement only if the patients fail to improve after radiologic or endoscopic drainage. Finally, even with documented infected necrosis, we recommend that patients undergo a step-up approach to surgical intervention as the preferred surgical approach. Systematic review/guideline, level III.

Improving integration and coordination of funding, technical assistance, and reporting/data collection: recommendations from CDC and USAPI stakeholders.

PubMed

Ka'opua, Lana Sue I; White, Susan F; Rochester, Phyllis F; Holden, Debra J

2010-09-01

Current US Federal funding mechanisms may foster program silos that disable sharing of resources and information across programs within a larger system of public health services. Such silos present challenges to USAPI communities where human resources, health infrastructure, and health financing are limited. Integrative and coordinated approaches have been recommended. The CDC Pacific Islands Integration and Coordination project was initiated by the Division of Cancer Prevention and Control (DCPC). Its project aim was to identify ways for the CDC to collaborate with the USAPI in improving CDC activities and processes related to chronic disease. This article focuses on recommendations for improving coordination and integration in three core areas of health services programming: funding, program reporting/data collection and analysis, and technical assistance. Preliminary information on challenges and issues relevant to the core areas was gathered through site visits, focus groups, key informant interviews, and other sources. This information was used by stakeholder groups from the CDC and the USAPI to develop recommendations in the core programming areas. Recommendations generated at the CDC and USAPI stakeholder meetings were prepared into a single set of recommendations and stakeholders reviewed the document for accuracy prior to its dissemination to CDC's National Center for Chronic Disease Prevention and Health Promotion programs management and staff. Key recommendations, include: (1) consideration of resource s and other challenges unique to the USAPI when reviewing funding applications, (2) consideration of ways to increase flexibility in USAPI use of program funds, (3) dedicate funding and human resources for technical assistance, (4) provide opportunities for capacity-building across programs and jurisdictions, (5) consider ways to more directly link program reporting with technical assistance. This project provided a unique opportunity for CDC and USAPI stakeholders to share diverse perspectives on challenges to public health programs in the USAPI. Despite diverse experiences, the final set of recommendations reflected a high level of concordance between USAPI and CDC stakeholders on ways to improve coordination and integration of CDC processes and activities in the three core areas. Recommendations have informed some actions already initiated by the DCPC, including the dedication of funds for leadership institutes aimed at enhancing USAPI capacity for sustainable, integrated regional and jurisdictional cancer control infrastructure. Such efforts are an important beginning, but more remains to be done. Indicated is the need for continuous dialogue and collaboration. While this project focused on the USAPI, our results may be relevant to those interested in inter-organizational collaborations, medically underserved areas, public health services programs, and community-based participatory approaches.

Proceedings of the Ocean Climate Data Workshop

NASA Technical Reports Server (NTRS)

Churgin, James (Compiler)

1992-01-01

The First Consultative Meeting on Responsible National Oceanographic Data Centres (RNODC's) and Climate DataServices met in February 1988 and made a number of recommendations related to improving services to meet the needs of climate programmes. Included in these discussions was a recommendation for a Workshop on Ocean Climate Data Management. This workshop will be talking about ways to establish a Global Ocean Observing System (GOOS).

STS-61 mission director's post-mission report

NASA Technical Reports Server (NTRS)

Newman, Ronald L.

1995-01-01

To ensure the success of the complex Hubble Space Telescope servicing mission, STS-61, NASA established a number of independent review groups to assess management, design, planning, and preparation for the mission. One of the resulting recommendations for mission success was that an overall Mission Director be appointed to coordinate management activities of the Space Shuttle and Hubble programs and to consolidate results of the team reviews and expedite responses to recommendations. This report presents pre-mission events important to the experience base of mission management, with related Mission Director's recommendations following the event(s) to which they apply. All Mission Director's recommendations are presented collectively in an appendix. Other appendixes contain recommendations from the various review groups, including Payload Officers, the JSC Extravehicular Activity (EVA) Section, JSC EVA Management Office, JSC Crew and Thermal Systems Division, and the STS-61 crew itself. This report also lists mission events in chronological order and includes as an appendix a post-mission summary by the lead Payload Deployment and Retrieval System Officer. Recommendations range from those pertaining to specific component use or operating techniques to those for improved management, review, planning, and safety procedures.

Open Workshop on Solar Technologies: Proceedings

NASA Astrophysics Data System (ADS)

1980-07-01

The deliberations, conclusions, and recommendations of six panels asked to provide advice to the Department of Energy on the subject of solar energy are detailed. Introductory speeches by seven experts, excerpts from the succeeding two half days of discussion, the final reports for the panel chairpersons, and subsequent discussion and questioning are included. Approximately 125 findings and recommendations were developed by the six panels covering a wide variety of topics. Major recurring themes were recommendations for increased funding, federal program improvement, conservation, outreach programs small business funding, and solar training programs.

Actions to Implement the Recommendations of the Presidential Commission on the Space Shuttle Challenger Accident: Executive Summary

NASA Technical Reports Server (NTRS)

1986-01-01

The status of the implementation of the recommendations of the Presidential Commission on the Space Shuttle Challenger Accident is reported. The implementation of recommendations in the following areas is detailed: (1) solid rocket motor design; (2) shuttle management structure, including the shuttle safety panel and astronauts in management; (3) critical item review and hazard analysis; (4) safety organization; (5) improved communication; (6) landing safety; (7) launch abort and crew escape; (8) flight rate; and (9) maintenance safeguards. Supporting memoranda and communications from NASA are appended.

Opportunities for improving the nation's health through collaboration with the mass media.

PubMed Central

Arkin, E B

1990-01-01

Understanding the mass media is a prerequisite to gaining the cooperation of those who control access to media time and space to improve the coverage of health issues about which the public needs, and often wants, to know. To address the complexities of the mass media and how they influence the public's health, a group of Public Health Service agencies, foundations, and research institutions collaborated to review recent changes in the mass media and public health sectors and to recommend steps for increased interaction. These included broadening strategies to include paid advertising, media advocacy, and other tactics beyond public service campaigns; increasing awareness within the public health sector of the media's perspective on health; working collaboratively with media professionals and organizations, including the minority media; and developing guidelines for public-private sector partnerships. These recommendations, and factors affecting the roles of the media and public health communities in informing the public about health, are described in this paper. A complete discussion of these recommendations and related issues can be found in "Mass Media and Health," edited by Caroline McNeil and Elaine Bratic Arkin, a forthcoming publication of the Office of Disease Prevention and Health Promotion, Public Health Service. PMID:2113678

Information Technology-Based Interventions to Improve Drug-Drug Interaction Outcomes: A Systematic Review on Features and Effects.

PubMed

Nabovati, Ehsan; Vakili-Arki, Hasan; Taherzadeh, Zhila; Saberi, Mohammad Reza; Medlock, Stephanie; Abu-Hanna, Ameen; Eslami, Saeid

2017-01-01

The purpose of this systematic review was to identify features and effects of information technology (IT)-based interventions on outcomes related to drug-drug interactions (DDI outcomes). A literature search was conducted in Medline, EMBASE, and the Cochrane Library for published English-language studies. Studies were included if a main outcome was related to DDIs, the intervention involved an IT-based system, and the study design was experimental or observational with controls. Study characteristics, including features and effects of IT-based interventions, were extracted. Nineteen studies comprising five randomized controlled trials (RCT), five non-randomized controlled trials (NRCT) and nine observational studies with controls (OWC) were included. Sixty-four percent of prescriber-directed interventions, and all non-prescriber interventions, were effective. Each of the following characteristics corresponded to groups of studies of which a majority were effective: automatic provision of recommendations within the providers' workflow, intervention at the time of decision-making, integration into other systems, and requiring the reason for not following the recommendations. Only two studies measured clinical outcomes: an RCT that showed no significant improvement and an OWC that showed improvement, but did not statistically assess the effect. Most studies that measured surrogate outcomes (e.g. potential DDIs) and other outcomes (e.g. adherence to alerts) showed improvements. IT-based interventions improve surrogate clinical outcomes and adherence to DDI alerts. However, there is lack of robust evidence about their effectiveness on clinical outcomes. It is recommended that researchers consider the identified features of effective interventions in the design of interventions and evaluate the effectiveness on DDI outcomes, particularly clinical outcomes.

How to Improve the Supply of High-Quality Teachers

ERIC Educational Resources Information Center

Hanushek, Eric Alan; Rivkin, Steven G.

2004-01-01

Virtually everybody interested in improving the performance of schools concentrates on the importance of teacher quality. Yet policy recommendations related to teacher quality frequently do not incorporate existing evidence about performance. This paper reviews the various strands of research related to teacher quality, including the role of…

Proceedings of the American Academy of Nursing Conference on Using Innovative Technology to Decrease Nursing Demand and Enhance Patient Care Delivery.

ERIC Educational Resources Information Center

Nursing Outlook, 2003

2003-01-01

Includes an introduction and 13 papers that address the following: nursing shortages; the role of technology in improving patient safety and care, simulating practice environments, and improving efficiency; and recommendations of conference participants. Many papers contain references. (JOW)

Safety in the Chemical Laboratory. Safety in the Laboratory: Are We Making Any Progress?

ERIC Educational Resources Information Center

McKusick, Blaine C.

1987-01-01

Reviews trends in laboratory safety found in both industrial and academic situations. Reports that large industrial labs generally have excellent safety programs but that, although there have been improvements, academia still lags behind industry in safety. Includes recommendations for improving lab safety. (ML)

Geotechnical Centrifuge Experiments to Evaluate Piping in Foundation Soils

DTIC Science & Technology

2014-05-01

verifiable results. These tests were successful in design , construction, and execution of a realistic simulation of internal erosion leading to failure...possible “scale effects,” “modeling of models” testing protocol should be included in the test program. Also, the model design should minimize the scale...recommendations for improving the centrifuge tests include the following: • Design improved system for reservoir control to provide definitive and

Easing the Burden of External Reporting

ERIC Educational Resources Information Center

LoGrasso, Marc F.

2015-01-01

In this chapter, the author presents suggestions for improving the effectiveness of external reporting while minimizing burden. Recommendations include repurposing existing internal reports to address the needs of external reports.

Teaching Strategies for Improving Algebra Knowledge in Middle and High School Students. Educator's Practice Guide. What Works Clearinghouse.™ NCEE 2015-4010

ERIC Educational Resources Information Center

Star, Jon R.; Foegen, Anne; Larson, Matthew R.; McCallum, William G.; Porath, Jane; Zbiek, Rose Mary; Caronongan, Pia; Furgeson, Joshua,; Keating, Betsy; Lyskawa, Julia

2015-01-01

Mastering algebra is important for future math and postsecondary success. Educators will find practical recommendations for how to improve algebra instruction in the What Works Clearinghouse (WWC) practice guide, "Teaching Strategies for Improving Algebra Knowledge in Middle and High School Students". The methods and examples included in…

OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records.

PubMed

Chen, Jonathan H; Podchiyska, Tanya; Altman, Russ B

2016-03-01

To answer a "grand challenge" in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com's product recommender. EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender's ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10(-10)) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10(-16)). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from "correct" ones. Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. "interesting" suggestions). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government employees and is in the public domain in the US.

Mobile mammography: An evaluation of organizational, process, and information systems challenges.

PubMed

Browder, Casey; Eberth, Jan M; Schooley, Benjamin; Porter, Nancy R

2015-03-01

The purpose of this case study was to evaluate the information systems, personnel, and processes involved in mobile mammography settings, and offer recommendations to improve efficiency and satisfaction among patients and staff. Data includes on-site observations, interviews, and an electronic medical record review of a hospital who offers both mobile and fixed facility mammography services to their community. The optimal expectations for the process of mobile mammography from multiple perspectives were defined as (1) patient receives mammogram the day of their visit, (2) patient has efficient intake process with little wait time, (3) follow-up is completed and timely, (4) site contact and van staff are satisfied with van visit and choose to schedule future visits, and (5) the MMU is able to assess its performance and set goals for improvement. Challenges that prevent the realization of those expectations include a low patient pre-registration rate, difficulty obtaining required physician orders, frequent information system downtime/Internet connectivity issues, ill-defined organizational communication/roles, insufficient site host/patient education, and disparate organizational and information systems. Our recommendations include employing a dedicated mobile mammography team for end-to-end oversight, mitigating for system connectivity issues, allowing for patient self-referrals, integrating scheduling and registration processes, and a focused approach to educating site hosts and respective patients about expectations for the day of the visit. The MMU is an important community resource; we recommend simple process improvements and information flow improvements to further enable the MMU׳s goals. Copyright © 2015 Elsevier Inc. All rights reserved.

Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercise in the management of hip osteoarthritis.

PubMed

Brosseau, Lucie; Wells, George A; Pugh, Arlanna G; Smith, Christine Am; Rahman, Prinon; Àlvarez Gallardo, Inmaculada C; Toupin-April, Karine; Loew, Laurianne; De Angelis, Gino; Cavallo, Sabrina; Taki, Jade; Marcotte, Rachel; Fransen, Marlene; Hernandez-Molina, Gabriela; Kenny, Glen P; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; Brooks, Sydney; Laferriere, Lucie; McLean, Linda; Longchamp, Guy

2016-10-01

The primary objective is to identify effective land-based therapeutic exercise interventions and provide evidence-based recommendations for managing hip osteoarthritis. A secondary objective is to develop an Ottawa Panel evidence-based clinical practice guideline for hip osteoarthritis. The search strategy and modified selection criteria from a Cochrane review were used. Studies included hip osteoarthritis patients in comparative controlled trials with therapeutic exercise interventions. An Expert Panel arrived at a Delphi survey consensus to endorse the recommendations. The Ottawa Panel hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) considered the study design (level I: randomized controlled trial and level II: controlled clinical trial), statistical significance (p < 0.5), and clinical importance (⩾15% improvement). Four high-quality studies were included, which demonstrated that variations of strength training, stretching, and flexibility exercises are generally effective for improving the management of hip osteoarthritis. Strength training exercises displayed the greatest improvements for pain (Grade A), disability (Grades A and C+), physical function (Grade A), stiffness (Grade A), and range of motion (Grade A) within a short time period (8-24 weeks). Stretching also greatly improved physical function (Grade A), and flexibility exercises improved pain (Grade A), range of motion (Grade A), physical function (Grade A), and stiffness (Grade C+). The Ottawa Panel recommends land-based therapeutic exercise, notably strength training, for management of hip osteoarthritis in reducing pain, stiffness and self-reported disability, and improving physical function and range of motion. © The Author(s) 2015.

The effects of a lifestyle-focused text-messaging intervention on adherence to dietary guideline recommendations in patients with coronary heart disease: an analysis of the TEXT ME study.

PubMed

Santo, Karla; Hyun, Karice; de Keizer, Laura; Thiagalingam, Aravinda; Hillis, Graham S; Chalmers, John; Redfern, Julie; Chow, Clara K

2018-05-23

A healthy diet is an important component of secondary prevention of coronary heart disease (CHD). The TEXT ME study was a randomised clinical trial of people with CHD that were randomised into standard care or a text-message programme in addition to standard care. This analysis aimed to: 1) assess the effects of the intervention onadherence to the dietary guideline recommendations; 2) assess the consistency of effect across sub-groups; and 3) assess whether adherence to the dietary guideline recommendations mediated the improvements in objective clinical outcomes. Dietary data were collected using a self-report questionnaire to evaluate adherence to eight dietary guideline recommendations in Australia, including consumption of vegetables, fruits, fish, type of fat used for cooking and in spreads, takeaway food, salt and standard alcohol drinks. The primary outcome of this analysis was the proportion of patients adhering to ≥ 4 dietary guideline recommendations concomitantly and each recommendation was assessed individually as secondary outcomes. Data were analysed using log-binomial regression for categorical variables and analysis of covariance for continuous variables. Among 710 patients, 54% were adhering to ≥ 4 dietary guideline recommendations (intervention 53% vs control 56%, p = 0.376) at baseline. At six months, the intervention group had a significantly higher proportion of patients adhering to ≥ 4 recommendations (314, 93%) compared to the control group (264, 75%, RR 1.23, 95% CI 1.15-1.31, p < 0.001). In addition, the intervention patients reported consuming higher amounts of vegetables, fruits, and fish per week; less takeaway foods per week; and greater salt intake control. The intervention had a similar effect in all sub-groups tested. There were significant mediational effects of the increase in adherence to the recommendations for the association between the intervention and LDL-cholesterol (p < 0.001) and body mass index (BMI) at six months follow-up (p = 0.005). A lifestyle-focused text-message programme improved adherence to the dietary guideline recommendations, and specifically improved self-reported consumption of vegetables, fruits, fish, takeaway foods and salt intake. Importantly, these improvements partially mediated improvements in LDL-cholesterol and BMI. This simple and scalable text-messaging intervention could be used as a strategy to improve diet in people with CHD. Australia and New Zealand Clinical Trials Registry ACTRN12611000161921 . Registered on 10 February 2011.

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

PubMed

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

2016-04-05

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

Characteristics of attitude and recommendation of oncologists toward exercise in South Korea: a cross sectional survey study.

PubMed

Park, Ji-Hye; Oh, Minsuk; Yoon, Yong Jin; Lee, Chul Won; Jones, Lee W; Kim, Seung Il; Kim, Nam Kyu; Jeon, Justin Y

2015-04-10

The purpose of the present study was to examine 1) characteristics and attitudes of oncologists toward exercise and toward recommending exercise to their patients, 2) association among oncologists' own physical activity levels, exercise recommendations, and their attitudes toward recommending exercise. A total of 167 oncologists participated in this survey study (41 surgeons, 78 medical oncologists, 25 radiation oncologists, and 21 others). Most oncologists included in the study treat more than one type of cancer, including colorectal, gastric, breast, lung, and liver cancer. To analyze the data, the one-way ANOVA, and t-test were used. All data were indicated for mean, SD, and proportions. Most oncologists agreed that exercise is beneficial (72.8%) and important (69.6%), but only 39.2% of them agreed that exercise is safe, and only 7.2% believed that cancer patients manage to exercise during cancer treatment. Forty-six percentage of the surveyed oncologists recommended exercise to their patients during the past month. The average amount of participation in physical activity by oncologists who participated in the study was 139.5 ± 120.3 min per week, and 11.4% of the study participants met the American College of Sports Medicine (ACSM) guidelines. Oncologists' own physical activity levels were associated with their attitudes toward recommending exercise. Belief in the benefits of exercise in the performance of daily tasks, improvement of mental health, and the attenuation of physical decline from treatment were the three most prevalent reasons why oncologists recommend exercise to their patients. Barriers to recommending exercise to patients included lack of time, unclear exercise recommendations, and the safety of patients. Oncologists have favorable attitudes toward exercise and toward recommending exercise to their patients during treatment. However, they also experience barriers to recommending exercise, including lack of time, unclear exercise guidelines for cancer patients, and concerns regarding the safety of exercise.

Impact of provider-patient communication on cancer screening adherence: A systematic review.

PubMed

Peterson, Emily B; Ostroff, Jamie S; DuHamel, Katherine N; D'Agostino, Thomas A; Hernandez, Marisol; Canzona, Mollie R; Bylund, Carma L

2016-12-01

Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence. Copyright © 2016 Elsevier Inc. All rights reserved.

Improved sexual history taking in the 2012 BASHH asymptomatic screening re-audit.

PubMed

Menon-Johansson, A S; McClean, H; Carne, C A; Estreich, S; Knapper, C; Sethi, G; Smith, A; Sullivan, A K

2014-04-01

Effective asymptomatic screening for sexually transmitted infections is an important public health service because a significant proportion of sexually transmitted infections do not present with symptoms. In 2009, the National Audit Group of the British Association of Sexual Health and HIV (BASHH) audited the management of asymptomatic patients and recommended increased documentation about oral and anal sex, regional strategies for nucleic acid amplification test (NAAT) use for gonorrhoea, improved screening for hepatitis B in men who have sex with men and an increase in screening for HIV. The 2012 audit used web-based forms to collect submissions from 180 consultant-led centres (65% response rate) that included episodes of care from 6669 asymptomatic patients. An improvement was demonstrated for all the areas measured during the 2009 audit. A doubling of gonorrhoea testing using NAATs was seen and yet 10% of asymptomatic patients continued to have microscopy despite these tests not being recommended by BASHH guidelines. This audit recommends universal adoption of gonorrhoea NAATs across the United Kingdom.

Research Priorities in Spasmodic Dysphonia

PubMed Central

Ludlow, Christy L.; Adler, Charles H.; Berke, Gerald S.; Bielamowicz, Steven A.; Blitzer, Andrew; Bressman, Susan B.; Hallett, Mark; Jinnah, H. A.; Juergens, Uwe; Martin, Sandra B.; Perlmutter, Joel S.; Sapienza, Christine; Singleton, Andrew; Tanner, Caroline M.; Woodson, Gayle E.

2009-01-01

OBJECTIVE To identify research priorities for increasing understanding of the pathogenesis, diagnosis and improved treatment of spasmodic dysphonia. STUDY DESIGN AND SETTING A multidisciplinary working group was formed including both scientists and clinicians from multiple disciplines, otolaryngology, neurology, speech pathology, genetics and neuroscience, to review currently available information on spasmodic dysphonia and to identify research priorities. RESULTS Operational definitions for spasmodic dysphonia at different levels of certainty were recommended for diagnosis and recommendations made for a multi-center multidisciplinary validation study. CONCLUSIONS The highest priority is to characterize the disorder and identify risk factors that may contribute to its onset. Future research should compare and contrast spasmodic dysphonia with other forms of focal dystonia. Development of animal models is recommended to explore hypotheses related to pathogenesis. Improved understanding of the pathophysiology of SD should provide the basis for developing new treatment options and exploratory clinical trials. SIGNIFICANCE This document should foster future research to improve the care of patients with this chronic debilitating voice and speech disorder by otolaryngology, neurology, and speech pathology. PMID:18922334

Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan.

PubMed

Lin, Mei-Chun; Shueng, Pei-Wei; Chang, Wei-Kuo; Mu-Hsin Chang, Peter; Feng, Hsin-Chun; Yang, Muh-Hwa; Lou, Pei-Jen

2018-06-01

Because of the anatomical location, patients with head and neck cancer (HNC) frequently experience dysphagia and malnutrition at the time of diagnosis and these conditions are often exacerbated after chemoradiotherapy. There is an emerging medical need to establish a consensus on nutritional intervention for these patients. A panel of 30 senior physicians and experts from multidisciplinary teams drafted clinical recommendations to improve the management of nutritional interventions in Taiwan and to provide updated treatment strategy recommendations in hope of improving the nutritional status of patients with HNC. This clinical review describes the resulting consensus document, including the impact of malnutrition on clinical outcomes, the role of prophylactic tube feeding, the choice of tube feeding, and the benefit of oral nutritional supplements in patients with HNC undergoing chemoradiotherapy. The outcomes of this review will support clinicians in their efforts to improve the nutritional status of patients with HNC. Copyright © 2018 Elsevier Ltd. All rights reserved.

Improving Underrepresented Minority Student Persistence in STEM

PubMed Central

Estrada, Mica; Burnett, Myra; Campbell, Andrew G.; Campbell, Patricia B.; Denetclaw, Wilfred F.; Gutiérrez, Carlos G.; Hurtado, Sylvia; John, Gilbert H.; Matsui, John; McGee, Richard; Okpodu, Camellia Moses; Robinson, T. Joan; Summers, Michael F.; Werner-Washburne, Maggie; Zavala, MariaElena

2016-01-01

Members of the Joint Working Group on Improving Underrepresented Minorities (URMs) Persistence in Science, Technology, Engineering, and Mathematics (STEM)—convened by the National Institute of General Medical Sciences and the Howard Hughes Medical Institute—review current data and propose deliberation about why the academic “pathways” leak more for URM than white or Asian STEM students. They suggest expanding to include a stronger focus on the institutional barriers that need to be removed and the types of interventions that “lift” students’ interests, commitment, and ability to persist in STEM fields. Using Kurt Lewin’s planned approach to change, the committee describes five recommendations to increase URM persistence in STEM at the undergraduate level. These recommendations capitalize on known successes, recognize the need for accountability, and are framed to facilitate greater progress in the future. The impact of these recommendations rests upon enacting the first recommendation: to track successes and failures at the institutional level and collect data that help explain the existing trends. PMID:27543633

Advanced power generation systems for the 21st Century: Market survey and recommendations for a design philosophy

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

Andriulli, J.B.; Gates, A.E.; Haynes, H.D.

1999-11-01

The purpose of this report is to document the results of a study designed to enhance the performance of future military generator sets (gen-sets) in the medium power range. The study includes a market survey of the state of the art in several key component areas and recommendations comprising a design philosophy for future military gen-sets. The market survey revealed that the commercial market is in a state of flux, but it is currently or will soon be capable of providing the technologies recommended here in a cost-effective manner. The recommendations, if implemented, should result in future power generation systemsmore » that are much more functional than today's gen-sets. The number of differing units necessary (both family sizes and frequency modes) to cover the medium power range would be decreased significantly, while the weight and volume of each unit would decrease, improving the transportability of the power source. Improved fuel economy and overall performance would result from more effective utilization of the prime mover in the generator. The units would allow for more flexibility and control, improved reliability, and more effective power management in the field.« less

Improving preventive health services training in chiropractic colleges part II: enhancing outcomes through improved training and accountability processes.

PubMed

Globe, Gary; Redwood, Daniel; Brantingham, James W; Hawk, Cheryl; Terre, Lisa; Globe, Denise; Mayer, Stephan

2009-01-01

Over the past decade, chiropractic colleges have introduced clinical prevention services (CPS) training. This has included an updated public health curriculum and procedures for student interns to determine the need for preventive services and to provide these services directly or through referral to other health professionals. The purpose of this study was to evaluate the effect of a program to train chiropractic interns to deliver CPS to patients. Program evaluation used retrospective chart review, comparing the proportion of patients receiving CPS recommendations before and after implementation of the program. The main outcome measures were the percentage of appropriate CPS recommendations based upon chart reviews. Chart reviews in 2006 indicated appropriate CPS recommendations in 47.4% of cases (295/623). Chart reviews in 2007, after an additional year of sustained implementation of procedures to ensure intern and faculty accountability, showed appropriate counseling recommendations in 87% of files (137/156). Requiring interns to attend didactic presentations on CPS had no measurable effect on their performance. Major improvements occurred after a series of clinically relevant training interventions; new forms and audit procedures were implemented to increase intern and clinical faculty accountability.

Evaluation of Several Common Antimotion Sickness Medications and Recommendations Concerning Their Potential Usefulness During Special Operations

DTIC Science & Technology

2009-12-02

include oral caffeine (200 mg) to counteract any sedation from the treatment medications. Motion sickness was elicited via 12 roll tilts per minute...susceptibility (MSSQ) via ANCOVA. Three treatment conditions (promethazine, oral scopolamine, transdermal scopolamine) were not planned for ANCOVA...requested improved treatments for motion sickness, because the currently recommended regimen of meclizine was not as effective as desired and was sometimes

Air Force Can Improve Controls Over Base Retail Inventory

DTIC Science & Technology

2011-11-23

numbers included in the inventory accuracy testing population had quantity discrepancies; and • $5.2 billion of base retail inventory was misstated ...the risk of theft or mismanagement of inventory assets and can negatively affect mission operations. What We Recommend We recommend that the Air...was misstated by an absolute value (overstatements and understatements) of $77.3 million.3 In addition, floor-to-record testing at 20 of the 71

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

New York State Public Health System Response to Hurricane Sandy: Lessons From the Field.

PubMed

Shipp Hilts, Asante; Mack, Stephanie; Eidson, Millicent; Nguyen, Trang; Birkhead, Guthrie S

2016-06-01

The aim of this study was to conduct interviews with public health staff who responded to Hurricane Sandy and to analyze their feedback to assess response strengths and challenges and recommend improvements for future disaster preparedness and response. Qualitative analysis was conducted of information from individual confidential interviews with 35 staff from 3 local health departments in New York State (NYS) impacted by Hurricane Sandy and the NYS Department of Health. Staff were asked about their experiences during Hurricane Sandy and their recommendations for improvements. Open coding was used to analyze interview transcripts for reoccurring themes, which were labeled as strengths, challenges, or recommendations and then categorized into public health preparedness capabilities. The most commonly cited strengths, challenges, and recommendations related to the Hurricane Sandy public health response in NYS were within the emergency operations coordination preparedness capability, which includes the abilities of health department staff to partner among government agencies, coordinate with emergency operation centers, conduct routine conference calls with partners, and manage resources. Health departments should ensure that emergency planning includes protocols to coordinate backup staffing, delineation of services that can be halted during disasters, clear guidelines to coordinate resources across agencies, and training for transitioning into unfamiliar disaster response roles. (Disaster Med Public Health Preparedness. 2016;10:443-453).

Strengthening rehabilitation services in Indonesia: A brief situation analysis.

PubMed

Nugraha, Boya; Setyono, Garry Rahardian; Defi, Irma Ruslina; Gutenbrunner, Christoph

2018-04-18

People with disability (PWD) in Indonesia are often neglected by society. Improving their life situation towards full participation in society is crucial. As a health strategy, rehabilitation can improve func-tioning, quality of life and participation in society. However, rehabilitation services in Indonesia need improvement. Making a situation analysis of rehabilitation services and their provision in the country is a pre-requisite to taking any action towards improvement. This paper compiles available data related to disability and rehabilitation services in Indonesia, using the Rehabilitation Services Assessment Tool (RSAT) as a framework. Gaps in provision were analysed, resulting in the compilation of a list of generic recommendations to improve rehabilitation services in the country. Indonesia faces many challenges in rehabilitation services, including the health workforce and the provision of services. This situation analysis and list of generic recommendations may be used in further discussions with relevant stakeholders in the country to develop a national strategy to strengthen rehabilitation services.

REPORT OF THE SOUTHWEST TEXAS STATE COLLEGE RESEARCH CONFERENCE ON THE PROBLEM OF DYSLEXIA AND RELATED DISORDERS IN PUBLIC SCHOOLS OF THE UNITED STATES. REPORT OF THE WORKING GROUP ON TEACHER PREPARATION.

ERIC Educational Resources Information Center

ZEDLER, EMPRESS Y.

SOME GUIDELINES AND RECOMMENDATIONS FOR IMPROVING TEACHER EDUCATION IN ORDER TO MEET THE NEEDS OF SEVERELY DISABLED LEARNERS ARE PRESENTED. THE SUGGESTIONS INCLUDE IMPROVING PROFESSIONAL TRAINING FOR TEACHERS, PSYCHOLOGISTS, SUPERVISORS, AND COUNSELORS AT ALL LEVELS. TRAINING SHOULD INCLUDE THE STUDY OF DYSLEXIA AND THE PREPARATION OF A PILOT…

Physical activity promotion in business and industry: evidence, context, and recommendations for a national plan.

PubMed

Pronk, Nicolaas P

2009-11-01

The contemporary workplace setting is in need of interventions that effectively promote higher levels of occupational and habitual physical activity. It is the purpose of this paper to outline an evidence-based approach to promote physical activity in the business and industry sector in support of a National Physical Activity Plan. Comprehensive literature searches identified systematic reviews, comprehensive reviews, and consensus documents on the impact of physical activity interventions in the business and industry sector. A framework for action and priority recommendations for practice and research were generated. Comprehensive, multicomponent work-site programs that include physical activity components generate significant improvements in health, reduce absenteeism and sick leave, and can generate a positive financial return. Specific evidence-based physical activity interventions are presented. Recommendations for practice include implementing comprehensive, multicomponent programs that make physical activity interventions possible, simple, rewarding and relevant in the context of a social-ecological model. The business and industry sector has significant opportunities to improve physical activity among employees, their dependents, and the community at-large and to reap important benefits related to worker health and business performance.

Physical Activity Promotion in Business and Industry: Evidence, Context, and Recommendations for a National Plan.

PubMed

Pronk, Nicolaas P

2009-11-01

The contemporary workplace setting is in need of interventions that effectively promote higher levels of occupational and habitual physical activity. It is the purpose of this paper to outline an evidence-based approach to promote physical activity in the business and industry sector in support of a National Physical Activity Plan. Comprehensive literature searches identified systematic reviews, comprehensive reviews, and consensus documents on the impact of physical activity interventions in the business and industry sector. A framework for action and priority recommendations for practice and research were generated. Comprehensive, multicomponent worksite programs that include physical activity components generate significant improvements in health, reduce absenteeism and sick leave, and can generate a positive financial return. Specific evidence-based physical activity interventions are presented. Recommendations for practice include implementing comprehensive, multicomponent programs that make physical activity interventions possible, simple, rewarding and relevant in the context of a social-ecological model. The business and industry sector has significant opportunities to improve physical activity among employees, their dependents, and the community at-large and to reap important benefits related to worker health and business performance.

The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices.

PubMed

Deer, Timothy R; Narouze, Samer; Provenzano, David A; Pope, Jason E; Falowski, Steven M; Russo, Marc A; Benzon, Honorio; Slavin, Konstantin; Pilitsis, Julie G; Alo, Kenneth; Carlson, Jonathan D; McRoberts, Porter; Lad, Shivanand P; Arle, Jeffrey; Levy, Robert M; Simpson, Brian; Mekhail, Nagy

2017-01-01

The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation. The INS strives to improve patient care in an evidence-based fashion. The NACC members were appointed or recruited by the INS leadership for diverse expertise, including international clinical expertise in many areas of neurostimulation, evidence evaluation, and publication. The group developed best practices based on peer-reviewed evidence and, in the absence of specific evidence, on expert opinion. Recommendations were based on international evidence in accordance with guideline creation. The NACC has recommended specific measures to reduce the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery. © 2017 International Neuromodulation Society.

Therapeutic communication training in long-term care institutions: recommendations for future research.

PubMed

Levy-Storms, Lené

2008-10-01

The purpose of this review is to critique contemporary experimental research and to recommend future directions for research interventions on nursing aides' therapeutic communication with older adults who have cognitive impairment and/or dementia in institutional long-term care settings. This literature review covers 13 journal articles (1999-2006) and focuses on the strengths and weaknesses of experimental research interventions to improve nursing aides' therapeutic communication with older adults who have cognitive impairment and/or dementia in long-term care settings. Based on this review, recommendations for improved experimental designs include a minimum of two groups with one being a control and randomization of subjects at the care unit level, an average 3-5h of total training, a minimum of a 6-month total evaluation period, and objective outcomes relevant to both nursing aides and residents. Findings from studies in this review indicate that the following therapeutic communication techniques can be taught and can benefit staffs and older adults' quality of life: verbal and non-verbal communication behaviors including open-ended questions, positive statements, eye contact, affective touch, and smiling. Some evidence exists to support that nursing aides can improve their therapeutic communication during care. Nursing aides need not only more training in therapeutic communication but also ongoing, dedicated supervision in psychosocial aspects of care.

Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review.

PubMed

East, James E; Vleugels, Jasper L; Roelandt, Philip; Bhandari, Pradeep; Bisschops, Raf; Dekker, Evelien; Hassan, Cesare; Horgan, Gareth; Kiesslich, Ralf; Longcroft-Wheaton, Gaius; Wilson, Ana; Dumonceau, Jean-Marc

2016-11-01

Background and aim: This technical review is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the utilization of advanced endoscopic imaging in gastrointestinal (GI) endoscopy. Methods: This technical review is based on a systematic literature search to evaluate the evidence supporting the use of advanced endoscopic imaging throughout the GI tract. Technologies considered include narrowed-spectrum endoscopy (narrow band imaging [NBI]; flexible spectral imaging color enhancement [FICE]; i-Scan digital contrast [I-SCAN]), autofluorescence imaging (AFI), and confocal laser endomicroscopy (CLE). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence. Main recommendations: 1. We suggest advanced endoscopic imaging technologies improve mucosal visualization and enhance fine structural and microvascular detail. Expert endoscopic diagnosis may be improved by advanced imaging, but as yet in community-based practice no technology has been shown consistently to be diagnostically superior to current practice with high definition white light. (Low quality evidence.) 2. We recommend the use of validated classification systems to support the use of optical diagnosis with advanced endoscopic imaging in the upper and lower GI tracts (strong recommendation, moderate quality evidence). 3. We suggest that training improves performance in the use of advanced endoscopic imaging techniques and that it is a prerequisite for use in clinical practice. A learning curve exists and training alone does not guarantee sustained high performances in clinical practice. (Weak recommendation, low quality evidence.) Conclusion: Advanced endoscopic imaging can improve mucosal visualization and endoscopic diagnosis; however it requires training and the use of validated classification systems. © Georg Thieme Verlag KG Stuttgart · New York.

Improving the Use of Suprasegmentals with Severely Handicapped Children through Music and Movement.

ERIC Educational Resources Information Center

Leung, Katherine

1985-01-01

The paper reviews techniques suggested in the literature for the improvement of suprasegmentals (prosody) and the role of music in speech remediation with communicatively impaired children. Specific strategies, including the Z. Kodaly method of teaching singing and the use of a quartz metronome, are recommended. (Author/CL)

A Dean Speaks Out: The Financial Aid Profession in Higher Education.

ERIC Educational Resources Information Center

Meyerson, Ely

1981-01-01

Although financial aid staff feel they are treated as second-class citizens, they are seen as their own worst enemy. Some recommendations to improve the profession include: avoid use of jargon, reduce use of forms, promote the consolidation of loan activities, establish goals and objectives, and improve organizational development. (MLW)

Scholastic Audits. Research Brief

ERIC Educational Resources Information Center

Walker, Karen

2009-01-01

What is a scholastic audit? The purpose of the audit is to assist individual schools and districts improve. The focus is on gathering data and preparing recommendations that can be used to guide school improvement initiatives. Scholastic audits use a multi-step approach and include: (1) Preparing for the Audit; (2) Audit process; (3) Audit report;…

Continuous Energy Improvement in Motor Driven Systems - A Guidebook for Industry

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

Gilbert A. McCoy and John G. Douglass

2014-02-01

This guidebook provides a step-by-step approach to developing a motor system energy-improvement action plan. An action plan includes which motors should be repaired or replaced with higher efficiency models, recommendations on maintaining a spares inventory, and discussion of improvements in maintenance practices. The guidebook is the successor to DOE’s 1997 Energy Management for Motor Driven Systems. It builds on its predecessor publication by including topics such as power transmission systems and matching driven equipment to process requirements in addition to motors.

EURRECA: development of tools to improve the alignment of micronutrient recommendations.

PubMed

Matthys, C; Bucchini, L; Busstra, M C; Cavelaars, A E J M; Eleftheriou, P; Garcia-Alvarez, A; Fairweather-Tait, S; Gurinović, M; van Ommen, B; Contor, L

2010-11-01

Approaches through which reference values for micronutrients are derived, as well as the reference values themselves, vary considerably across countries. Harmonisation is needed to improve nutrition policy and public health strategies. The EURRECA (EURopean micronutrient RECommendations Aligned, http://www.eurreca.org) Network of Excellence is developing generic tools for systematically establishing and updating micronutrient reference values or recommendations. Different types of instruments (including best practice guidelines, interlinked web pages, online databases and decision trees) have been identified. The first set of instruments is for training purposes and includes mainly interactive digital learning materials. The second set of instruments comprises collection and interlinkage of diverse information sources that have widely varying contents and purposes. In general, these sources are collections of existing information. The purpose of the majority of these information sources is to provide guidance on best practice for use in a wider scientific community or for users and stakeholders of reference values. The third set of instruments includes decision trees and frameworks. The purpose of these tools is to guide non-scientists in decision making based on scientific evidence. This platform of instruments will, in particular in Central and Eastern European countries, contribute to future capacity-building development in nutrition. The use of these tools by the scientific community, the European Food Safety Authority, bodies responsible for setting national nutrient requirements and others should ultimately help to align nutrient-based recommendations across Europe. Therefore, EURRECA can contribute towards nutrition policy development and public health strategies.

Improvements in Clinical Trials Information Will Improve the Reproductive Health and Fertility of Cancer Patients.

PubMed

Dauti, Angela; Gerstl, Brigitte; Chong, Serena; Chisholm, Orin; Anazodo, Antoinette

2017-06-01

There are a number of barriers that result in cancer patients not being referred for oncofertility care, which include knowledge about reproductive risks of antineoplastic agents. Without this information, clinicians do not always make recommendations for oncofertility care. The objective of this study was to describe the level of reproductive information and recommendations that clinicians have available in clinical trial protocols regarding oncofertility management and follow-up, and the information that patients may receive in clinical trials patient information sheets or consent forms. A literature review of the 71 antineoplastic drugs included in the 68 clinical trial protocols showed that 68% of the antineoplastic drugs had gonadotoxic animal data, 32% had gonadotoxic human data, 83% had teratogenic animal data, and 32% had teratogenic human data. When the clinical trial protocols were reviewed, only 22% of the protocols reported the teratogenic risks and 32% of the protocols reported the gonadotoxic risk. Only 56% of phase 3 protocols had gonadotoxic information and 13% of phase 3 protocols had teratogenic information. Nine percent of the protocols provided fertility preservation recommendations and 4% provided reproductive information in the follow-up and survivorship period. Twenty-six percent had a section in the clinical trials protocol, which identified oncofertility information easily. When gonadotoxic and teratogenic effects of treatment were known, they were not consistently included in the clinical trial protocols and the lack of data for new drugs was not reported. Very few protocols gave recommendations for oncofertility management and follow-up following the completion of cancer treatment. The research team proposes a number of recommendations that should be required for clinicians and pharmaceutical companies developing new trials.

Climate services to improve public health.

PubMed

Jancloes, Michel; Thomson, Madeleine; Costa, María Mánez; Hewitt, Chris; Corvalan, Carlos; Dinku, Tufa; Lowe, Rachel; Hayden, Mary

2014-04-25

A high level expert panel discussed how climate and health services could best collaborate to improve public health. This was on the agenda of the recent Third International Climate Services Conference, held in Montego Bay, Jamaica, 4-6 December 2013. Issues and challenges concerning a demand led approach to serve the health sector needs, were identified and analysed. Important recommendations emerged to ensure that innovative collaboration between climate and health services assist decision-making processes and the management of climate-sensitive health risk. Key recommendations included: a move from risk assessment towards risk management; the engagement of the public health community with both the climate sector and development sectors, whose decisions impact on health, particularly the most vulnerable; to increase operational research on the use of policy-relevant climate information to manage climate- sensitive health risks; and to develop in-country capacities to improve local knowledge (including collection of epidemiological, climate and socio-economic data), along with institutional interaction with policy makers.

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

Manualization of Occupational Therapy Using Ayres Sensory Integration® for Autism.

PubMed

Hunt, Joanne; van Hooydonk, Elke; Faller, Patricia; Mailloux, Zoe; Schaaf, Roseann

2017-07-01

This article reports on the development of a Stage 3 manual (following pilot effectiveness study) for implementing occupational therapy using Ayres Sensory Integration® (OT/ASI) for children with autism spectrum disorders to enhance participation in daily occupations. Three stakeholder groups were surveyed to aid in translation of manual from research to practice (i.e., Stage 3 manual) and an expert consensus meeting was held to finalize recommendations. Data indicated that the manuals usability could be improved by including a section on frequently encountered problems and solutions, and by including video case examples. Also recommended were greater chapter uniformity, improved clarity of forms and charts, and inclusion of a glossary. Changes were made and subject to expert review and consensus using modified Delphi process. The Stage 3 manual has been rigorously vetted and is ready for practice and research replication.

[Anti-pneumococcal vaccine coverage for hospitalized risk patients: Assessment and suggestions for improvements].

PubMed

Richard, C; Le Garlantezec, P; Lamand, V; Rasamijao, V; Rapp, C

2016-05-01

Streptococcus pneumoniae can cause invasive infections. Incidence and severity are linked to patients' risk factors. Due to the resistance to leading antibiotics, the anti-pneumococcal vaccination has become a major public health issue. The purpose of this survey was to evaluate the anti-pneumococcal vaccine coverage in a population of adults with risk factors. This was a prospective study that included patients with at least one recommendation for pneumococcal vaccination as indicated by the Weekly Epidemiological Bulletin (BEH), to which three further US recommendations were added (diabetes, obesity and age>65years). One hundred and thirty-four patients with an average age of 70 years were included. The physician could only confirm 68 % of the patients' vaccination status. Vaccination coverage as recommended by the BEH board was 30 % (n=54). All HIV patients were vaccinated (n=2) and the vaccination coverage was 75 % (n=8) for patients treated for autoimmune diseases and only 10 % (n=20) for patients treated with chemotherapy. Patients with no vaccination didn't know the existence of the vaccine or didn't know that vaccination was recommended to them. This study has highlighted a deficit in pneumococcal vaccination coverage and a high level of ignorance of the existence of recommended vaccination. In addition to awareness campaign for patients and caregiver training, the expansion of the vaccine e-book utilization could improve the vaccination status. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Patient engagement with surgical site infection prevention: an expert panel perspective.

PubMed

Tartari, E; Weterings, V; Gastmeier, P; Rodríguez Baño, J; Widmer, A; Kluytmans, J; Voss, A

2017-01-01

Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

Mental Health in the Workplace: A Call to Action Proceedings From the Mental Health in the Workplace-Public Health Summit.

PubMed

Goetzel, Ron Z; Roemer, Enid Chung; Holingue, Calliope; Fallin, M Daniele; McCleary, Katherine; Eaton, William; Agnew, Jacqueline; Azocar, Francisca; Ballard, David; Bartlett, John; Braga, Michael; Conway, Heidi; Crighton, K Andrew; Frank, Richard; Jinnett, Kim; Keller-Greene, Debra; Rauch, Sara Martin; Safeer, Richard; Saporito, Dick; Schill, Anita; Shern, David; Strecher, Victor; Wald, Peter; Wang, Philip; Mattingly, C Richard

2018-04-01

The aim of the study was to declare a call to action to improve mental health in the workplace. We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of workers. The Advisory Council narrowed the list of ideas to four priority projects. The recommendations for action include developing a mental health in the workplace (1) "how to" guide, (2) scorecard, (3) recognition program, and (4) executive training.

Mental Health in the Workplace: A Call to Action Proceedings from the Mental Health in the Workplace: Public Health Summit

PubMed Central

Goetzel, Ron Z.; Roemer, Enid Chung; Holingue, Calliope; Fallin, M. Daniele; McCleary, Katherine; Eaton, William; Agnew, Jacqueline; Azocar, Francisca; Ballard, David; Bartlett, John; Braga, Michael; Conway, Heidi; Crighton, K. Andrew; Frank, Richard; Jinnett, Kim; Keller-Greene, Debra; Rauch, Sara Martin; Safeer, Richard; Saporito, Dick; Schill, Anita; Shern, David; Strecher, Victor; Wald, Peter; Wang, Philip; Mattingly, C. Richard

2018-01-01

Objective To declare a call to action to improve mental health in the workplace. Methods We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of workers. Results The Advisory Council narrowed the list of ideas to four priority projects. Conclusions The recommendations for action include developing a Mental Health in the Workplace 1) “How to” Guide, 2) Scorecard, 3) Recognition Program, and 4) Executive Training. PMID:29280775

Factors Influencing Competence and Performance of Reference Librarians in Academic Libraries in Nigeria.

ERIC Educational Resources Information Center

Omoniyi, Joseph O.

2002-01-01

Reports on research that focused on competence and performance of reference libraries in academic libraries in Nigeria. Includes recommendations for improving competence and performance, including the reference process; staffing and other resources; education for reference librarians; knowledge of modern technology; and emotional stability and…

What are the determinants of food security among regional and remote Western Australian children?

PubMed

Godrich, Stephanie L; Davies, Christina R; Darby, Jill; Devine, Amanda

2017-01-22

To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi-structured interviews with 20 key informants. Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health: Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills. © 2017 Public Health Association of Australia.

Reporting Guidelines for Music-based Interventions

PubMed Central

Robb, Sheri L.; Burns, Debra S.; Carpenter, Janet S.

2013-01-01

Music-based interventions are used to address a variety of problems experienced by individuals across the developmental lifespan (infants to elderly adults). In order to improve the transparency and specificity of reporting music-based interventions, a set of specific reporting guidelines is recommended. Recommendations pertain to reporting seven different components of music-based interventions including intervention theory, intervention content, intervention delivery schedule, interventionist, treatment fidelity, setting, and unit of delivery. Recommendations are intended to support CONSORT and TREND statements for transparent reporting of interventions while taking into account the variety, complexity, and uniqueness of music-based interventions. PMID:23646227

Actions to implement the recommendations of the Presidential Commission on the Space Shuttle Challenger Accident. Report to the President

NASA Technical Reports Server (NTRS)

1986-01-01

The status of the implementation of the recommendations of the Presidential Commission on the Space Shuttle Challenger Accident is reported. The implementation of recommendations in the following areas is detailed: (1) solid rocket motor design; (2) shuttle management structure, including the shuttle safety panel and astronauts in management; (3) critical item review and hazard analysis; (4) safety organization; (5) improved communication; (6) landing safety; (7) launch abort and crew escape; (8) flight rate; and (9) maintenance safeguards. Supporting memoranda and communications from NASA are appended.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs.

PubMed

Brosseau, Lucie; Taki, Jade; Desjardins, Brigit; Thevenot, Odette; Fransen, Marlene; Wells, George A; Mizusaki Imoto, Aline; Toupin-April, Karine; Westby, Marie; Álvarez Gallardo, Inmaculada C; Gifford, Wendy; Laferrière, Lucie; Rahman, Prinon; Loew, Laurianne; De Angelis, Gino; Cavallo, Sabrina; Shallwani, Shirin Mehdi; Aburub, Ala'; Bennell, Kim L; Van der Esch, Martin; Simic, Milena; McConnell, Sara; Harmer, Alison; Kenny, Glen P; Paterson, Gail; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; McLean, Linda

2017-05-01

To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). The five high-quality studies included demonstrated that various aerobic training exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

Complex Relationships Between Food, Diet, and the Microbiome.

PubMed

Pace, Laura A; Crowe, Sheila E

2016-06-01

Diet is a risk factor in several medically important disease states, including obesity, celiac disease, and functional gastrointestinal disorders. Modification of diet can prevent, treat, or alleviate some of the symptoms associated with these diseases and improve general health. It is important to provide patients with simple dietary recommendations to increase the probability of successful implementation. These recommendations include increasing vegetable, fruit, and fiber intake, consuming lean protein sources to enhance satiety, avoiding or severely limiting highly processed foods, and reducing portion sizes for overweight and obese patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Rural emergency care 360°: mobilising healthcare professionals, decision-makers, patients and citizens to improve rural emergency care in the province of Quebec, Canada: a qualitative study protocol.

PubMed

Fleet, Richard; Dupuis, Gilles; Fortin, Jean-Paul; Gravel, Jocelyn; Ouimet, Mathieu; Poitras, Julien; Légaré, France

2017-08-17

Emergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens. Our goal is to build recommendations for improving services by mobilising stakeholders interested in rural emergency care. With help and full engagement of stakeholders, we will (1) identify solutions for improving quality and performance in rural EDs; (2) formulate and prioritise recommendations; (3) transfer knowledge of the recommendations to rural EDs and support operationalisation and (4) assess knowledge transfer and explore further impacts of this participatory action research project. We will use a participatory action research approach. We will plan for a governance structure that includes all stakeholders’ representatives, so throughout this project, stakeholders are fully engaged at every step. Our sample will be 26 EDs in rural Quebec. We will conduct semistructured individual and focus group interviews with relevant and representative participants, including patients and citizens (estimated n=200). Interviews will be thematically analysed to extract potential solutions and other qualitative information.An expert panel (±15) will use an analysis grid to develop consensus recommendations from solutions suggested and will evaluate feasibility, impacts, costs, conditions for implementation and establish monitoring indicators. Recommendations will be transferred to stakeholders using tailored knowledge translation strategies (web platform, meetings and so on). This study will result in a comprehensive consensus list of feasible and high-priority recommendations enabling decision-makers in emergency care to implement improvements in rural emergency care in Quebec. This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project number: MP 2017-009). The qualitative material will be kept confidential and the data will be presented in a way that respects confidentiality. The dissemination plan for the study includes publications in scientific and professional journals. We will also use social media to disseminate our findings and activities such as communications in public conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Improving Transfer of Learning: An Innovative Comentoring Program to Enhance Workplace Implementation After an Occupational Therapy Course on Autism Spectrum Disorders.

PubMed

Ashburner, Jill; Ziviani, Jenny; Rodger, Sylvia; Hinder, Elizabeth A; Cartmill, Linda; White, Jessica; Vickerstaff, Sandy

2015-01-01

Research suggests that learning gained through training is infrequently implemented in the workplace. A short-term postcourse comentoring program was developed with the aim of facilitating workplace implementation of learning after a 3-day course for occupational therapists. The program was evaluated for usefulness, successes, challenges, recommended improvements, and associations with changes in self-rated knowledge and confidence. Two months after the course, 42 participants completed an evaluation of the comentoring program with closed- and open-ended questions addressing usefulness, successes, challenges, pairing preferences, and recommendations. They also completed a record on whether or not they had worked on goals nominated in their comentoring contract. Before and 2 months after the course, they completed a self-rated questionnaire on knowledge and confidence. The comentoring program was recommended by 80% of participants. Benefits included opportunities for information and resource sharing, debriefing, problem solving, reassurance, and implementation of ideas. Ninety-five percent of participants worked on some or all their comentoring goals. Although there were significant improvements in knowledge (P < 0.001) and confidence (P < 0.001), the total comentoring evaluation score was not significantly associated with these changes. It is therefore possible that these improvements related to the course itself rather than the comentoring program. Challenges related to time, scheduling, distance, and pairing of comentors. Reported benefits of the program included enhanced psychosocial support and prompting to trial newly learned strategies. Effectiveness may be improved by setting aside time for comentoring in the workplace and better matching of comentors.

55+ Drivers: Needs and Problems of Older Drivers: Survey Results and Recommendations. Proceedings of the Older Driver Colloquium (Orlando, Florida, February 4-7, 1985).

ERIC Educational Resources Information Center

Malfetti, James L., Ed.

These proceedings include 11 background papers that were presented by a panel of authorities in traffic safety and/or gerontology who were professionally concerned with older drivers and pedestrians. Papers focus on the needs and problems of older drivers and on what can and should be done to deal with them. Recommendations to improve safety for…

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.

Dysphagia screening after acute stroke: a quality improvement project using criteria-based clinical audit.

PubMed

Sivertsen, Jorun; Graverholt, Birgitte; Espehaug, Birgitte

2017-01-01

Dysphagia is common after stroke and represents a major risk factor for developing aspiration pneumonia. Early detection can reduce the risk of pulmonary complications and death. Despite the fact that evidence-based guidelines recommend screening for swallowing deficit using a standardized screening tool, national audits has identified a gap between practice and this recommendation. The aim was to determine the level of adherence to an evidence-based recommendation on swallow assessment and to take actions to improve practice if necessary. We carried out a criteria-based clinical audit (CBCA) in a small stroke unit at a Norwegian hospital. Patients with hemorrhagic stroke, ischemic stroke and transient ischemic attack were included. A power calculation informed the number of included patients at baseline ( n  = 80) and at re-audit ( n  = 35). We compared the baseline result with the evidence-based criteria and gave feedback to management and staff. A brainstorming session, a root-cause analysis and implementation science were used to inform the quality improvement actions which consisted of workshops, use of local opinion leaders, manual paper reminders and feedback. We completed a re-audit after implementation. Percentages and median are reported with 95% confidence intervals (CI). Among 88 cases at baseline, documentation of swallow screening was complete for 6% (95% CI 2-11). In the re-audit ( n  = 51) 61% (95% CI 45-74) had a complete screening. A CBCA involving management and staff, and using multiple tailored intervention targeting barriers, led to greater adherence with the recommendation for screening stroke patients for dysphagia.

Are root cause analyses recommendations effective and sustainable? An observational study.

PubMed

Hibbert, Peter D; Thomas, Matthew J W; Deakin, Anita; Runciman, William B; Braithwaite, Jeffrey; Lomax, Stephanie; Prescott, Jonathan; Gorrie, Glenda; Szczygielski, Amy; Surwald, Tanja; Fraser, Catherine

2018-03-01

To assess the strength of root cause analysis (RCA) recommendations and their perceived levels of effectiveness and sustainability. All RCAs related to sentinel events (SEs) undertaken between the years 2010 and 2015 in the public health system in Victoria, Australia were analysed. The type and strength of each recommendation in the RCA reports were coded by an expert patient safety classifier using the US Department of Veteran Affairs type and strength criteria. Thirty-six public health services. The proportion of RCA recommendations which were classified as 'strong' (more likely to be effective and sustainable), 'medium' (possibly effective and sustainable) or 'weak' (less likely to be effective and sustainable). There were 227 RCAs in the period of study. In these RCAs, 1137 recommendations were made. Of these 8% were 'strong', 44% 'medium' and 48% were 'weak'. In 31 RCAs, or nearly 15%, only weak recommendations were made. In 24 (11%) RCAs five or more weak recommendations were made. In 165 (72%) RCAs no strong recommendations were made. The most frequent recommendation types were reviewing or enhancing a policy/guideline/documentation, and training and education. Only a small proportion of recommendations arising from RCAs in Victoria are 'strong'. This suggests that insights from the majority of RCAs are not likely to inform practice or process improvements. Suggested improvements include more human factors expertise and independence in investigations, more extensive application of existing tools that assist teams to prioritize recommendations that are likely to be effective, and greater use of observational and simulation techniques to understand the underlying systems factors. Time spent in repeatedly investigating similar incidents may be better spent aggregating and thematically analysing existing sources of information about patient safety.

Factors related to receipt of well-child visits in insured children.

PubMed

Goedken, Amber M; Urmie, Julie M; Polgreen, Linnea A

2014-04-01

Our objective was to identify factors related to receipt of the recommended number of well-child visits in insured children. We hypothesized parent insurance status would be related to receipt of well-child visits, with those with uninsured parents more likely to have fewer visits than recommended. Data for the study came from the 2007 Medical Expenditure Panel Survey-Household Component. The sample included children <18 years of age with full-year insurance coverage and parents who were insured or uninsured the entire year. The outcome variable indicated whether children had received fewer than the recommended number of well-child visits in physician offices or outpatient departments. Parent, family, and child characteristics were measured. Forty-eight percent of the 4,650 children included in the study had fewer well-child visits than recommended. Children whose parents did not visit a physician during the year and children whose parents had not completed high school were more likely to miss recommended visits. Parent insurance status did not affect well-child visits. We identified child, family, and parent factors influencing well-child visits in insured children, including the parent's own use of physician visits. Contrary to our hypothesis, well-child visits were not influenced by parent insurance status. Determining which insured children are at greater risk of missing recommended well-child visits aids policymakers in identifying those who may benefit from interventions to improve use of preventive care.

Practical recommendations for the evaluation of improvement initiatives

PubMed Central

Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

2018-01-01

Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome.

PubMed

Hao, Yongchen; Liu, Jing; Liu, Jun; Smith, Sidney C; Huo, Yong; Fonarow, Gregg C; Ma, Changsheng; Ge, Junbo; Taubert, Kathryn A; Morgan, Louise; Guo, Yang; Zhang, Qian; Wang, Wei; Zhao, Dong

2016-09-01

A sizeable gap exists between guideline recommendations for treatment of acute coronary syndrome (ACS) and application of these recommendations in clinical practice. The CCC-ACS project is a novel national quality enhancement registry designed to help medical care providers bridge this gap, thereby improving clinical outcomes for ACS patients in China. The CCC-ACS project uses data collection, analysis, feedback, rapid-cycle improvement, and performance recognition to extend the use of evidence-based guidelines throughout the health care system and improve cardiovascular health. The project was launched in 2014, with 150 centers recruited representing the diversity of care for ACS patients in tertiary hospitals across China. Clinical information for patients with ACS is collected via a Web-based data collecting platform, including patients' demographics, medical history, symptoms on arrival, in-hospital treatment and procedures, in-hospital outcomes, and discharge medications for secondary prevention. Improvement in adherence to guideline recommendations is facilitated through monthly benchmarked hospital quality reports, recognition of hospital quality achievement, and regular webinars. As of April 16, 2016, a total of 35,616 ACS cases have been enrolled. The CCC-ACS is a national hospital-based quality improvement program, aiming to increase adherence to ACS guidelines in China and improve patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

The pediatric orthopaedics workforce demands, needs, and resources.

PubMed

Schwend, Richard M

2009-01-01

The Pediatric Orthopaedic Society of North America Practice Management Committee evaluated current and future pediatric orthopaedic workforce needs. The resulting informational article summarizes its findings and makes recommendations for improvement of our workforce. Whereas policy decisions are often in the hands of the government with its emphasis on access and cost containment, the area that we can control, the quality of our workforce should be our primary effort. Specific recommendations include the prospective collection of accurate workforce data, increasing the interest of residents and students to enter our specialty, assisting members to improve practice efficiencies and assuming leadership in the musculoskeletal education of our primary care colleagues. We expect that by improving our workforce and professional work environment, we can make a difference for our young patients and for the society.

Challenges and Opportunities for School Improvement: Recommendations for Urban School Principals

ERIC Educational Resources Information Center

Dolph, David

2017-01-01

Insofar as urban school systems that are often identified as ineffective include such a large segment of U.S. P-12 students, it is vital to improve academic success. To provide context, the article first discusses key challenges facing urban schools. Second, the article identifies and briefly reviews a variety of approaches to reform models often…

Informing Writing: The Benefits of Formative Assessment. A Report from Carnegie Corporation of New York

ERIC Educational Resources Information Center

Graham, Steve; Harris, Karen; Hebert, Michael

2011-01-01

During this decade there have been numerous efforts to identify instructional practices that improve students' writing. These include "Reading Next" (Biancarosa and Snow, 2004), which provided a set of instructional recommendations for improving writing, and "Writing Next" (Graham and Perin, 2007) and "Writing to Read" (Graham and Hebert, 2010),…

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.

Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

PubMed Central

Harris, Matthew J.; Rocha, Marcia Gomes

2017-01-01

Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil. PMID:28252498

The impact of a unique knowledge translation programme implemented in a large multisite paediatric hospital.

PubMed

Christensen, Catie; Wessells, David; Byars, Michelle; Marrie, James; Coffman, Shaun; Gates, Erin; Selhorst, Mitch

2017-04-01

Physical therapists (PTs) display positive attitudes toward evidence-based practice (EBP), and implementing it can improve patient outcomes and reduce costs. However, barriers can lead to inconsistent use of EBP. The objectives of this manuscript are to (i) describe the initiation and revisions to a knowledge translation (KT) programme, (ii) assess staff participation in KT, and (iii) evaluate availability, internal use and external dissemination of evidence-based recommendations and research. The KT programme was implemented in a large paediatric hospital employing 66 PTs who provide services in the inpatient, outpatient developmental and sports and orthopaedics settings in 15 locations. The KT programme was initiated 9 years ago but underwent improvements over the past 3 years. Five key revisions included the subdivision of the EBP and Research Coordinator positions by area of practice, increasing the structure of the KT programme, implementing strategies to encourage use of local recommendations, obtaining leadership support to emphasize KT and providing staff education. With the revisions, staff participation in local recommendation development increased from 16.3-68.2%. Research involvement increased from 4.1-50%. The number of local recommendations increased from 1 to 9, and an overall compliance rate of 79% was achieved for the recommendations presented in an algorithm format. External dissemination increased from 1 to 44 for presentations and 0 to 7 for publications. Revisions to a KT programme improved PT engagement in KT activities, increased the availability of local recommendations, encouraged use of EBP and increased external dissemination of information. © 2016 John Wiley & Sons, Ltd.

Quality and consistency of guidelines for the management of mild traumatic brain injury in the emergency department.

PubMed

Tavender, Emma J; Bosch, Marije; Green, Sally; O'Connor, Denise; Pitt, Veronica; Phillips, Kate; Bragge, Peter; Gruen, Russell L

2011-08-01

The objective was to provide an overview of the recommendations and quality of evidence-based clinical practice guidelines (CPGs) for the emergency management of mild traumatic brain injury (mTBI), with a view to informing best practice and improving the consistency of recommendations. Electronic searches of health databases (MEDLINE, EMBASE, The Cochrane Library, PsycINFO), CPG clearinghouse websites, CPG developer websites, and Internet search engines up to January 2010 were conducted. CPGs were included if 1) they were published in English and freely accessible, 2) their scope included the management of mTBI in the emergency department (ED), 3) the date of last search was within the past 10 years (2000 onward), 4) systematic methods were used to search for evidence, and 5) there was an explicit link between the recommendations and the supporting evidence. Four authors independently assessed the quality of the included CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) Instrument. The authors extracted and categorized recommendations according to initial clinical assessment, imaging, management, observation, discharge planning, and patient information and follow-up. The search identified 18 potential CPGs, of which six met the inclusion criteria. The included CPGs varied in scope, target population, size, and guideline development processes. Four CPGs were assessed as "strongly recommended." The majority of CPGs did not provide information about the level of stakeholder involvement (mean AGREE standardized domain score = 57%, range = 25% to 81%), nor did they address the organizational/cost implications of applying the recommendations or provide criteria for monitoring and review of recommendations in practice (mean AGREE standardized domain score = 46.6%, range = 19% to 94%). Recommendations were mostly consistent in terms of the use of the Glasgow Coma Scale (GCS) score (adult and pediatric) to assess the level of consciousness, initial assessment criteria, the use of computed tomography (CT) scanning as imaging investigation of choice, and the provision of patient information. The CPGs defined mTBI in a variety of ways and described different rules to determine the need for CT scanning and therefore used different criteria to identify high-risk patients. Higher-quality CPGs for mTBI are consistent in their recommendations about assessment, imaging, and provision of patient information. There is not, however, an agreed definition of mTBI, and the quality of future CPGs could be improved with better reporting of stakeholder involvement, procedures for updating, and greater consideration of the applicability of the recommendations (cost implications, monitoring procedures). Nevertheless, guideline developers may benefit from adapting existing CPGs to their local context rather than investing in developing CPGs de novo. © 2011 by the Society for Academic Emergency Medicine.

Achieving organizational change in pediatric pain management

PubMed Central

Dowden, Stephanie; McCarthy, Maria; Chalkiadis, George

2008-01-01

BACKGROUND: Pain in hospitalized children is often under-treated. Little information exists to guide the process of organizational change with a view to improving pain management practices. OBJECTIVES: To describe the process and results of a hospital-wide review of pain management practices designed to identify deficiencies in service provision and recommend directions for change in a pediatric hospital. DESIGN: Prospective consultation of the clinical staff of a specialist pediatric hospital, using qualitative research methodology involving semistructured individual and group interviews. Recommendations based on the interview findings were made by a hospital-appointed working party. RESULTS: A total of 454 staff (27% of all clinical staff) from a variety of professional backgrounds, representing almost every hospital unit or department, were interviewed. Procedural and persistent (chronic) pain was identified as the area needing the most improvement. Barriers to improving pain management included variability in practice, outmoded beliefs and inadequate knowledge, factors which were seen to contribute to a culture of slow or no change. Recommendations of the working party and changes achieved after the review are described. CONCLUSION: The review process identified deficiencies in the management of pain in children, and barriers to its effective management. With institutional support, the present review has guided improvement. PMID:18719714

A Dynamic Recommender System for Improved Web Usage Mining and CRM Using Swarm Intelligence.

PubMed

Alphy, Anna; Prabakaran, S

2015-01-01

In modern days, to enrich e-business, the websites are personalized for each user by understanding their interests and behavior. The main challenges of online usage data are information overload and their dynamic nature. In this paper, to address these issues, a WebBluegillRecom-annealing dynamic recommender system that uses web usage mining techniques in tandem with software agents developed for providing dynamic recommendations to users that can be used for customizing a website is proposed. The proposed WebBluegillRecom-annealing dynamic recommender uses swarm intelligence from the foraging behavior of a bluegill fish. It overcomes the information overload by handling dynamic behaviors of users. Our dynamic recommender system was compared against traditional collaborative filtering systems. The results show that the proposed system has higher precision, coverage, F1 measure, and scalability than the traditional collaborative filtering systems. Moreover, the recommendations given by our system overcome the overspecialization problem by including variety in recommendations.

A Dynamic Recommender System for Improved Web Usage Mining and CRM Using Swarm Intelligence

PubMed Central

Alphy, Anna; Prabakaran, S.

2015-01-01

In modern days, to enrich e-business, the websites are personalized for each user by understanding their interests and behavior. The main challenges of online usage data are information overload and their dynamic nature. In this paper, to address these issues, a WebBluegillRecom-annealing dynamic recommender system that uses web usage mining techniques in tandem with software agents developed for providing dynamic recommendations to users that can be used for customizing a website is proposed. The proposed WebBluegillRecom-annealing dynamic recommender uses swarm intelligence from the foraging behavior of a bluegill fish. It overcomes the information overload by handling dynamic behaviors of users. Our dynamic recommender system was compared against traditional collaborative filtering systems. The results show that the proposed system has higher precision, coverage, F1 measure, and scalability than the traditional collaborative filtering systems. Moreover, the recommendations given by our system overcome the overspecialization problem by including variety in recommendations. PMID:26229978

The physician as disability advisor for patients with musculoskeletal complaints.

PubMed

Rainville, James; Pransky, Glenn; Indahl, Aage; Mayer, Eric K

2005-11-15

Literature review. To review the literature about the performance of physicians as mediators of temporary and permanent disability for patients with chronic musculoskeletal complaints. To assess specifically the nature and variance of recommendations from physicians, factors influencing physician performance, and efforts to influence physician behavior in this area. While caring for patients with musculoskeletal injuries, physicians are often asked to recommend appropriate levels of activity and work. These recommendations have significant consequences for patients' general health, employment, and financial well-being. Medical literature search. Physician recommendations limiting activity and work after injury are highly variable, often reflecting their own pain attitudes and beliefs. Patients' desires strongly predict disability recommendations (i.e., physicians often acquiesce to patients' requests). Other influences include jurisdiction, employer, insurer, and medical system factors. The most successful efforts to influence physician recommendations have used mass communication to influence public attitudes, while reinforcing the current standard of practice for physicians. Physician recommendations for work and activity have important health and financial implications. Systemic, multidimensional approaches are necessary to improve performance.

Interventions to improve hand hygiene compliance in patient care.

PubMed

Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H; Taljaard, Monica

2017-09-01

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention.Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes.Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low.Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence.Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence.Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence.Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.

American Society of Clinical Oncology Position Statement: Strategies for Reducing Cancer Health Disparities Among Sexual and Gender Minority Populations.

PubMed

Griggs, Jennifer; Maingi, Shail; Blinder, Victoria; Denduluri, Neelima; Khorana, Alok A; Norton, Larry; Francisco, Michael; Wollins, Dana S; Rowland, Julia H

2017-07-01

ASCO is committed to addressing the needs of sexual and gender minority (SGM) populations as a diverse group at risk for receiving disparate care and having suboptimal experiences, including discrimination, throughout the cancer care continuum. This position statement outlines five areas of recommendations to address the needs of both SGM populations affected by cancer and members of the oncology workforce who identify as SGM: (1) patient education and support; (2) workforce development and diversity; (3) quality improvement strategies; (4) policy solutions; and (5) research strategies. In making these recommendations, the Society calls for increased outreach and educational support for SGM patients; increased SGM cultural competency training for providers; improvement of quality-of-care metrics that include sexual orientation and gender information variables; and increased data collection to inform future work addressing the needs of SGM communities.

Comparison of information about the quality of apparel in three retail formats.

PubMed

Bye, Elizabeth K; Reiley, Kathryn

2003-06-01

Multiple options are available for selection and purchase of apparel including in-store, catalogue, and Internet. The present purpose was to compare information about quality available to consumers in three retail formats. Students studying quality of apparel selected a product which could be purchased in each of the three formats, completed an evaluation from both a consumer's and preprofessional perspective, and made recommendations for improving information on quality. A total of 413 recommendations were categorized and tested for independence. Students had similar expectations for cues of quality across Internet, catalogue, and in-store formats including fiber content, country of origin, 3-dimensional information about fit, color accuracy, size charts, and strong customer service. Students expected a uniform array of information on quality regardless of the shopping format. Merchandisers must be aware of the total image across formats and be prepared to explore methods for improving communication of information on quality in each.

Water Resources Investigation. Cape Girardeau - Jackson Metropolitan Area, Missouri. Volume 4. Appendix C. Public Views and Responses.

DTIC Science & Technology

1983-12-01

reconsider the pooling device proposed for the Independence Street reach of Cape La Croix Creek. 3. The environmental corridor along the Cape La Croix Creek...hiking and biking trail should be restored to the recommended project. As discussed earlier, such a corridor would improve the quality of outdoor...was considered useful. The present recommended plan does not include channelization between miles 3.8 and 5.1. *Comment: The environmental corridor

Recommendations from the International Union of Radioecology to improve guidance on radiation protection.

PubMed

Bréchignac, François; Bradshaw, Clare; Carroll, Simon; Jaworska, Alicja; Kapustka, Larry; Monte, Luigi; Oughton, Deborah

2011-07-01

This brief commentary summarizes the views of a working group assembled by the International Union of Radioecology to advance the approaches used to evaluate effects of radioactive materials in the environment. The key message in both the research needs and the recommendations for management of radioactive materials centers around the need to adopt an ecocentric approach that recognizes the interconnectedness of biota, including humans, and ecological processes. Copyright © 2011 SETAC.

Tailored Educational Approaches for Consumer Health: A Model to Address Health Promotion in an Era of Personalized Medicine.

PubMed

Cohn, Wendy F; Lyman, Jason; Broshek, Donna K; Guterbock, Thomas M; Hartman, David; Kinzie, Mable; Mick, David; Pannone, Aaron; Sturz, Vanessa; Schubart, Jane; Garson, Arthur T

2018-01-01

To develop a model, based on market segmentation, to improve the quality and efficiency of health promotion materials and programs. Market segmentation to create segments (groups) based on a cross-sectional questionnaire measuring individual characteristics and preferences for health information. Educational and delivery recommendations developed for each group. General population of adults in Virginia. Random sample of 1201 Virginia residents. Respondents are representative of the general population with the exception of older age. Multiple factors known to impact health promotion including health status, health system utilization, health literacy, Internet use, learning styles, and preferences. Cluster analysis and discriminate analysis to create and validate segments. Common sized means to compare factors across segments. Developed educational and delivery recommendations matched to the 8 distinct segments. For example, the "health challenged and hard to reach" are older, lower literacy, and not likely to seek out health information. Their educational and delivery recommendations include a sixth-grade reading level, delivery through a provider, and using a "push" strategy. This model addresses a need to improve the efficiency and quality of health promotion efforts in an era of personalized medicine. It demonstrates that there are distinct groups with clearly defined educational and delivery recommendations. Health promotion professionals can consider Tailored Educational Approaches for Consumer Health to develop and deliver tailored materials to encourage behavior change.

[Detection of small for gestational age fetuses during third trimester ultrasound. A monocentric observational study].

PubMed

Peyronnet, V; Kayem, G; Mandelbrot, L; Sibiude, J

2016-09-01

Fetus small for gestational age (SGA) screening rate is evaluated around 21,7 % in France. Recommendations were developed to improve the efficiency of ultrasound conducted in the third trimester (T3), because neonatal consequences can be significant. This study aims to evaluate screening of SGA during T3 ultrasound and to describe causes for failure and differences with the recommendations of CNGOF. All children born between 2011 and 2012 with a birth weight below the 3rd percentile were included in this observational, retrospective, monocentric study. We noted that the diagnosis of SGA was placed on file. Then, as recommended by the CNGOF, we calculated estimated fetal weight (EFW) with Hadlock 3 and Hadlock 4, and the corresponding percentiles, using the biometrics from the ultrasound report. We thus could evaluate a new screening rate with SGA fetus identified through this technique. A total of 142 patients were included. By calculating correctly all EFW and checking abdominal circumference percentiles, the screening rate of SGA fetuses with T3 ultrasound increased from 40 % to 50 % and the overall screening rate (clinical and ultrasound) from 54 % to 66 %. By following the recommendations we found a real improvement in fetal SGA screening rates to T3 ultrasound with a potential benefit for their care. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Better Tests, Better Care: Improved Diagnostics for Infectious Diseases

PubMed Central

Caliendo, Angela M.; Gilbert, David N.; Ginocchio, Christine C.; Hanson, Kimberly E.; May, Larissa; Quinn, Thomas C.; Tenover, Fred C.; Alland, David; Blaschke, Anne J.; Bonomo, Robert A.; Carroll, Karen C.; Ferraro, Mary Jane; Hirschhorn, Lisa R.; Joseph, W. Patrick; Karchmer, Tobi; MacIntyre, Ann T.; Reller, L. Barth; Jackson, Audrey F.

2013-01-01

In this IDSA policy paper, we review the current diagnostic landscape, including unmet needs and emerging technologies, and assess the challenges to the development and clinical integration of improved tests. To fulfill the promise of emerging diagnostics, IDSA presents recommendations that address a host of identified barriers. Achieving these goals will require the engagement and coordination of a number of stakeholders, including Congress, funding and regulatory bodies, public health agencies, the diagnostics industry, healthcare systems, professional societies, and individual clinicians. PMID:24200831

The NASA Monographs on Shell Stability Design Recommendations: A Review and Suggested Improvements

NASA Technical Reports Server (NTRS)

Nemeth, Michael P.; Starnes, James H., Jr.

1998-01-01

A summary of existing NASA design criteria monographs for the design of buckling-resistant thin-shell structures is presented. Subsequent improvements in the analysis for nonlinear shell response are reviewed, and current issues in shell stability analysis are discussed. Examples of nonlinear shell responses that are not included in the existing shell design monographs are presented, and an approach for including reliability based analysis procedures in the shell design process is discussed. Suggestions for conducting future shell experiments are presented, and proposed improvements to the NASA shell design criteria monographs are discussed.

The NASA Monographs on Shell Stability Design Recommendations: A Review and Suggested Improvements

NASA Technical Reports Server (NTRS)

Nemeth, Michael P.; Starnes, James H., Jr.

1998-01-01

A summary of the existing NASA design criteria monographs for the design of buckling-resistant thin-shell structures is presented. Subsequent improvements in the analysis for nonlinear shell response are reviewed, and current issues in shell stability analysis are discussed. Examples of nonlinear shell responses that are not included in the existing shell design monographs are presented, and an approach for including reliability-based analysis procedures in the shell design process is discussed. Suggestions for conducting future shell experiments are presented, and proposed improvements to the NASA shell design criteria monographs are discussed.

Consensus recommendations for improvement of unmet clinical needs--the example of chronic graft-versus-host disease: a systematic review and meta-analysis.

PubMed

Olivieri, Jacopo; Manfredi, Lucia; Postacchini, Laura; Tedesco, Silvia; Leoni, Pietro; Gabrielli, Armando; Rambaldi, Alessandro; Bacigalupo, Andrea; Olivieri, Attilio; Pomponio, Giovanni

2015-07-01

Consensus recommendations are used to improve the methodology of research about rare disorders, but their uptake is unknown. We studied the uptake of consensus recommendations in steroid-refractory chronic graft-versus-host disease (SR-cGVHD). Although in 2006 the National Institutes of Health (NIH) cGVHD consensus project produced recommendations for clinical trials, guidelines have emphasised the scarcity of valuable evidence for all tested interventions. We searched Medline (PubMed) between Jan 1, 1998, and Oct 1, 2013, for non-randomised studies of systemic treatment for SR-cGVHD. To measure adherence to NIH recommendations, we applied a 61 item checklist derived from the NIH consensus document. We did a meta-analysis to measure pooled effect size for overall response rate (ORR) and meta-regression analyses to measure the effect of deviations from NIH recommendations on pooled effect size. We included 82 studies related to nine interventions. Conformity to NIH recommendations was evenly low across the analysed timeframe (1998-2013), and did not change significantly after publication of NIH recommendations. The pooled effect size for ORR for systemic treatment of SR-cGVHD was 0.66 (95% CI 0.62-0.70). Increased adherence to NIH recommendations in a score of items defining correct response assessment was associated with a significant reduction in ORR (-4.2%, 95% CI -6.6 to -1.9; p=0.001). We recorded no significant association between ORR and sets of items related to correct diagnostic definition of SR-cGVHD (change in ORR -3.1%, 95% CI -7.7 to 1.5), specification of primary intervention (0, -3.8 to 3.6), or concomitant treatments (-1.6%, -5.4 to 2.3). The score of items defining correct response assessment increased after publication of NIH recommendations. Our findings show evidence of bias in the reported efficacy of treatment of SR-cGVHD. The overall effect of NIH recommendations in scientific literature is scarce; however, NIH recommendations improved assessment of response, possibly reducing the overestimation bias. Better implementation of NIH recommendations might reduce false expectations about new interventions, and thus prevent clinical studies with ineffective treatments. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

International summit on the nutrition of adolescent girls and young women: consensus statement.

PubMed

Krebs, Nancy; Bagby, Susan; Bhutta, Zulfiqar A; Dewey, Kathryn; Fall, Caroline; Gregory, Fred; Hay, William; Rhuman, Lisa; Caldwell, Christine Wallace; Thornburg, Kent L

2017-07-01

An international summit focusing on the difficult challenge of providing adequate nutrition for adolescent girls and young women in low- and middle-income countries was held in Portland, Oregon in 2015. Sixty-seven delegates from 17 countries agreed on a series of recommendations that would make progress toward improving the nutritional status of girls and young women in countries where their access to nutrition is compromised. Delegate recommendations include: (1) elevate the urgency of nutrition for girls and young women to a high international priority, (2) raise the social status of girls and young women in all regions of the world, (3) identify major knowledge gaps in the biology of adolescence that could be filled by robust research efforts, (4) and improve access to nutrient-rich foods for girls and young women. Attention to these recommendations would improve the health of young women in all nations of the world. © 2017 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of New York Academy of Sciences.

Electronic prescribing in pediatrics: toward safer and more effective medication management.

PubMed

Johnson, Kevin B; Lehmann, Christoph U

2013-04-01

This technical report discusses recent advances in electronic prescribing (e-prescribing) systems, including the evidence base supporting their limitations and potential benefits. Specifically, this report acknowledges that there are limited but positive pediatric data supporting the role of e-prescribing in mitigating medication errors, improving communication with dispensing pharmacists, and improving medication adherence. On the basis of these data and on the basis of federal statutes that provide incentives for the use of e-prescribing systems, the American Academy of Pediatrics recommends the adoption of e-prescribing systems with pediatric functionality. This report supports the accompanying policy statement from the American Academy of Pediatrics recommending the adoption of e-prescribing by pediatric health care providers.

Improving integration and coordination of funding, technical assistance, and reporting/data collection: recommendations from CDC and USAPI stakeholders.

PubMed

Ka'opua, Lana Sue I; White, Susan F; Rochester, Phyllis F; Holden, Debra J

2011-03-01

Current US Federal funding mechanisms may foster program silos that disable sharing of resources and information across programs within a larger system of public health services. Such silos present challenges to USAPI communities where human resources, health infrastructure, and health financing are limited. Integrative and coordinated approaches have been recommended. The CDC Pacific Islands Integration and Coordination project was initiated by the CDC Division of Cancer Prevention and Control (DCPC). The project aim was to identify ways for the CDC to collaborate with the USAPI in improving CDC activities and processes related to chronic disease. This article focuses on recommendations for improving coordination and integration in three core areas of health services programming: funding, program reporting/data collection and analysis, and technical assistance. Preliminary information on challenges and issues relevant to the core areas was gathered through site visits, focus groups, key informant interviews, and other sources. This information was used by stakeholder groups from the CDC and the USAPI to develop recommendations in the core programming areas. Recommendations generated at the CDC and USAPI stakeholder meetings were prepared into a single set of recommendations and stakeholders reviewed the document for accuracy prior to its dissemination to CDC's National Center for Chronic Disease Prevention and Health Promotion programs management and staff. Key recommendations, include: (1) consideration of resources and other challenges unique to the USAPI when reviewing funding applications, (2) consideration of ways to increase flexibility in USAPI use of program funds, (3) dedication of funding and human resources for technical assistance, (4) provision of opportunities for capacity-building across programs and jurisdictions, (5) consideration of ways to more directly link program reporting with technical assistance. This project provided a unique opportunity for CDC and USAPI stakeholders to share diverse perspectives on challenges to public health programs in the USAPI. Despite diverse experiences, the final set of recommendations reflected a high level of concordance between USAPI and CDC stakeholders. Recommendations have informed or reinforced actions initiated by the DCPC, including the dedication of funds for leadership institutes aimed at enhancing USAPI capacity for sustainable, integrated regional and jurisdictional cancer control infrastructure. Such efforts are an important beginning, but more remains to be done. Indicated is the need for continuous dialogue and collaboration. While this project focused on the USAPI, our results may be relevant to those interested in inter-organizational collaborations, medically underserved areas, public health services programs, and community-based participatory approaches.

European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection.

PubMed

Crobach, M J T; Planche, T; Eckert, C; Barbut, F; Terveer, E M; Dekkers, O M; Wilcox, M H; Kuijper, E J

2016-08-01

In 2009 the first European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline for diagnosing Clostridium difficile infection (CDI) was launched. Since then newer tests for diagnosing CDI have become available, especially nucleic acid amplification tests. The main objectives of this update of the guidance document are to summarize the currently available evidence concerning laboratory diagnosis of CDI and to formulate and revise recommendations to optimize CDI testing. This update is essential to improve the diagnosis of CDI and to improve uniformity in CDI diagnosis for surveillance purposes among Europe. An electronic search for literature concerning the laboratory diagnosis of CDI was performed. Studies evaluating a commercial laboratory test compared to a reference test were also included in a meta-analysis. The commercial tests that were evaluated included enzyme immunoassays (EIAs) detecting glutamate dehydrogenase, EIAs detecting toxins A and B and nucleic acid amplification tests. Recommendations were formulated by an executive committee, and the strength of recommendations and quality of evidence were graded using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. No single commercial test can be used as a stand-alone test for diagnosing CDI as a result of inadequate positive predictive values at low CDI prevalence. Therefore, the use of a two-step algorithm is recommended. Samples without free toxin detected by toxins A and B EIA but with positive glutamate dehydrogenase EIA, nucleic acid amplification test or toxigenic culture results need clinical evaluation to discern CDI from asymptomatic carriage. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Satellite Instrument Calibration for Measuring Global Climate Change. Report of a Workshop at the University of Maryland Inn and Conference Center, College Park, MD. , November 12-14, 2002

NASA Technical Reports Server (NTRS)

Ohring, G.; Wielicki, B.; Spencer, R.; Emery, B.; Datla, R.

2004-01-01

Measuring the small changes associated with long-term global climate change from space is a daunting task. To address these problems and recommend directions for improvements in satellite instrument calibration some 75 scientists, including researchers who develop and analyze long-term data sets from satellites, experts in the field of satellite instrument calibration, and physicists working on state of the art calibration sources and standards met November 12 - 14, 2002 and discussed the issues. The workshop defined the absolute accuracies and long-term stabilities of global climate data sets that are needed to detect expected trends, translated these data set accuracies and stabilities to required satellite instrument accuracies and stabilities, and evaluated the ability of current observing systems to meet these requirements. The workshop's recommendations include a set of basic axioms or overarching principles that must guide high quality climate observations in general, and a roadmap for improving satellite instrument characterization, calibration, inter-calibration, and associated activities to meet the challenge of measuring global climate change. It is also recommended that a follow-up workshop be conducted to discuss implementation of the roadmap developed at this workshop.

A Clinical Audit of Escorts' Awareness And Patients' Safety Following Intravenous Sedation In Adult Oral Surgery.

PubMed

Licheri, Luca; Erriu, Matteo; Bryant, Vincenzo; Piras, Vincenzo

2016-01-01

To evaluate current level of safety under the care of an escort following intravenous sedation, post-sedation arrangements and to identify potential risk levels. Information and post-sedation arrangements are important to patients'safety following surgery but although there is a general consensus over what is recommended for patients and their escorts, there is little, if any, literature on the escorts' awareness of sedation and accordance to post-sedation arrangement and recommendations. Escorts of 113 consecutive patients treated in oral surgery under sedation (midazolam) completed a questionnaire composed of 27 questions divided into seven sections including demographics, awareness of sedation, source of information and post-operative arrangement. From the data collected, two scores were calculated representative of the escorts' Safety and Reliability. Data were then analysed by ANOVA. Safety scores were statistically correlated with instruction source while Reliability correlated to a wider variety of parameters including gender, age as well as information source. Provision of clear written information to escorts is recommended as likely to improve patients' safety. Assessment of escorts' Safety and Reliability could provide a means for improving quality and safety of sedation service.

mHealth Education Applications Along the Cancer Continuum.

PubMed

Davis, Sharon Watkins; Oakley-Girvan, Ingrid

2015-06-01

The majority of adults worldwide own a mobile phone, including those in under-resourced communities. Mobile health (mhealth) education technologies present a promising mechanism for improving cancer prevention, treatment, and follow-up. The purpose of this study was to summarize the literature related to mobile phone (mhealth) applications for patient education specific to cancer and identify current recommendations from randomized studies. In particular, we were interested in identifying mobile phone applications along the cancer continuum, from cancer prevention to survivorship. The authors identified 28 articles reporting on mobile applications for patients related to cancer. Articles were identified in all categories along the cancer continuum, including health professional involvement in application development. Of these, six involved direct patient education, and eight focused on improving patient/professional communication and patient self-management. However, only six of the studies were randomized interventions. The potential for mobile applications to help overcome the "health care gap" has not yet been realized in the studies from the USA that were reviewed for this paper. However, early recommendations are emerging that support the use of mHealth communications to change behaviors for cancer prevention, early detection, and symptom management and improved patient-provider communication. Recommendations include short messages, use of multiple modalities as patient characteristics dictate comfort with mHealth communication, and the inclusion of patients and health professionals to develop and test applications. Tailoring mHealth to particular cultures, languages, and ethnic groups may also represent a unique possibility to provide accessible information and education at minimal cost for under-resourced communities and individuals.

High School Students' Recommendations to Improve School Food Environments: Insights from a Critical Stakeholder Group

ERIC Educational Resources Information Center

Asada, Yuka; Hughes, Alejandro G.; Read, Margaret; Schwartz, Marlene B.; Chriqui, Jamie F.

2017-01-01

Background: The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) directed the US Department of Agriculture (USDA) to revise school meal standards. Students are most affected by efforts to improve the school food environment; yet, few studies directly include students. This study examined high school students' experiences of school meal reform to gain…

Nearshore Current Model Workshop Summary.

DTIC Science & Technology

1983-09-01

dissipation , and wave-current interaction. b. Incorporation into models of wave-breaking. c. Parameterization of turbulence in models. d. Incorporation...into models of surf zone energy dissipation . e. Methods to specify waves and currents on the boundaries of the grid. f. Incorporation into models of...also recommended. Improvements should include nonlinear and irregular wave effects and improved models of wave-breaking and wave energy dissipation in

Living Donor Kidney Transplantation: Improving Education Outside of Transplant Centers about Live Donor Transplantation—Recommendations from a Consensus Conference

PubMed Central

Morgievich, Marie; Cohen, David J.; Butt, Zeeshan; Chakkera, Harini A.; Lindower, Carrie; Hays, Rebecca E.; Hiller, Janet M.; Lentine, Krista L.; Matas, Arthur J.; Poggio, Emilio D.; Rees, Michael A.; Rodrigue, James R.; LaPointe Rudow, Dianne

2015-01-01

Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation’s Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidence-based public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates. PMID:26116651

Living Donor Kidney Transplantation: Improving Education Outside of Transplant Centers about Live Donor Transplantation--Recommendations from a Consensus Conference.

PubMed

Waterman, Amy D; Morgievich, Marie; Cohen, David J; Butt, Zeeshan; Chakkera, Harini A; Lindower, Carrie; Hays, Rebecca E; Hiller, Janet M; Lentine, Krista L; Matas, Arthur J; Poggio, Emilio D; Rees, Michael A; Rodrigue, James R; LaPointe Rudow, Dianne

2015-09-04

Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation's Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidence-based public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates. Copyright © 2015 by the American Society of Nephrology.

An Ontology-Based Tourism Recommender System Based on Spreading Activation Model

NASA Astrophysics Data System (ADS)

Bahramian, Z.; Abbaspour, R. Ali

2015-12-01

A tourist has time and budget limitations; hence, he needs to select points of interest (POIs) optimally. Since the available information about POIs is overloading, it is difficult for a tourist to select the most appreciate ones considering preferences. In this paper, a new travel recommender system is proposed to overcome information overload problem. A recommender system (RS) evaluates the overwhelming number of POIs and provides personalized recommendations to users based on their preferences. A content-based recommendation system is proposed, which uses the information about the user's preferences and POIs and calculates a degree of similarity between them. It selects POIs, which have highest similarity with the user's preferences. The proposed content-based recommender system is enhanced using the ontological information about tourism domain to represent both the user profile and the recommendable POIs. The proposed ontology-based recommendation process is performed in three steps including: ontology-based content analyzer, ontology-based profile learner, and ontology-based filtering component. User's feedback adapts the user's preferences using Spreading Activation (SA) strategy. It shows the proposed recommender system is effective and improves the overall performance of the traditional content-based recommender systems.

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

PubMed

Groller, Karen D; Teel, Cynthia; Stegenga, Kristin H; El Chaar, Maher

2018-02-17

Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. Participants were recruited from a university hospital-based WMC in Pennsylvania. This qualitative descriptive study used purposive sampling and inductive content analysis. A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Truck size and weight enforcement technologies : implementation plan

DOT National Transportation Integrated Search

2009-06-01

The purpose of this Implementation Plan is to recommend strategies to encourage the deployment of roadside technologies to improve truck size and weight enforcement in the United States. The plan includes strategies that State practitioners can use t...

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...

Energy and Environment Guide to Action - Chapter 4.3: Building Codes for Energy Efficiency

EPA Pesticide Factsheets

Provides guidance and recommendations for establishing, implementing, and evaluating state building codes for energy efficiency, which improve energy efficiency in new construction and major renovations. State success stories are included for reference.

Investigating financial incentives for maternal health: an introduction.

PubMed

Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

2013-12-01

Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured feedback on recommendations which the teams included in their final papers appearing in this Supplement. Papers in this Supplement review the evidence for a specific financial incentive mechanism (e.g. pay for performance, conditional cash transfer) to improve the use and quality of maternal healthcare and makes recommendations for programmes and future research. While data on programmes using financial incentives for improved use and indications of the quality of maternal health services support specific conclusions and recommendations, including those for future research, data linking the use of financial incentives with improved health outcomes are minimal.

Probiotics and prebiotics: prospects for public health and nutritional recommendations.

PubMed

Sanders, Mary Ellen; Lenoir-Wijnkoop, Irene; Salminen, Seppo; Merenstein, Daniel J; Gibson, Glenn R; Petschow, Bryon W; Nieuwdorp, Max; Tancredi, Daniel J; Cifelli, Christopher J; Jacques, Paul; Pot, Bruno

2014-02-01

Probiotics and prebiotics are useful interventions for improving human health through direct or indirect effects on the colonizing microbiota. However, translation of these research findings into nutritional recommendations and public health policy endorsements has not been achieved in a manner consistent with the strength of the evidence. More progress has been made with clinical recommendations. Conclusions include that beneficial cultures, including probiotics and live cultures in fermented foods, can contribute towards the health of the general population; prebiotics, in part due to their function as a special type of soluble fiber, can contribute to the health of the general population; and a number of challenges must be addressed in order to fully realize probiotic and prebiotic benefits, including the need for greater awareness of the accumulated evidence on probiotics and prebiotics among policy makers, strategies to cope with regulatory roadblocks to research, and high-quality human trials that address outstanding research questions in the field. © 2014 New York Academy of Sciences.

Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan

PubMed Central

Teich, Jonathan M.; Osheroff, Jerome A.; Pifer, Eric A.; Sittig, Dean F.; Jenders, Robert A.

2005-01-01

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption. PMID:15802474

Recommendations to Improve Employee Thermal Comfort When Working in 40°F Refrigerated Cold Rooms.

PubMed

Ceballos, Diana; Mead, Kenneth; Ramsey, Jessica

2015-01-01

Cold rooms are commonly used for food storage and preparation, and are usually kept around 40°F following food safety guidelines. Some food preparation employees may spend 8 or more hours inside cold rooms. These employees may not be aware of the risks associated with mildly cold temperatures, dampness, and limited ventilation. We performed an evaluation of cold rooms at an airline catering facility because of concerns with exposure to cold temperatures. We spoke with and observed employees in two cold rooms, reviewed daily temperature logs, evaluated employee's physical activity, work/rest schedule, and protective clothing. We measured temperature, percent relative humidity, and air velocities at different work stations inside the cold rooms. We concluded that thermal comfort concerns perceived by cold room employees may have been the result of air drafts at their workstations, insufficient use of personal protective equipment due to dexterity concerns, work practices, and lack of knowledge about good health and safety practices in cold rooms. These moderately cold work conditions with low air velocities are not well covered in current occupational health and safety guidelines, and wind chill calculations do not apply. We provide practical recommendations to improve thermal comfort of cold room employees. Engineering control recommendations include the redesigning of air deflectors and installing of suspended baffles. Administrative controls include the changing out of wet clothing, providing hand warmers outside of cold rooms, and educating employees on cold stress. We also recommended providing more options on personal protective equipment. However, there is a need for guidelines and educational materials tailored to employees in moderately cold environments to improve thermal comfort and minimize health and safety problems.

Recommendations to Improve Employee Thermal Comfort When Working in 40°F Refrigerated Cold Rooms

PubMed Central

Ceballos, Diana; Mead, Kenneth; Ramsey, Jessica

2015-01-01

Cold rooms are commonly used for food storage and preparation, and are usually kept around 40°F following food safety guidelines. Some food preparation employees may spend 8 or more hours inside cold rooms. These employees may not be aware of the risks associated with mildly cold temperatures, dampness, and limited ventilation. We performed an evaluation of cold rooms at an airline catering facility because of concerns with exposure to cold temperatures. We spoke with and observed employees in two cold rooms, reviewed daily temperature logs, evaluated employee’s physical activity, work/rest schedule, and protective clothing. We measured temperature, percent relative humidity, and air velocities at different work stations inside the cold rooms. We concluded that thermal comfort concerns perceived by cold room employees may have been the result of air drafts at their workstations, insufficient use of personal protective equipment due to dexterity concerns, work practices, and lack of knowledge about good health and safety practices in cold rooms. These moderately cold work conditions with low air velocities are not well covered in current occupational health and safety guidelines, and wind chill calculations do not apply. We provide practical recommendations to improve thermal comfort of cold room employees. Engineering control recommendations include the redesigning of air deflectors and installing of suspended baffles. Administrative controls include the changing out of wet clothing, providing hand warmers outside of cold rooms, and educating employees on cold stress. We also recommended providing more options on personal protective equipment. However, there is a need for guidelines and educational materials tailored to employees in moderately cold environments to improve thermal comfort and minimize health and safety problems. PMID:25961447

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.

Venous thromboprophylaxis in general surgery ward admissions: strategies for improvement.

PubMed

Galante, Mariana; Languasco, Agustín; Gotta, Daniel; Bell, Soledad; Lancelotti, Tomás; Knaze, Viktoria; Saubidet, Cristián Lopez; Grand, Beatriz; Milberg, Matías

2012-12-01

To estimate the adherence to institutional venous thromboprophylaxis clinical practice guidelines (CPGs) in general surgery patients and to assess the effectiveness of a multi-strategy improvement intervention. A prospective before-after study. Two teaching hospitals located in the city of Buenos Aires, Argentina. Prescriptions belonging to patients admitted to the general surgery wards were evaluated. A multi-strategy intervention that included (i) simplification of institutional CPGs for venous thromboprophylaxis using a single drug at a single dose, based on the American College of Chest Physicians recommendations, (ii) distribution of pocket cards with an algorithm for the implementation of new recommendations to both, physicians and nurses, working in the general surgery units, (iii) educational talks, (iv) paper-based reminders and (v) audit and feedback. The adherence of the venous thromboprophylaxis prescription to the institutional recommendations. The prescriptions of 100 admitted patients before and 90 after the intervention were included in the analysis. The initial rate of adherence was 31%. After the intervention this rate rose to 71.1% (P< 0.001). The major improvement observed was the reduction in omitted prophylaxis in patients at risk of venous thromboembolism from 45 to 13.3% (P< 0.001). In the adjusted model, prescribing compliance with CPGs was five times more likely during the second stage than during the first stage (OR = 5.60, 95% CI = 2.92-10.74). Simple and economical interventions such as those described in this study can improve general surgeons compliance with the institutional and international guidelines, thus assuring patient safety and quality of health care.

A systematic review of nosocomial waterborne infections in neonates and mothers.

PubMed

Moffa, Michelle; Guo, Wilson; Li, Trudy; Cronk, Ryan; Abebe, Lydia S; Bartram, Jamie

2017-11-01

Water is an important, overlooked, and controllable source of nosocomial infection. Hospitalized neonates and their mothers are particularly vulnerable to nosocomial waterborne infections. Our objectives through this systematic review were to: investigate water sources, reservoirs, and transmission routes that lead to nosocomial waterborne infections in neonates and their mothers; establish patient risk factors; compile measures for controlling outbreaks and recommended strategies for prevention; and identify information gaps to improve guidelines for reporting future outbreaks. We searched PubMed, Web of Science, Embase, and clinicaltrials.gov. Peer-reviewed studies reporting contaminated water as a route of transmission to neonates and/or their mothers were included. Twenty-five studies were included. The most common contaminated water sources in healthcare facilities associated with infection transmission were tap water, sinks, and faucets. Low birthweights, preterm or premature birth, and underlying disease increased neonatal risk of infection. Effective control measures commonly included replacing or cleaning faucets and increased or alternative methods for hand disinfection, and recommendations for prevention of future infections highlighted the need for additional surveillance. The implementation of control measures and recommended prevention strategies by healthcare workers and managing authorities of healthcare facilities and improved reporting of future outbreaks may contribute to a reduction in the incidence of nosocomial waterborne infections in neonates and their mothers. Copyright © 2017 Elsevier GmbH. All rights reserved.

The respect of recommendations provided in an international travelers' medical service: far from the cup to the lips.

PubMed

Muller, Jean Michel; Simonet, Anne Laure; Binois, Raphaelle; Muggeo, Elisabeth; Bugnon, Pierre; Liet, Jérome; Duong, Michel; Chavanet, Pascal; Piroth, Lionel

2013-01-01

It is not clearly known how frequently the recommendations given to travelers are followed, and what factors could encourage compliance with these recommended measures. Adults consulting at a Medical Department for International Travelers (International Travelers' Medical Services, ITMS) in October and November 2010 were asked to answer a questionnaire before their journey. They were also contacted for a post-travel telephone interview to determine whether they had followed the recommendations regarding vaccinations and malaria prevention, and the reasons for poor or noncompliance with these recommendations. A total of 353 travelers were included, with post-travel data available for 321 of them. Complete compliance with all the recommendations (vaccinations and malaria chemoprophylaxis) was observed in 186/321 (57.9%) of the travelers. Only 55.6% (233/419) of the prescribed vaccinations were given, with huge variability according to the type of vaccine. Only 57.3% (184/321) of the patients used a mosquito net. Among the 287 prescriptions for antimalarial drugs, 219 (76.3%) were taken correctly, 37 (12.9%) were taken incorrectly (noncompliance with the duration and/or dosage), and 31 (10.8%) were not taken at all. Traveling to areas of mass tourism (Kenya/Senegal), consulting their general practitioner (GP), and being retired were significantly and independently associated with better overall compliance in univariate and multivariate analyses. Compliance could be improved by focusing on factors associated with poor compliance to improve the advice given to less compliant travelers, by providing clear information tailored to each traveler, with a focus on key messages, and by improving coordination between ITMS and GPs. © 2012 International Society of Travel Medicine.

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.

PubMed

Günthard, Huldrych F; Saag, Michael S; Benson, Constance A; del Rio, Carlos; Eron, Joseph J; Gallant, Joel E; Hoy, Jennifer F; Mugavero, Michael J; Sax, Paul E; Thompson, Melanie A; Gandhi, Rajesh T; Landovitz, Raphael J; Smith, Davey M; Jacobsen, Donna M; Volberding, Paul A

2016-07-12

New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure. Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults.

Mais Médicos (More Doctors) Program: its contribution in view of WHO recommendations for provision of doctors.

PubMed

Carvalho, Viviane Karoline da Silva; Marques, Carla Pintas; Silva, Everton Nunes da

2016-09-01

In order to examine whether Brazil's Mais Médicos (More Doctors) Programme (PMM) reflected World Health Organisation (WHO) recommendations for improved attraction, retention and recruitment of health workers in remote and rural areas, this descriptive, qualitative study drew on document analysis in order to compare the WHO recommendations published in 2010 with Brazil's Law No. 12,871/13, which instituted the PMM. Of the 16 WHO recommendations systematised here, the PMM met 37.5%. Recommendations not incorporated into the PMM include career development programmes and public recognition strategies. Although reflecting WHO recommendations and already in place elsewhere in the SUS prior to announcement of the PMM, the National Retention Grant Programme and multi-professional teams (as in the Family Health Strategy) were not implemented by the PMM. The programme contains innovative components such as a new curriculum for medical schools and compulsory medical service. On the other hand, the PMM could have invested more in personal and professional support.

A trust-based recommendation method using network diffusion processes

NASA Astrophysics Data System (ADS)

Chen, Ling-Jiao; Gao, Jian

2018-09-01

A variety of rating-based recommendation methods have been extensively studied including the well-known collaborative filtering approaches and some network diffusion-based methods, however, social trust relations are not sufficiently considered when making recommendations. In this paper, we contribute to the literature by proposing a trust-based recommendation method, named CosRA+T, after integrating the information of trust relations into the resource-redistribution process. Specifically, a tunable parameter is used to scale the resources received by trusted users before the redistribution back to the objects. Interestingly, we find an optimal scaling parameter for the proposed CosRA+T method to achieve its best recommendation accuracy, and the optimal value seems to be universal under several evaluation metrics across different datasets. Moreover, results of extensive experiments on the two real-world rating datasets with trust relations, Epinions and FriendFeed, suggest that CosRA+T has a remarkable improvement in overall accuracy, diversity and novelty. Our work takes a step towards designing better recommendation algorithms by employing multiple resources of social network information.

Research Agenda for an Improved Novice Driver Program

DOT National Transportation Integrated Search

1994-05-31

This report documents previous NHTSA efforts in driver education. These include the results of a major demonstration evaluation that was conducted in DeKalb County Georgia and a summary of a workshop held last year that resulted in numerous recommend...

Best practices for veterinary toxicologic clinical pathology, with emphasis on the pharmaceutical and biotechnology industries.

PubMed

Tomlinson, Lindsay; Boone, Laura I; Ramaiah, Lila; Penraat, Kelley A; von Beust, Barbara R; Ameri, Mehrdad; Poitout-Belissent, Florence M; Weingand, Kurt; Workman, Heather C; Aulbach, Adam D; Meyer, Dennis J; Brown, Diane E; MacNeill, Amy L; Bolliger, Anne Provencher; Bounous, Denise I

2013-09-01

The purpose of this paper by the Regulatory Affairs Committee (RAC) of the American Society for Veterinary Clinical Pathology (ASVCP) is to review the current regulatory guidances (eg, guidelines) and published recommendations for best practices in veterinary toxicologic clinical pathology, particularly in the pharmaceutical and biotechnology industries, and to utilize the combined experience of ASVCP RAC to provide updated recommendations. Discussion points include (1) instrumentation, validation, and sample collection, (2) routine laboratory variables, (3) cytologic laboratory variables, (4) data interpretation and reporting (including peer review, reference intervals and statistics), and (5) roles and responsibilities of clinical pathologists and laboratory personnel. Revision and improvement of current practices should be in alignment with evolving regulatory guidance documents, new technology, and expanding understanding and utility of clinical pathology. These recommendations provide a contemporary guide for the refinement of veterinary toxicologic clinical pathology best practices. © 2013 American Society for Veterinary Clinical Pathology.

Trust-aware recommendation for improving aggregate diversity

NASA Astrophysics Data System (ADS)

Liu, Haifeng; Bai, Xiaomei; Yang, Zhuo; Tolba, Amr; Xia, Feng

2015-10-01

Recommender systems are becoming increasingly important and prevalent because of the ability of solving information overload. In recent years, researchers are paying increasing attention to aggregate diversity as a key metric beyond accuracy, because improving aggregate recommendation diversity may increase long tails and sales diversity. Trust is often used to improve recommendation accuracy. However, how to utilize trust to improve aggregate recommendation diversity is unexplored. In this paper, we focus on solving this problem and propose a novel trust-aware recommendation method by incorporating time factor into similarity computation. The rationale underlying the proposed method is that, trustees with later creation time of trust relation can bring more diverse items to recommend to their trustors than other trustees with earlier creation time of trust relation. Through relevant experiments on publicly available dataset, we demonstrate that the proposed method outperforms the baseline method in terms of aggregate diversity while maintaining almost the same recall.

Improved collaborative filtering recommendation algorithm of similarity measure

NASA Astrophysics Data System (ADS)

Zhang, Baofu; Yuan, Baoping

2017-05-01

The Collaborative filtering recommendation algorithm is one of the most widely used recommendation algorithm in personalized recommender systems. The key is to find the nearest neighbor set of the active user by using similarity measure. However, the methods of traditional similarity measure mainly focus on the similarity of user common rating items, but ignore the relationship between the user common rating items and all items the user rates. And because rating matrix is very sparse, traditional collaborative filtering recommendation algorithm is not high efficiency. In order to obtain better accuracy, based on the consideration of common preference between users, the difference of rating scale and score of common items, this paper presents an improved similarity measure method, and based on this method, a collaborative filtering recommendation algorithm based on similarity improvement is proposed. Experimental results show that the algorithm can effectively improve the quality of recommendation, thus alleviate the impact of data sparseness.

78 FR 36547 - Technological Advisory Council Recommendation for Improving Receiver Performance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... Council Recommendation for Improving Receiver Performance AGENCY: Federal Communications Commission... of receivers in ensuring the efficient use of spectrum and to provide recommendations on avoiding... Advisory Council (``TAC'') White Paper. OET invited comment on the TAC white paper and its recommendations...

[Degree of compliance with health care quality criteria in the treatment of lower airway obstruction in Spanish pediatric emergency departments, reasons for noncompliance, and recommendations for improvement].

PubMed

Claret Teruel, Gemma; Solé Ribalta, Anna; González Balenciaga, María; Paniagua Calzón, Natalia Marta; Korta Murua, Javier

2016-06-01

To determine the degree of compliance with health care quality criteria in the treatment of patients with lower airway obstruction in Spanish pediatric emergency departments (PEDs), to explore the reasons for noncompliance, and to make recommendations for improvement. We carried out a retrospective, cross-sectional study of a series of patients under the age of 14 years to determine the degree of compliance with 5 quality indicators. The patients were attended in 22 PEDs on days 1 and 15 of each month in 2013. We also distributed a questionnaire to chiefs of department to discover possible reasons for noncompliance. Finally, a group of experts followed a process to produce consensus-based recommendations to improve quality of care through compliance with the indicators. We included 2935 patients with a median (interquartile range) age of 2.8 (1.4-5.1) years. The overall rates of compliance were 39.8% for assessment of severity, 0.1% for measurement of peak flow, 64.4% for delay in attending a patient with severe shortness of breath, 59.1% for checking oxygen saturation and respiratory frequency, and 34.3% for treatment with inhalers and a spacer. The most common reasons for noncompliance were lack of time or material and the absence of the recommendation in protocols. The following improvement steps were recommended: reassess the usefulness of peak flow measurement in PEDs, reformulate the criteria for delay in attending patients with severe dyspnea, and adopt new indicators and templates that facilitate the recording of vital constants and scores on severity scales. An acceptable level of compliance was not achieved on any of the health care quality indicators for a variety of reasons. A series of steps should be taken to improve compliance.

Exercise in the healthy older adult.

PubMed

Karani, R; McLaughlin, M A; Cassel, C K

2001-01-01

Habitual exercise provides numerous health benefits to the older adult. While dynamic aerobic activities increase stamina and lung capacity, isometric or resistance training improves muscle strength and endurance. Long-term benefits of continued exercise include a decreased risk of death from heart disease, enhanced balance and mobility, a decreased risk of diabetes, and an improvement in depressive symptoms. While the hazards of exercise relate predominantly to extremes of intensity and duration, all older adults should consult with a physician before beginning a new activity program. A prescription for exercise should include both aerobic and resistance training components, and frequent follow-up to improve adherence is highly recommended. (c)2001 CVRR, Inc.

Improvements and validation of the erythropoiesis control model for bed rest simulation

NASA Technical Reports Server (NTRS)

Leonard, J. I.

1977-01-01

The most significant improvement in the model is the explicit formulation of separate elements representing erythropoietin production and red cell production. Other modifications include bone marrow time-delays, capability to shift oxyhemoglobin affinity and an algorithm for entering experimental data as time-varying driving functions. An area of model development is suggested by applying the model to simulating onset, diagnosis and treatment of a hematologic disorder. Recommendations for further improvements in the model and suggestions for experimental application are also discussed. A detailed analysis of the hematologic response to bed rest including simulation of the recent Baylor Medical College bed rest studies is also presented.

Use of wetlands for water quality improvement under the USEPA Region V Clean Lakes Program

NASA Astrophysics Data System (ADS)

Landers, Judith C.; Knuth, Barbara A.

1991-03-01

The United States Environmental Protection Agency (USEPA) Region V Clean Lakes Program employs artificial and modified natural wetlands in an effort to improve the water quality of selected lakes. We examined use of wetlands at seven lake sites and evaluated the physical and institutional means by which wetland projects are implemented and managed, relative to USEPA program goals and expert recommendations on the use of wetlands for water quality improvement. Management practices recommended by wetlands experts addressed water level and retention, sheet flow, nutrient removal, chemical treatment, ecological and effectiveness monitoring, and resource enhancement. Institutional characteristics recommended included local monitoring, regulation, and enforcement and shared responsibilities among jurisdictions. Institutional and ecological objectives of the National Clean Lakes Program were met to some degree at every site. Social objectives were achieved to a lesser extent. Wetland protection mechanisms and appropriate institutional decentralization were present at all sites. Optimal management techniques were employed to varying degrees at each site, but most projects lack adequate monitoring to determine adverse ecological impacts and effectiveness of pollutant removal and do not extensively address needs for recreation and wildlife habitat. There is evidence that the wetland projects are contributing to improved lake water quality; however, more emphasis needs to be placed on wetland protection and long-term project evaluation.

Electroconvulsive therapy for depression in Parkinson's disease: systematic review of evidence and recommendations.

PubMed

Borisovskaya, Anna; Bryson, William Culbertson; Buchholz, Jonathan; Samii, Ali; Borson, Soo

2016-04-01

We performed a systematic review of evidence regarding treatment of depression in Parkinson's disease (PD) utilizing electroconvulsive therapy. The search led to the inclusion of 43 articles, mainly case reports or case series, with the largest number of patients totaling 19. The analysis included 116 patients with depression and PD; depression improved in 93.1%. Where motor symptoms' severity was reported, 83% of patients improved. Cognition did not worsen in the majority (94%). Many patients experienced delirium or transient confusion, sometimes necessitating discontinuation of electroconvulsive therapy (ECT). Little is known about maintenance ECT in this population. ECT can benefit patients suffering from PD and depression. We recommend an algorithm for treatment of depression in PD, utilizing ECT sooner rather than later.

Women deans' perceptions of the gender gap in American medical deanships.

PubMed

Humberstone, Elizabeth

2017-01-01

: Women account for 16% of deans of American medical schools. To investigate this gender gap, female deans were interviewed about the barriers facing women advancing toward deanships. The author conducted semi-structured interviews with eight women deans. Interviews were analyzed using provisional coding and sub coding techniques. Four main themes emerged during the interviews: (1) the role of relationships in personal and career development, (2) leadership challenges, (3) barriers between women and leadership advancement, and (4) recommendations for improvement. Recommendations included allocating resources, mentorship, career flexibility, faculty development, updating the criteria for deanships, and restructuring search committees. The barriers identified by the deans are similar to those found in previous studies on female faculty and department chairs, suggesting limited improvement in gender equity progress.

Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

PubMed Central

McMurtry, C. Meghan; Taddio, Anna; Noel, Melanie; Antony, Martin M.; Chambers, Christine T.; Asmundson, Gordon J. G.; Pillai Riddell, Rebecca; Shah, Vibhuti; MacDonald, Noni E.; Rogers, Jess; Bucci, Lucie M.; Mousmanis, Patricia; Lang, Eddy; Halperin, Scott; Bowles, Susan; Halpert, Christine; Ipp, Moshe; Rieder, Michael J.; Robson, Kate; Uleryk, Elizabeth; Votta Bleeker, Elizabeth; Dubey, Vinita; Hanrahan, Anita; Lockett, Donna; Scott, Jeffrey

2016-01-01

Abstract Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided. PMID:27007463

Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research.

PubMed

McMurtry, C Meghan; Taddio, Anna; Noel, Melanie; Antony, Martin M; Chambers, Christine T; Asmundson, Gordon J G; Pillai Riddell, Rebecca; Shah, Vibhuti; MacDonald, Noni E; Rogers, Jess; Bucci, Lucie M; Mousmanis, Patricia; Lang, Eddy; Halperin, Scott; Bowles, Susan; Halpert, Christine; Ipp, Moshe; Rieder, Michael J; Robson, Kate; Uleryk, Elizabeth; Votta Bleeker, Elizabeth; Dubey, Vinita; Hanrahan, Anita; Lockett, Donna; Scott, Jeffrey

2016-04-01

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.

Clinical practice guideline: allergic rhinitis executive summary.

PubMed

Seidman, Michael D; Gurgel, Richard K; Lin, Sandra Y; Schwartz, Seth R; Baroody, Fuad M; Bonner, James R; Dawson, Douglas E; Dykewicz, Mark S; Hackell, Jesse M; Han, Joseph K; Ishman, Stacey L; Krouse, Helene J; Malekzadeh, Sonya; Mims, James Whit W; Omole, Folashade S; Reddy, William D; Wallace, Dana V; Walsh, Sandra A; Warren, Barbara E; Wilson, Meghan N; Nnacheta, Lorraine C

2015-02-01

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Allergic Rhinitis. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed address the evaluation of patients with allergic rhinitis, including performing and interpretation of diagnostic testing and assessment and documentation of chronic conditions and comorbidities. It will then focus on the recommendations to guide the evaluation and treatment of patients with allergic rhinitis, to determine the most appropriate interventions to improve symptoms and quality of life for patients with allergic rhinitis. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users

PubMed Central

Requejo, Philip S.; Furumasu, Jan; Mulroy, Sara J.

2015-01-01

Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area. PMID:26366040

Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment: Conference Key Findings and Next Steps

PubMed Central

Wilfley, Denise E.; Staiano, Amanda E.; Altman, Myra; Lindros, Jeanne; Lima, Angela; Hassink, Sandra G.; Dietz, William H.; Cook, Stephen

2017-01-01

Objectives To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e. clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 hours over 6–12 months to improve weight status) and to expand payment for these services. Methods In July 2015, forty-three cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. Results Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multi-disciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g. >25 hours) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. Conclusion Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale-up training to ensure quality of care. PMID:27925451

Improving access and systems of care for evidence-based childhood obesity treatment: Conference key findings and next steps.

PubMed

Wilfley, Denise E; Staiano, Amanda E; Altman, Myra; Lindros, Jeanne; Lima, Angela; Hassink, Sandra G; Dietz, William H; Cook, Stephen

2017-01-01

To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e., clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 h over 6 to 12 months to improve weight status) and to expand payment for these services. In July 2015, 43 cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g., >25 h) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale up training to ensure quality of care. © 2016 The Obesity Society.

What is the experience of national quality campaigns? Views from the field.

PubMed

Bradley, Elizabeth H; Nembhard, Ingrid M; Yuan, Christina T; Stern, Amy F; Curtis, Jeptha P; Nallamothu, Brahmajee K; Brush, John E; Krumholz, Harlan M

2010-12-01

To identify key characteristics of a national quality campaign that participants viewed as effective, to understand mechanisms by which the campaign influenced hospital practices, and to elucidate contextual factors that modified the perceived influence of the campaign on hospital improvements. In-depth interviews, hospital surveys, and Health Quality Alliance data. We conducted a qualitative study using in-depth interviews with clinical and administrative staff (N = 99) at hospitals reporting strong influence (n = 6) as well as hospitals reporting limited influence (n = 6) of the Door-to-Balloon (D2B) Alliance, a national quality campaign to improve heart attack care. We analyzed these qualitative data as well as changes in hospital use of recommended strategies reported through a hospital survey and changes in treatment times using Health Quality Alliance data. In-depth, open-ended interviews; hospital survey. Key characteristics of the national quality campaign viewed as enhancing its effectiveness were as follows: credibility of the recommendations, perceived simplicity of the recommendations, alignment with hospitals' strategic goals, practical implementation tools, and breadth of the network of peer hospitals in the D2B Alliance. Perceived mechanisms of the campaign's influence included raising awareness and influencing goals, fostering strategy adoption, and influencing aspects of organizational culture. Modifying contextual factors included perceptions about current performance and internal championship for the recommended changes. The impact of national quality campaigns may depend on both campaign design features and on the internal environment of participating hospitals. © Health Research and Educational Trust.

Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery.

PubMed

Jacobsen, Paul B; DeRosa, Antonio P; Henderson, Tara O; Mayer, Deborah K; Moskowitz, Chaya S; Paskett, Electra D; Rowland, Julia H

2018-05-18

Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers' concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.

Exercise and sports science Australia (ESSA) position statement on exercise and spinal cord injury.

PubMed

Tweedy, Sean M; Beckman, Emma M; Geraghty, Timothy J; Theisen, Daniel; Perret, Claudio; Harvey, Lisa A; Vanlandewijck, Yves C

2017-02-01

Traumatic spinal cord injury (SCI) may result in tetraplegia (motor and/or sensory nervous system impairment of the arms, trunk and legs) or paraplegia (motor and/or sensory impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: ≥30min of moderate aerobic exercise on ≥5d/week or ≥20min of vigorous aerobic ≥3d/week; strength training on ≥2d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2d/week flexibility training, including shoulder internal and external rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Improving the recommender algorithms with the detected communities in bipartite networks

NASA Astrophysics Data System (ADS)

Zhang, Peng; Wang, Duo; Xiao, Jinghua

2017-04-01

Recommender system offers a powerful tool to make information overload problem well solved and thus gains wide concerns of scholars and engineers. A key challenge is how to make recommendations more accurate and personalized. We notice that community structures widely exist in many real networks, which could significantly affect the recommendation results. By incorporating the information of detected communities in the recommendation algorithms, an improved recommendation approach for the networks with communities is proposed. The approach is examined in both artificial and real networks, the results show that the improvement on accuracy and diversity can be 20% and 7%, respectively. This reveals that it is beneficial to classify the nodes based on the inherent properties in recommender systems.

Perspectives on Healthy Eating Among Appalachian Residents

PubMed Central

Schoenberg, Nancy E.; Howell, Britteny M.; Swanson, Mark; Grosh, Christopher; Bardach, Shoshana

2013-01-01

Purpose Extensive attention has been focused on improving the dietary intake of Americans. Such focus is warranted due to increasing rates of overweight, obesity, and other dietary-related disease. To address suboptimal dietary intake requires an improved, contextualized understanding of the multiple and intersecting influences on healthy eating, particularly among those populations at greatest risk of and from poor diet, including rural residents. Methods During 8 focus groups (N=99) and 6 group key informant interviews (N=20), diverse Appalachian rural residents were queried about their perceptions of healthy eating, determinants of healthy food intake, and recommendations for improving the dietary intake of people in their communities. Participants included church members and other laypeople, public health officials, social service providers, health care professionals, and others. Findings Participants offered insights on healthy eating consistent with the categories of individual, interpersonal, community, physical, environmental and society-level influences described in the socioecological model. Although many participants identified gaps in dietary knowledge as a persistent problem, informants also identified extra-individual factors, including the influence of family, fellow church members, and schools, policy, advertising and media, and general societal trends, as challenges to healthy dietary intake. We highlight Appalachian residents’ recommendations for promoting healthier diets, including support groups, educational workshops, cooking classes, and community gardening. Conclusions We discuss the implications of these findings for programmatic development in the Appalachian context. PMID:23944277

Direct Lending: How To Improve Implementation.

ERIC Educational Resources Information Center

Jepsen, Keith

This evaluation study developed 29 recommendations concerning the implementation of direct loans in providing financial assistance to postsecondary school students. The investigation included examination of a current Department of Education (ED) pilot program, a video teleconference to discuss direct lending with 23 individuals in education…

Universities Face Wide-Ranging Changes

ERIC Educational Resources Information Center

Krieger, James H.

1976-01-01

Discusses problems facing the research university, including declining enrollments and funds, fewer opportunities for graduates, and the complexity of research problems. Recommends making more efficient use of resources, improving communications with the broader public, and reducing economic and social barriers to obtaining a higher education.…

Opening up towards Children's Languages: Enhancing Teachers' Tolerant Practices towards Multilingualism

ERIC Educational Resources Information Center

Van Der Wildt, Anouk; Van Avermaet, Piet; Van Houtte, Mieke

2017-01-01

Mainstream teachers struggle with linguistic diversity, often leading to restricting multilingualism. Scientific research, however, recommends including pupils' home languages in school. Various qualitative studies have evaluated implementations in schools and indicated possibilities for improving teachers' attitudes towards multilingualism. This…

Improving School Lighting for Video Display Units.

ERIC Educational Resources Information Center

Parker-Jenkins, Marie; Parker-Jenkins, William

1985-01-01

Provides information to identify and implement the key characteristics which contribute to an efficient and comfortable visual display unit (VDU) lighting installation. Areas addressed include VDU lighting requirements, glare, lighting controls, VDU environment, lighting retrofit, optical filters, and lighting recommendations. A checklist to…

CONCEPTUAL DESIGNS FOR A NEW HIGHWAY VEHICLE EMISSIONS ESTIMATION METHODOLOGY

EPA Science Inventory

The report discusses six conceptual designs for a new highway vehicle emissions estimation methodology and summarizes the recommendations of each design for improving the emissions and activity factors in the emissions estimation process. he complete design reports are included a...

20 CFR 438.605 - Inspector General report.

Code of Federal Regulations, 2010 CFR

2010-04-01

....605 Employees' Benefits SOCIAL SECURITY ADMINISTRATION RESTRICTIONS ON LOBBYING Agency Reports § 438.605 Inspector General report. (a) The Inspector General of Social Security, or other official as... include any recommended changes that may be necessary to strengthen or improve the requirements. (b) The...

The factors influencing the decision making of operative treatment for proximal humeral fractures.

PubMed

Hageman, Michiel G J S; Jayakumar, Prakash; King, John D; Guitton, Thierry G; Doornberg, Job N; Ring, David

2015-01-01

The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations. A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment. Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture mechanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon. Patient information-older age in particular-is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Considerations for ceramic inlays in posterior teeth: a review

PubMed Central

Hopp, Christa D; Land, Martin F

2013-01-01

This review of ceramic inlays in posterior teeth includes a review of the history of ceramic restorations, followed by common indications and contraindications for their use. A discussion on the potential for tooth wear is followed by a review of recommended preparation design considerations, fabrication methods, and material choices. Despite the improved materials available for fabrication of porcelain inlays, fracture remains a primary mode of inlay failure. Therefore, a brief discussion on strengthening methods for ceramics is included. The review concludes with a section on luting considerations, and offers the clinician specific recommendations for luting procedures. In conclusion, inlay success rates and longevity, as reported in the literature, are summarized. PMID:23750101

[Early recurrent miscarriage: Evaluation and management].

PubMed

Gallot, V; Nedellec, S; Capmas, P; Legendre, G; Lejeune-Saada, V; Subtil, D; Nizard, J; Levêque, J; Deffieux, X; Hervé, B; Vialard, F

2014-12-01

To establish recommendations for early recurrent miscarriages (≥3 miscarriages before 14weeks of amenorrhea). Literature review, establishing levels of evidence and recommendations for grades of clinical practice. Women evaluation includes the search for a diabetes (grade A), an antiphospholipid syndrome (APS) (grade A), a thyroid dysfunction (grade A), a hyperprolactinemia (grade B), a vitamin deficiency and a hyperhomocysteinemia (grade C), a uterine abnormality (grade C), an altered ovarian reserve (grade C), and a couple chromosome analysis (grade A). For unexplained early recurrent miscarriages, treatment includes folic acid and progesterone supplementation, and a reinsurance policy in the first quarter (grade C). It is recommended to prescribe the combination of aspirin and low-molecular-weight heparin when APS (grade A), glycemic control in diabetes (grade A), L-Thyroxine in case of hypothyroidism (grade A) or the presence of thyroid antibodies (grade B), bromocriptine if hyperprolactinemia (grade B), a substitution for vitamin deficiency or hyperhomocysteinemia (grade C), sectionning a uterine septum (grade C) and treating an uterine acquired abnormality (grade C). These recommendations should improve the management of couples faced with early recurrent miscarriages. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Recommendations for genetic testing to reduce the incidence of anthracycline-induced cardiotoxicity.

PubMed

Aminkeng, Folefac; Ross, Colin J D; Rassekh, Shahrad R; Hwang, Soomi; Rieder, Michael J; Bhavsar, Amit P; Smith, Anne; Sanatani, Shubhayan; Gelmon, Karen A; Bernstein, Daniel; Hayden, Michael R; Amstutz, Ursula; Carleton, Bruce C

2016-09-01

Anthracycline-induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline-based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence-based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk. We followed a standard guideline development process, including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group. RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B - moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow-up, as well as therapeutic options within the current standard of clinical practice. Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT. © 2016 The British Pharmacological Society.

Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE): protocol and preliminary results.

PubMed

Treweek, Shaun; Oxman, Andrew D; Alderson, Philip; Bossuyt, Patrick M; Brandt, Linn; Brożek, Jan; Davoli, Marina; Flottorp, Signe; Harbour, Robin; Hill, Suzanne; Liberati, Alessandro; Liira, Helena; Schünemann, Holger J; Rosenbaum, Sarah; Thornton, Judith; Vandvik, Per Olav; Alonso-Coello, Pablo

2013-01-09

Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear. GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (http://www.decide-collaboration.eu/), which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines. Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally.

Recommendations for genetic testing to reduce the incidence of anthracycline‐induced cardiotoxicity

PubMed Central

Aminkeng, Folefac; Ross, Colin J. D.; Rassekh, Shahrad R.; Hwang, Soomi; Rieder, Michael J.; Bhavsar, Amit P.; Smith, Anne; Sanatani, Shubhayan; Gelmon, Karen A.; Bernstein, Daniel; Hayden, Michael R.; Amstutz, Ursula

2016-01-01

Aims Anthracycline‐induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline‐based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence‐based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk. Methods We followed a standard guideline development process, including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group. Results RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B – moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow‐up, as well as therapeutic options within the current standard of clinical practice. Conclusions Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT. PMID:27197003

Let the pyramid guide your food choices: capturing the total diet concept.

PubMed

Dixon, L B; Cronin, F J; Krebs-Smith, S M

2001-02-01

This paper discusses how the guideline "Eat a variety of foods" became "Let the Pyramid guide your food choices," presents background information on the food guidance system upon which the Food Guide Pyramid is based and reviews methods that have been used to assess aspects of the total diet, i.e., the variety, moderation and proportionality, promoted by this guidance. The methods include measures of dietary variety, patterns based on Pyramid food group intakes and scoring methods comprised of multiple dietary components. Highlights of results from these methods include the following. Although approximately one third of the U.S. population eat at least some food from all Pyramid food groups, only approximately 1-3% eat the recommended number of servings from all food groups on a given day. Fruits are the most commonly omitted food group. Vegetables and meat are the groups most commonly met by adults, and dairy the most commonly met by youth. Intakes of specific types of vegetables (i.e., dark green, deep yellow) and of grains (i.e., whole grains) are well below that recommended; intakes of total fat and added sugars exceed current recommendations. Scoring methods show those diets of the majority of the population require improvement, and that diets improve with increases in education and income. This paper also discusses the limitations and strengths of these approaches, and concludes with suggestions to improve current food guidance and methods to assess the total diet.

Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force.

PubMed

Thombs, Brett D; Saadat, Nazanin; Riehm, Kira E; Karter, Justin Michael; Vaswani, Akansha; Andrews, Bonnie K; Simons, Peter; Cosgrove, Lisa

2017-08-09

Recently, health screening recommendations have gone beyond screening for early-stage, asymptomatic disease to include "screening" for presently experienced health problems and symptoms using self-report questionnaires. We examined recommendations from three major national guideline organizations to determine the consistency of recommendations, identify sources of divergent recommendations, and determine if guideline organizations have identified any direct randomized controlled trial (RCT) evidence for the effectiveness of questionnaire-based screening. We reviewed recommendation statements listed by the Canadian Task Force on Preventive Health Care (CTFPHC), the United Kingdom National Screening Committee (UKNSC), and the United States Preventive Services Task Force (USPSTF) as of 5 September 2016. Eligible recommendations focused on using self-report questionnaires to identify patients with presently experienced health problems or symptoms. Within each recommendation and accompanying evidence review we identified screening RCTs. We identified 22 separate recommendations on questionnaire-based screening, including three CTFPHC recommendations against screening, eight UKNSC recommendations against screening, four USPSTF recommendations in favor of screening (alcohol misuse, adolescent depression, adult depression, intimate partner violence), and seven USPSTF recommendations that did not recommend for or against screening. In the four cases where the USPSTF recommended screening, either the CTFPHC, the UKNSC, or both recommended against. When recommendations diverged, the USPSTF expressed confidence in benefits based on indirect evidence, evaluated potential harms as minimal, and did not consider cost or resource use. CTFPHC and UKNSC recommendations against screening, on the other hand, focused on the lack of direct evidence of benefit and raised concerns about harms to patients and resource use. Of six RCTs that directly evaluated screening interventions, five did not report any statistically significant primary or secondary health outcomes in favor of screening, and one trial reported equivocal results. Only the USPSTF has made any recommendations for screening with questionnaires for presently experienced problems or symptoms. The CTFPHC and UKNSC recommended against screening in all of their recommendations. Differences in recommendations appear to reflect differences in willingness to assume benefit from indirect evidence and different approaches to assessing possible harms and resource consumption. There were no examples in any recommendations of RCTs with direct evidence of improved health outcomes.

Effectiveness of a video-based aging services technology education program for health care professionals.

PubMed

Weakley, Alyssa; Tam, Joyce W; Van Son, Catherine; Schmitter-Edgecombe, Maureen

2017-01-19

Health care professionals (HCPs) are a critical source of recommendations for older adults. Aging services technologies (ASTs), which include devices to support the health-care needs of older adults, are underutilized despite evidence for improving functional outcomes and safety and reducing caregiver burden and health costs. This study evaluated a video-based educational program aimed at improving HCP awareness of ASTs. Sixty-five HCPs viewed AST videos related to medication management, daily living, and memory. Following the program, participants' objective and perceived AST knowledge improved, as did self-efficacy and anticipated AST engagement. About 95% of participants stated they were more likely to recommend ASTs postprogram. Participants benefitted equally regardless of years of experience or previous AST familiarity. Furthermore, change in self-efficacy and perceived knowledge were significant predictors of engagement change. Overall, the educational program was effective in improving HCPs' awareness of ASTs and appeared to benefit all participants regardless of experience and prior knowledge.

Recommendation System Based On Association Rules For Distributed E-Learning Management Systems

NASA Astrophysics Data System (ADS)

Mihai, Gabroveanu

2015-09-01

Traditional Learning Management Systems are installed on a single server where learning materials and user data are kept. To increase its performance, the Learning Management System can be installed on multiple servers; learning materials and user data could be distributed across these servers obtaining a Distributed Learning Management System. In this paper is proposed the prototype of a recommendation system based on association rules for Distributed Learning Management System. Information from LMS databases is analyzed using distributed data mining algorithms in order to extract the association rules. Then the extracted rules are used as inference rules to provide personalized recommendations. The quality of provided recommendations is improved because the rules used to make the inferences are more accurate, since these rules aggregate knowledge from all e-Learning systems included in Distributed Learning Management System.

Practice Guideline Recommendations on Perioperative Fasting: A Systematic Review.

PubMed

Lambert, Eva; Carey, Sharon

2016-11-01

Traditionally, perioperative fasting consisted of being nil by mouth (NBM) from midnight before surgery and fasting postoperatively until recovery of bowel function. These outdated practices persist despite emerging evidence revealing that excessive fasting results in negative outcomes and delayed recovery. Various evidence-based, multimodal, enhanced recovery protocols incorporating minimized perioperative fasting have arisen to improve patient outcomes and streamline recovery, but implementation remains limited. This article aims to review current fasting guidelines, assess their quality, summarize relevant recommendations, and identify gaps in evidence. A systematic literature search of Medline and CINAHL and a manual search of relevant websites identified guidelines containing suitable grading systems and fasting recommendations. Guideline quality was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Grading systems were standardized to the American Society for Parenteral and Enteral Nutrition format and recommendations summarized based on grading and guideline quality. Nineteen guidelines were included. Rigor of development scores ranged from 29%-95%, with only 8 guidelines explicitly declaring the use of systematic methodology. Applicability scores were lowest, averaging 32%. Ten recommendation types were extracted and summarized. Strong and consistent evidence exists for the minimization of perioperative fasting, for a 2-hour preoperative fast after clear fluids, and for early recommencement of oral food and fluid intake postoperatively. This article presents several high-level recommendations ready for immediate implementation, while poorly graded and inconsistent recommendations reveal key areas for future research. Meanwhile, guideline quality requires improvement, especially regarding rigor of development and applicability, through systematic methodology, reporting transparency, and implementation strategies. © 2015 American Society for Parenteral and Enteral Nutrition.

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.

Enhancing Dissemination, Implementation, and Improvement Science in CTSAs through Regional Partnerships.

PubMed

Inkelas, Moira; Brown, Arleen F; Vassar, Stefanie D; Sankaré, Ibrahima C; Martinez, Arturo B; Kubicek, Katrina; Kuo, Tony; Mahajan, Anish; Gould, Michael; Mittman, Brian S

2015-12-01

Challenges in healthcare policy and practice have stimulated interest in dissemination and implementation science. The Institute of Medicine Committee on the Clinical Translational Science Award (CTSA) program recommended expanding the CTSA program's investment and activity in this domain. Guidance is needed to facilitate successful growth of DII science infrastructure, activity and impacts. Several CTSAs in Southern California collaborated to identify and respond to local challenges and opportunities to expand dissemination, implementation and improvement research by strengthening capacity and relationships between DII researchers and community, health system, and population health partners. Planning and outreach by the Southern California CTSAs increased awareness and interest in DII research and generated recommendations for growth. Recommendations include: increasing strong partnerships with healthcare and population health systems to guide policy research agendas and collaborative DII science; promoting multi-sector partnerships that involve researchers and delivery systems throughout DII processes; bringing together multiple disciplines; and addressing national and international barriers as well as opportunities in DII science. CTSAs through regional collaboration can increase their contributions to improved community health via skill-building, partnership development and enhanced outreach to local healthcare and public health agencies and delivery systems. © 2015 Wiley Periodicals, Inc.

Enhancing Dissemination, Implementation, and Improvement Science in CTSAs through Regional Partnerships

PubMed Central

Brown, Arleen F.; Vassar, Stefanie D.; Sankaré, Ibrahima C.; Martinez, Arturo B.; Kubicek, Katrina; Kuo, Tony; Mahajan, Anish; Gould, Michael; Mittman, Brian S.

2015-01-01

Abstract Background and Importance Challenges in healthcare policy and practice have stimulated interest in dissemination and implementation science. The Institute of Medicine Committee on the Clinical Translational Science Award (CTSA) program recommended expanding the CTSA program's investment and activity in this domain. Guidance is needed to facilitate successful growth of DII science infrastructure, activity and impacts. Objectives Several CTSAs in Southern California collaborated to identify and respond to local challenges and opportunities to expand dissemination, implementation and improvement research by strengthening capacity and relationships between DII researchers and community, health system, and population health partners. Main outcomes Planning and outreach by the Southern California CTSAs increased awareness and interest in DII research and generated recommendations for growth. Recommendations include: increasing strong partnerships with healthcare and population health systems to guide policy research agendas and collaborative DII science; promoting multi‐sector partnerships that involve researchers and delivery systems throughout DII processes; bringing together multiple disciplines; and addressing national and international barriers as well as opportunities in DII science. Implications CTSAs through regional collaboration can increase their contributions to improved community health via skill‐building, partnership development and enhanced outreach to local healthcare and public health agencies and delivery systems. PMID:26602191

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

An annotated bibliography of selected guides for stream habitat improvement in the Pacific Northwest

USGS Publications Warehouse

Keim, R.F.; Price, A.B.; Hardin, T. S.; Skaugset, Arne E.; Bateman, D.S.; Gresswell, R.E.; Tesch, S. D.

2004-01-01

This annotated bibliography is a response to widespread interest in stream habitat improvement in the Pacific Northwest by land managers, governmental and nongovernmental organizations, and the lay public. Several guides to stream habitat improvement have been written in the past, but may not be easily accessible to people from diverse backgrounds. This annotated bibliography reviews 11 guides to stream habitat improvement so that readers can find literature appropriate to their needs. All reviews begin with summaries of the contents, stated audiences, and goals of each guide. Reviews also include subjective comments on the strengths and weaknesses of each guide. Finally, this bibliography includes recommendations of guides and combinations of guides judged most useful for a range of purposes. 

Peridigm summary report : lessons learned in development with agile components.

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

Salinger, Andrew Gerhard; Mitchell, John Anthony; Littlewood, David John

2011-09-01

This report details efforts to deploy Agile Components for rapid development of a peridynamics code, Peridigm. The goal of Agile Components is to enable the efficient development of production-quality software by providing a well-defined, unifying interface to a powerful set of component-based software. Specifically, Agile Components facilitate interoperability among packages within the Trilinos Project, including data management, time integration, uncertainty quantification, and optimization. Development of the Peridigm code served as a testbed for Agile Components and resulted in a number of recommendations for future development. Agile Components successfully enabled rapid integration of Trilinos packages into Peridigm. A cost of thismore » approach, however, was a set of restrictions on Peridigm's architecture which impacted the ability to track history-dependent material data, dynamically modify the model discretization, and interject user-defined routines into the time integration algorithm. These restrictions resulted in modifications to the Agile Components approach, as implemented in Peridigm, and in a set of recommendations for future Agile Components development. Specific recommendations include improved handling of material states, a more flexible flow control model, and improved documentation. A demonstration mini-application, SimpleODE, was developed at the onset of this project and is offered as a potential supplement to Agile Components documentation.« less

77 FR 45944 - Final Priorities and Definitions; State Personnel Development Grants

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-02

... designed broadly to focus on the effective and efficient delivery of professional development using... development. For example, some commenters recommended including references to universal design for learning... culturally competent, provided the project is designed to improve professional development in this area...

78 FR 31554 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-24

... Brief Description Cardiovascular disease (CVD), which includes heart disease, myocardial infarction, and... assess the effectiveness of the WISEWOMAN program in reducing the burden of cardiovascular disease risk... incidence, cardiovascular disease risk-factors, health promotion, to improve the availability of screening...

Conducting One's Own Communication Audit.

ERIC Educational Resources Information Center

Rogers, Donald P.; Goldhaber, Gerald M.

1978-01-01

Guidelines are offered to a college or university for conducting a communication audit. These include steps in planning the audit, use of the variety of tools available for administering the audit, the development and feedback to the institution, and development of recommendations to improve institutional communication. (JMF)

Improving Endowment Management. AGB Special Report.

ERIC Educational Resources Information Center

Association of Governing Boards of Universities and Colleges, 1985

1985-01-01

Endowment practices at 23 institutions during 1978-1983 were studied to provide recommendations on endowment fund management for colleges and universities. Although most of the participating colleges were privately supported, two state-supported universities were included. Twelve of the institutions used a systematic approach to improving…

2007/08 Annual Service Plan Report

ERIC Educational Resources Information Center

Ministry of Advanced Education, 2008

2008-01-01

Since receiving "Campus 2020 Thinking Ahead: The Report," the Ministry of Advanced Education and Labour Market Development has been reviewing its recommendations to improve post-secondary education in British Columbia. Several of these have been implemented, including: undertaking a review of student financial assistance and completing a…

California Programs and Services for Students with Serious Emotional Disturbances.

ERIC Educational Resources Information Center

Winget, Pat, Ed.; Kirk, Joyce, Ed.

This monograph presents an overview of the current status of programs for students with serious emotional disturbances in California and makes recommendations for program improvements. An introductory chapter summarizes important themes including screening, prevention, and early intervention; definitions; eligibility issues; assessment;…

Towards a Net Zero Building Cluster Energy Systems Analysis for US Army Installations

DTIC Science & Technology

2011-05-01

depending on the alternative chosen. Since the proposed energy efficiency work includes the implementation of DOAS and high efficiency dehumidification ...cluster Net Zero fossil fuel energy. The recommended, integrated energy solution demonstrates that vastly improved energy efficiency and greenhouse gas

7 CFR 955.50 - Research and development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... development and marketing promotion projects, including paid advertising, designed to assist, improve, or... project for the promotion and advertising of Vidalia onions may utilize an identifying mark which shall be... projects; and (3) Its recommendations as to promotion activity and paid advertising. (d) Upon conclusion of...

Patient identification in blood sampling.

PubMed

Davidson, Anne; Bolton-Maggs, Paula

The majority of adverse reports relating to blood transfusions result from human error, including misidentification of patients and incorrect labelling of samples. This article outlines best practice in blood sampling for transfusion (but is recommended for all pathology samples) and the role of patient empowerment in improving safety.

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

Policy considerations for improving influenza vaccination rates among pregnant women.

PubMed

Mollard, Elizabeth K; Guenzel, Nicholas; Brown, Peggy A; Keeler, Heidi J; Cramer, Mary E

2014-01-01

Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates. © 2014 Wiley Periodicals, Inc.

Suicidality and veterans with a history of traumatic brain injury: precipitants events, protective factors, and prevention strategies.

PubMed

Brenner, Lisa A; Homaifar, Beeta Y; Adler, Lawrence E; Wolfman, Jessica H; Kemp, Jan

2009-11-01

To increase understanding regarding precipitating and preventative factors of suicidal behavior and to highlight past experiences and recommendations regarding services aimed at suicide prevention among Veterans with a history of traumatic brain injury (TBI). Qualitative. Sample of 13 Veterans with a history of TBI, and a history of clinically significant suicidal ideation or behavior. In-person interviews were conducted and data were analyzed using a hermeneutic approach. Shared precipitants noted included loss-of-self post-TBI, cognitive sequelae, and psychiatric and emotional disturbances. Common protective factors noted included social supports, a sense of purpose regarding the future, religion and spirituality, and mental health care. Means of improving care were also identified (e.g., increasing the availability of services and mental health professionals' knowledge regarding TBI, providing more structured treatment). Findings highlight potential areas of importance in the assessment and treatment of suicidal Veterans with a history of TBI. Recommendations regarding means of improving care are also presented.

Recommendations for patient engagement in patient-oriented emergency medicine research.

PubMed

Archambault, Patrick M; McGavin, Colleen; Dainty, Katie N; McLeod, Shelley L; Vaillancourt, Christian; Lee, Jacques S; Perry, Jeffrey J; Gauvin, François-Pierre; Boivin, Antoine

2018-05-01

To make pragmatic recommendations on best practices for the engagement of patients in emergency medicine (EM) research. We created a panel of expert Canadian EM researchers, physicians, and a patient partner to develop our recommendations. We used mixed methods consisting of 1) a literature review; 2) a survey of Canadian EM researchers; 3) qualitative interviews with key informants; and 4) feedback during the 2017 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. We synthesized our literature review into categories including identification and engagement, patients' roles, perceived benefits, harms, and barriers to patient engagement; 40/75 (53% response rate) invited researchers completed our survey. Among respondents, 58% had engaged patients in research, and 83% intended to engage patients in future research. However, 95% stated that they need further guidance to engage patients. Our qualitative interviews revealed barriers to patient engagement, including the need for training and patient partner recruitment.Our panel recommends 1) an overarching positive recommendation to support patient engagement in EM research; 2) seven policy-level recommendations for CAEP to support the creation of a national patient council, to develop, adopt and adapt training material, guidelines, and tools for patient engagement, and to support increased patient engagement in EM research; and 3) nine pragmatic recommendations about engaging patients in the preparatory, execution, and translational phases of EM research. Patient engagement can improve EM research by helping researchers select meaningful outcomes, increase social acceptability of studies, and design knowledge translation strategies that target patients' needs.

Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis.

PubMed

Loza, Estíbaliz; Lajas, Cristina; Andreu, Jose Luis; Balsa, Alejandro; González-Álvaro, Isidoro; Illera, Oscar; Jover, Juan Ángel; Mateo, Isabel; Orte, Javier; Rivera, Javier; Rodríguez Heredia, José Manuel; Romero, Fredeswinda; Martínez-López, Juan Antonio; Ortiz, Ana María; Toledano, Esther; Villaverde, Virginia; Carmona, Loreto; Castañeda, Santos

2015-03-01

The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient's features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.

Aligning Documentation With Congenital Muscular Torticollis Clinical Practice Guidelines: Administrative Case Report.

PubMed

Gutierrez, Dennis; Kaplan, Sandra L

2016-01-01

A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). The Pediatric Therapy Services of St Joseph's Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture supportive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations. © 2016 American Physical Therapy Association.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report.

PubMed

Bevans, Margaret; El-Jawahri, Areej; Tierney, D Kathryn; Wiener, Lori; Wood, William A; Hoodin, Flora; Kent, Erin E; Jacobsen, Paul B; Lee, Stephanie J; Hsieh, Matthew M; Denzen, Ellen M; Syrjala, Karen L

2017-04-01

In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs. Published by Elsevier Inc.

Immunization of HIV-infected adult patients — French recommendations

PubMed Central

Frésard, Anne; Gagneux-Brunon, Amandine; Lucht, Frédéric; Botelho-Nevers, Elisabeth; Launay, Odile

2016-01-01

ABSTRACT Human immunodeficiency virus (HIV)-infected patients remain at increased risk of infection including vaccine-preventable diseases. Vaccines are therefore critical components in the protection of HIV-infected patients from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected patients persist and vaccine coverage in this population could be improved. This article presents the French recommendations regarding immunization of HIV-infected adults in the light of the evidence-based literature on the benefits and the potential risks of vaccines among this vulnerable population. PMID:27409293

Study and Simulation of Enhancements for TCP Performance Over Noisy High Latency Links

NASA Technical Reports Server (NTRS)

Partridge, Craig

1999-01-01

The goal of this study is to better understand how TCP behaves over noisy, high-latency links such as satellite links and propose improvements to TCP implementations such that TCP might better handle such links. This report is comprised of a series of smaller reports, presentations and recommendations. Included in these documents are a summary of the TCP enhancement techniques for large windows, protect against wrap around (PAWS), use of selective acknowledgements (SACK), increasing TCP's initial window and recommendations to implement TCP pacing.

Implementation of therapeutic hypothermia guidelines for post-cardiac arrest syndrome at a glacial pace: seeking guidance from the knowledge translation literature.

PubMed

Brooks, Steven C; Morrison, Laurie J

2008-06-01

The 2005 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations document represents the most extensive and rigorous systematic review of the resuscitation literature to date and included evidence-based recommendations for post-resuscitation care. A new recommendation for the induction of mild therapeutic hypothermia for comatose cardiac arrest survivors was included in this document. Accordingly, constituent national member associations of ILCOR, including the American Heart Association, incorporated the recommendation for therapeutic hypothermia into their respective guidelines. Despite these endorsements there is a concern that therapeutic hypothermia is not being used in practice. Data from a number of surveys in Europe and the United States suggest that rates of use among physicians may be as low as 30-40%. Despite the cost and effort associated with the production of these guidelines and the potential impact on patient care, current efforts in implementing the guideline have not achieved widespread success. This commentary explores the issue of underutilization of the American Heart Association guidelines for therapeutic hypothermia and looks to the knowledge translation literature to inform a new approach to implementation. We will review the underlying phenomenon of research implementation into practice, specific barriers to guideline implementation and interventions that may improve therapeutic hypothermia uptake.

Integrating palliative care into disease management guidelines.

PubMed

Emanuel, Linda; Alexander, Carla; Arnold, Robert M; Bernstein, Richard; Dart, Richard; Dellasantina, Christopher; Dykstra, Lee; Tulsky, James

2004-12-01

Palliative care should not be reserved for those who are close to dying; as a comprehensive approach to minimizing illness-related suffering, it is appropriate for patients with significant illness from the time of diagnosis on. The American Hospice Foundation Guidelines Committee's initiative aims to provide a practical approach for guideline writers and others to integrate palliative care into disease management and care services whenever it is relevant. A consensus approach was used to design recommendations for upgrading existing disease management and service guidelines to include palliative care. A template is described for identifying stages in disease management guidelines when integration of palliative care is appropriate: (1) Introductory sections to disease management guidelines should include prognosis and other disease consequences; (2) Diagnostic sections should include recommendations for conducting a whole patient assessment; (3) Treatment sections should include discernment of patient goals for care, continuous goal reassessment, palliative care interventions to reduce suffering as needed, and treatment decisions should include discussion of the type of expected improvement. Service guidelines should note the role of interdisciplinary team care as well as palliative care consultative or care services; (4) Sections that conclude the care provided to incurable patients should not end without recommendations on grief and bereavement care, and care during the last hours of living. The American Hospice Foundation Guidelines Committee recommends integration of relevant aspects of palliative care in introductory, diagnostic, treatment, and closing sections of management guidelines for all significant illnesses.

Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline.

PubMed

Lyman, Gary H; Greenlee, Heather; Bohlke, Kari; Bao, Ting; DeMichele, Angela M; Deng, Gary E; Fouladbakhsh, Judith M; Gil, Brigitte; Hershman, Dawn L; Mansfield, Sami; Mussallem, Dawn M; Mustian, Karen M; Price, Erin; Rafte, Susan; Cohen, Lorenzo

2018-06-11

Purpose The Society for Integrative Oncology (SIO) produced an evidence-based guideline on use of integrative therapies during and after breast cancer treatment that was determined to be relevant to the American Society of Clinical Oncology (ASCO) membership. ASCO considered the guideline for endorsement. Methods The SIO guideline addressed the use of integrative therapies for the management of symptoms and adverse effects, such as anxiety and stress, mood disorders, fatigue, quality of life, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Interventions of interest included mind and body practices, natural products, and lifestyle modifications. SIO systematic reviews focused on randomized controlled trials that were published from 1990 through 2015. The SIO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor. On favorable review, an ASCO Expert Panel was convened to review the guideline contents and recommendations. Results The ASCO Expert Panel determined that the recommendations in the SIO guideline-published in 2017-are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the guideline with a few added discussion points. Recommendations Key recommendations include the following: Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-l-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy because of a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related adverse effects. Additional information is available at: www.asco.org/supportive-care-guidelines .

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review.

PubMed

Price, Laura C; Wort, Stephen J; Finney, Simon J; Marino, Philip S; Brett, Stephen J

2010-01-01

Pulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care. A systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method. Clinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy. This systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

Personalized recommendation via an improved NBI algorithm and user influence model in a Microblog network

NASA Astrophysics Data System (ADS)

Lian, Jie; Liu, Yun; Zhang, Zhen-jiang; Gui, Chang-ni

2013-10-01

Bipartite network based recommendations have attracted extensive attentions in recent years. Differing from traditional object-oriented recommendations, the recommendation in a Microblog network has two crucial differences. One is high authority users or one’s special friends usually play a very active role in tweet-oriented recommendation. The other is that the object in a Microblog network corresponds to a set of tweets on same topic instead of an actual and single entity, e.g. goods or movies in traditional networks. Thus repeat recommendations of the tweets in one’s collected topics are indispensable. Therefore, this paper improves network based inference (NBI) algorithm by original link matrix and link weight on resource allocation processes. This paper finally proposes the Microblog recommendation model based on the factors of improved network based inference and user influence model. Adjusting the weights of these two factors could generate the best recommendation results in algorithm accuracy and recommendation personalization.

Summary of International Guidelines for Physical Activity Following Pregnancy

PubMed Central

Evenson, Kelly R.; Mottola, Michelle F.; Owe, Katrine M.; Rousham, Emily K.; Brown, Wendy J.

2014-01-01

Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety. This review summarizes current guidelines for postpartum physical activity worldwide. PubMed (MedLINE) was searched for country-specific government and clinical guidelines on physical activity following pregnancy through the year 2013. Only the most recent guideline was included in the review. An abstraction form facilitated extraction of key details and helped to summarize results. Six guidelines were identified from five countries (Australia, Canada, Norway, United Kingdom, United States). All guidelines were embedded within pregnancy-related physical activity recommendations. All provided physical activity advice related to breastfeeding and three remarked about physical activity following Caesarean delivery. Recommended physical activities mentioned in the guidelines included aerobic (3/6), pelvic floor exercise (3/6), strengthening (2/6), stretching (2/6), and walking (2/6). None of the guidelines discussed sedentary behavior. The guidelines that were identified lacked specificity for physical activity. Greater clarity in guidelines would be more useful to both practitioners and the women they serve. Postpartum physical activity guidelines have the potential to assist women to initiate or resume physical activity following childbirth, so that they can transition to meeting recommended levels of physical activity. Health care providers have a critical role in encouraging women to be active at this time, and the availability of more explicit guidelines may assist them to routinely include physical activity advice in their postpartum care. PMID:25112589

Implementing standardized performance indicators to improve hypertension control at both the population and healthcare organization levels

PubMed Central

Campbell, Norm; Ordunez, Pedro; Jafe, Marc G.; Orias, Marcelo; DiPete, Donald J.; Patel, Pragna; Khan, Nadia; Onuma, Oyere; Lackland, Daniel T.

2017-01-01

The ability to reliably evaluate the impact of interventions and changes in hypertension prevalence and control is critical if the burden of hypertension-related disease is to be reduced. Previously, a World Hypertension League Expert Committee made recommendations to standardize the reporting of population blood pressure surveys. We have added to those recommendations and also provide modified recommendations from a Pan American Health Organization expert meeting for “performance indicators” to be used to evaluate clinical practices. Core indicators for population surveys are recommended to include: (1) mean systolic blood pressure and (2) mean diastolic blood pressure, and the prevalences of: (3) hypertension, (4) awareness of hypertension, (5) drug-treated hypertension, and (6) drug-treated and controlled hypertension. Core indicators for clinical registries are recommended to include: (1) the prevalence of diagnosed hypertension and (2) the ratio of diagnosed hypertension to that expected by population surveys, and the prevalences of: (3) controlled hypertension, (4) lack of blood pressure measurement within a year in people diagnosed with hypertension, and (5) missed visits by people with hypertension. Definitions and additional indicators are provided. Widespread adoption of standardized population and clinical hypertension performance indicators could represent a major step forward in the effort to control hypertension. PMID:28191704

Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review

PubMed Central

Dahl, Camilla; Crichton, Megan; Jenkins, Julie; Nucera, Romina; Mahoney, Sophie; Marx, Wolfgang

2018-01-01

In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was “very low” quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was “very low” quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved. PMID:29382074

Utilization of Clinical Preventive Services for Cancer and Heart Disease Among Insured Adults: United States, 2015.

PubMed

Vahratian, Anjel; Blumberg, Stephen J

2017-03-01

Data from the National Health Interview Survey •Two-thirds of insured adults aged 50-75 were screened for colorectal cancer within the recommended intervals. •Insured women aged 30-39 (90.5%) were more likely than their older peers to be screened for cervical cancer within the recommended intervals. •Seventy-three percent of insured women aged 50-74 had a mammogram in the past 2 years. •The percentage of insured adults who had a cardiovascular risk screening (blood pressure, blood sugar) within the recommended intervals significantly increased with advancing age for both men and women. Recent improvements in health insurance coverage (1) have been associated with improved access to health care (2-4) and increased utilization of preventive services (5). Most insurance plans are now required to cover specific clinical preventive services without copayment from the insured adult (6). This report presents the proportion of insured adults who received selected services that are recommended for the prevention or early detection of cancer and heart disease. Sex- and age-specific differences are examined. The age groups included in each chart vary because the selected preventive services are recommended for different age groups. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Instability resistance training across the exercise continuum.

PubMed

Behm, David G; Colado, Juan C; Colado, Juan C

2013-11-01

Instability resistance training (IRT; unstable surfaces and devices to strengthen the core or trunk muscles) is popular in fitness training facilities. To examine contradictory IRT recommendations for health enthusiasts and rehabilitation. A literature search was performed using MEDLINE, SPORT Discus, ScienceDirect, Web of Science, and Google Scholar databases from 1990 to 2012. Databases were searched using key terms, including "balance," "stability," "instability," "resistance training," "core," "trunk," and "functional performance." Additionally, relevant articles were extracted from reference lists. To be included, research questions addressed the effect of balance or IRT on performance, healthy and active participants, and physiologic or performance outcome measures and had to be published in English in a peer-reviewed journal. There is a dichotomy of opinions on the effectiveness and application of instability devices and conditions for health and performance training. Balance training without resistance has been shown to improve not only balance but functional performance as well. IRT studies document similar training adaptations as stable resistance training programs with recreationally active individuals. Similar progressions with lower resistance may improve balance and stability, increase core activation, and improve motor control. IRT is highly recommended for youth, elderly, recreationally active individuals, and highly trained enthusiasts.

Quality of Care for PTSD and Depression in the Military Health System

DTIC Science & Technology

evaluate the receipt of recommended assessments and treatments. These measures draw on multiple data sources including administrative encounter data...services are effective in reducing symptoms. When comparing performance between 20122013 and 20132014, most measures demonstrated slight improvement ...in 20132014 for over 38,000 active-component service members with PTSD or depression. The assessment includes performance on 30 quality measures to

Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients.

PubMed

Sogg, Stephanie; Lauretti, Jennifer; West-Smith, Lisa

2016-05-01

Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

77 FR 50695 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-22

... guidance documents intended to improve contraceptive use and the delivery of quality family planning... implementation of recommendations included in the U.S. Medical Eligibility Criteria for Contraceptive Use... Contraceptive Use (U.S. SPR) and the forthcoming Guidance for Providing Quality Family Planning Services (QFPS...

The Teacher/Scientist: From Trainer to Educator.

ERIC Educational Resources Information Center

Ellerbrock, Michael J.

Problems and issues in U.S. undergraduate education are identified, and 10 recommendations for improvement are offered. Specific reference is made to agriculture faculty. Problems and issues include: current emphasis on academic specialization rather than the development of integrated, holistic students; the purpose of a liberal education versus…

Targeting Audiences and Content for Forest Fire Information Programs.

ERIC Educational Resources Information Center

Carpenter, Edwin H.; And Others

1986-01-01

Discusses opinion survey results for the purpose of improving the capabilities of forest managers to effectively communicate new fire management objectives and plans. Includes recommendations based on the analysis concerning the appropriate audiences and content to target in the design of fire information programs. (ML)

Texas Sustainable School Design Guideline.

ERIC Educational Resources Information Center

Nicklas, Michael; Bailey, Gary; Padia, Harshad D.; Malin, Nadav

This guide offers a detailed listing of the key practices and technologies that can help create a sustainable school. The document includes hundreds of cost-effective recommendations that can improve the energy performance and environmental quality of school designs. Each design and construction phase is addressed, from site selection through…

40 CFR 63.176 - Quality improvement program for pumps.

Code of Federal Regulations, 2014 CFR

2014-07-01

... and manufacturer; pump design (e.g., external shaft, flanged body); materials of construction; if... failure or of the pump leak and shall include recommendations, as appropriate, for design changes or..., operating or maintenance practices, and pump or pump seal designs or technologies that have poorer than...

The Highland Park Environmental Health Plan: Evaluation and Recommendations for Improving the Urban Environment.

ERIC Educational Resources Information Center

Michigan State Dept. of Commerce, Lansing. Community Planning Div.

The Highland Park environmental health plan includes the following components: Legal and administrative and programmatic relationships, planning studies, residential environment, disease vector control, water and sewage systems, sanitation, air pollution, food protection, industrial and radiological health, and solid waste facilities. (JR)

75 FR 152 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

... activities described in RFA DP0-901, Healthy Communities, Tobacco Control, Diabetes Prevention and Control... physical activity; improved nutrition (e.g., increased fruit/vegetable consumption, reduced consumption of... activities. The Recovery Act included $650 million for evidence-based clinical and community-based prevention...

Aerospace safety advisory panel

NASA Technical Reports Server (NTRS)

1983-01-01

Data acquired on the actual flight experience with the various subsystems are assessed. These subsystems include: flight control and performance, structural integrity, orbiter landing gear, lithium batteries, EVA and prebreathing, and main engines. Improvements for routine operations are recommended. Policy issues for operations and flight safety for aircraft operations are discussed.

Layout Study and Application of Mobile App Recommendation Approach Based On Spark Streaming Framework

NASA Astrophysics Data System (ADS)

Wang, H. T.; Chen, T. T.; Yan, C.; Pan, H.

2018-05-01

For App recommended areas of mobile phone software, made while using conduct App application recommended combined weighted Slope One algorithm collaborative filtering algorithm items based on further improvement of the traditional collaborative filtering algorithm in cold start, data matrix sparseness and other issues, will recommend Spark stasis parallel algorithm platform, the introduction of real-time streaming streaming real-time computing framework to improve real-time software applications recommended.

Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial.

PubMed

Munce, Sarah E P; Graham, Ian D; Salbach, Nancy M; Jaglal, Susan B; Richards, Carol L; Eng, Janice J; Desrosiers, Johanne; MacKay-Lyons, Marilyn; Wood-Dauphinee, Sharon; Korner-Bitensky, Nicol; Mayo, Nancy E; Teasell, Robert W; Zwarenstein, Merrick; Mokry, Jennifer; Black, Sandra; Bayley, Mark T

2017-06-26

The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was a cluster randomized controlled trial that evaluated two knowledge translation (KT) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function, postural control, and mobility. Twenty rehabilitation centers across Canada were randomly assigned to either the facilitated or passive KT intervention. The objective of the current study was to understand the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses, occupational therapists and physical therapists, and clinical managers following completion of the trial. A qualitative descriptive approach involving focus groups was used. Thematic analysis was used to understand the factors influencing the implementation of the recommended treatments and KT interventions. The Clinical Practice Guidelines Framework for Improvement guided the analysis. Thirty-three participants were interviewed from 11 of the 20 study sites (6 sites from the facilitated KT arm and 5 sites from the passive KT arm). The following factors influencing the implementation of the recommended treatments and KT interventions emerged: facilitation, agreement with the intervention - practical, familiarity with the recommended treatments, and environmental factors, including time and resources. Each of these themes includes the sub-themes of facilitator and/or barrier. Improved team communication and interdisciplinary collaboration emerged as an unintended outcome of the trial across both arms in addition to a facilitator to the implementation of the treatment recommendations. Facilitation was identified as a facilitator to implementation of the KT interventions in the passive KT intervention arm despite the lack of formally instituted facilitators in this arm of the trial. This is one of the first studies to examine the factors influencing the implementation of stroke recommendations and associated KT interventions within the context of a trial. Findings highlight the important role of self-selected facilitators to implementation efforts. Future research should seek to better understand the specific characteristics of facilitators that are associated with successful implementation and clinical outcomes, especially within the context of stroke rehabilitation.

An Improved Adaptive model for Information Recommending and Spreading

NASA Astrophysics Data System (ADS)

Chen, Duan-Bing; Gao, Hui

2012-04-01

People in the Internet era have to cope with information overload and expend great effort on finding what they need. Recent experiments indicate that recommendations based on users' past activities are usually less favored than those based on social relationships, and thus many researchers have proposed adaptive algorithms on social recommendation. However, in those methods, quite a number of users have little chance to recommend information, which might prevent valuable information from spreading. We present an improved algorithm that allows more users to have enough followers to spread information. Experimental results demonstrate that both recommendation precision and spreading effectiveness of our method can be improved significantly.

Challenges and opportunities for implementing evidence-based antenatal care in Mozambique: a qualitative study.

PubMed

Biza, Adriano; Jille-Traas, Ingeborg; Colomar, Mercedes; Belizan, Maria; Requejo Harris, Jennifer; Crahay, Beatrice; Merialdi, Mario; Nguyen, My Huong; Althabe, Fernando; Aleman, Alicia; Bergel, Eduardo; Carbonell, Alicia; Chavane, Leonardo; Delvaux, Therese; Geelhoed, Diederike; Gülmezoglu, Metin; Malapende, Celsa Regina; Melo, Armando; Osman, Nafissa Bique; Widmer, Mariana; Temmerman, Marleen; Betrán, Ana Pilar

2015-09-02

Maternal mortality remains a daunting problem in Mozambique and many other low-resource countries. High quality antenatal care (ANC) services can improve maternal and newborn health outcomes and increase the likelihood that women will seek skilled delivery care. This study explores the factors influencing provider uptake of the recommended package of ANC interventions in Mozambique. This study used qualitative research methods including key informant interviews with stakeholders from the health sector and a total of five focus group discussions with women with experience with ANC or women from the community. Study participants were selected from three health centers located in Maputo city, Tete, and Cabo Delgado provinces in Mozambique. Staff responsible for the medicines/supply chain at national, provincial and district level were interviewed. A check list was implemented to confirm the availability of the supplies required for ANC. Deductive content analysis was conducted. Three main groups of factors were identified that hinder the implementation of the ANC package in the study setting: a) system or organizational: include chronic supply chain deficiencies, failures in the continuing education system, lack of regular audits and supervision, absence of an efficient patient record system and poor environmental conditions at the health center; b) health care provider factors: such as limited awareness of current clinical guidelines and a resistant attitude to adopting new recommendations; and c) Users: challenges with accessing ANC, poor recognition amongst women about the purpose and importance of the specific interventions provided through ANC, and widespread perception of an unfriendly environment at the health center. The ANC package in Mozambique is not being fully implemented in the three study facilities, and a major barrier is poor functioning of the supply chain system. Recommendations for improving the implementation of antenatal interventions include ensuring clinical protocols based on the ANC model. Increasing the community understanding of the importance of ANC would improve demand for high quality ANC services. The supply chain functioning could be strengthened through the introduction of a kit system with all the necessary supplies for ANC and a simple monitoring system to track the stock levels is recommended.

Information filtering via a scaling-based function.

PubMed

Qiu, Tian; Zhang, Zi-Ke; Chen, Guang

2013-01-01

Finding a universal description of the algorithm optimization is one of the key challenges in personalized recommendation. In this article, for the first time, we introduce a scaling-based algorithm (SCL) independent of recommendation list length based on a hybrid algorithm of heat conduction and mass diffusion, by finding out the scaling function for the tunable parameter and object average degree. The optimal value of the tunable parameter can be abstracted from the scaling function, which is heterogeneous for the individual object. Experimental results obtained from three real datasets, Netflix, MovieLens and RYM, show that the SCL is highly accurate in recommendation. More importantly, compared with a number of excellent algorithms, including the mass diffusion method, the original hybrid method, and even an improved version of the hybrid method, the SCL algorithm remarkably promotes the personalized recommendation in three other aspects: solving the accuracy-diversity dilemma, presenting a high novelty, and solving the key challenge of cold start problem.

A vertex similarity index for better personalized recommendation

NASA Astrophysics Data System (ADS)

Chen, Ling-Jiao; Zhang, Zi-Ke; Liu, Jin-Hu; Gao, Jian; Zhou, Tao

2017-01-01

Recommender systems benefit us in tackling the problem of information overload by predicting our potential choices among diverse niche objects. So far, a variety of personalized recommendation algorithms have been proposed and most of them are based on similarities, such as collaborative filtering and mass diffusion. Here, we propose a novel vertex similarity index named CosRA, which combines advantages of both the cosine index and the resource-allocation (RA) index. By applying the CosRA index to real recommender systems including MovieLens, Netflix and RYM, we show that the CosRA-based method has better performance in accuracy, diversity and novelty than some benchmark methods. Moreover, the CosRA index is free of parameters, which is a significant advantage in real applications. Further experiments show that the introduction of two turnable parameters cannot remarkably improve the overall performance of the CosRA index.

SPREADSHEET-BASED PROGRAM FOR ERGONOMIC ADJUSTMENT OF NOTEBOOK COMPUTER AND WORKSTATION SETTINGS.

PubMed

Nanthavanij, Suebsak; Prae-Arporn, Kanlayanee; Chanjirawittaya, Sorajak; Paripoonyo, Satirajit; Rodloy, Somsak

2015-06-01

This paper discusses a computer program, ErgoNBC, which provides suggestions regarding the ergonomic settings of a notebook computer (NBC), workstation components, and selected accessories in order to help computer users to assume an appropriate work posture during the NBC work. From the users' body height, NBC and workstation component data, ErgoNBC computes the recommended tilt angle of NBC base unit, NBC screen angle, distance between the user and NBC, seat height and work surface height. If necessary, the NBC base support, seat cushion and footrest, including their settings, are recommended. An experiment involving twenty-four university students was conducted to evaluate the recommendations provided by ErgoNBC. The Rapid Upper Limb Assessment (RULA) technique was used to analyze their work postures both before and after implementing the Ergo NBC's recommendations. The results clearly showed that ErgoNBC could significantly help to improve the subjects' work postures.

Implementing AORN recommended practices for electrosurgery.

PubMed

Spruce, Lisa; Braswell, Melanie L

2012-03-01

Technology is constantly changing, and it is important for perioperative nurses to stay current on new products and technologies in the perioperative setting. AORN's "Recommended practices for electrosurgery" addresses safety standards that all perioperative personnel should follow to minimize risks to both patients and staff members during the use of electrosurgical devices. Recommendations include how to select electrosurgical units and accessories for purchase, how to minimize the potential for patient and staff member injuries, what precautions to take during minimally invasive surgery, and how to avoid surgical smoke hazards. The recommendations also address education/competency, documentation, policies and procedures, and quality assurance/performance improvement. Perioperative nurses should consider the use of checklists and safety posters to remind staff members of the dangers of electrosurgery and the steps to take to minimize the risks for injury. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs.

PubMed

Brosseau, Lucie; Taki, Jade; Desjardins, Brigit; Thevenot, Odette; Fransen, Marlene; Wells, George A; Mizusaki Imoto, Aline; Toupin-April, Karine; Westby, Marie; Álvarez Gallardo, Inmaculada C; Gifford, Wendy; Laferrière, Lucie; Rahman, Prinon; Loew, Laurianne; De Angelis, Gino; Cavallo, Sabrina; Shallwani, Shirin Mehdi; Aburub, Ala'; Bennell, Kim L; Van der Esch, Martin; Simic, Milena; McConnell, Sara; Harmer, Alison; Kenny, Glen P; Paterson, Gail; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; McLean, Linda

2017-05-01

To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p < 0.5) and clinical importance (⩾15% improvement). The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+). There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.

Sequencing the threat and recommendation components of persuasive messages differentially improves the effectiveness of high- and low-distressing imagery in an anti-alcohol message in students.

PubMed

Brown, Stephen L; West, Charlotte

2015-05-01

Distressing imagery is often used to improve the persuasiveness of mass-reach health promotion messages, but its effectiveness may be limited because audiences avoid attending to content. Prior self-affirmation or self-efficacy inductions have been shown to reduce avoidance and improve audience responsiveness to distressing messages, but these are difficult to introduce into a mass-reach context. Reasoning that a behavioural recommendation may have a similar effect, we reversed the traditional threat-behavioural recommendation health promotion message sequence. 2 × 2 experimental design: Factor 1, high- and low-distress images; Factor 2, threat-recommendation and recommendation-threat sequences. Ninety-one students were exposed to an identical text message accompanied by high- or low-distress imagery presented in threat-recommendation and recommendation-threat sequences. For the high-distress message, greater persuasion was observed for the recommendation-threat than the threat-recommendation sequence. This was partially mediated by participants' greater self-exposure to the threat component of the message, which we attribute to the effect of sequence in reducing attentional avoidance. For the low-distress message, greater persuasion was observed for the threat-recommendation sequence, which was not mediated by reading time allocated to the threat. Tailoring message sequence to suit the degree of distress that message developers wish to induce provides a tool that could improve persuasive messages. These findings provide a first step in this process and discuss further steps needed to consolidate and expand these findings. Statement of contribution What is already known on this subject? Health promotion messages accompanied by distressing imagery might, under some circumstances, persuade individuals to engage in healthier behaviour. Audiences can respond defensively to distressing imagery, but may be less inclined to do so when an easily followed behavioural recommendation is presented before imagery. Current literature is divided on whether presenting a behavioural recommendation before a threat component accompanied by distressing images will improve the persuasiveness of messages. What does this study add? We show that, when a behavioural recommendation precedes a threat containing distressing images, persuasiveness of a threatening message is stronger than a threat-recommendation sequence. We show that a recommendation-threat sequence improves persuasiveness of distressing imagery because it reduces attentional avoidance. © 2014 The British Psychological Society.

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

PubMed Central

Günthard, Huldrych F.; Saag, Michael S.; Benson, Constance A.; del Rio, Carlos; Eron, Joseph J.; Gallant, Joel E.; Hoy, Jennifer F.; Mugavero, Michael J.; Sax, Paul E.; Thompson, Melanie A.; Gandhi, Rajesh T.; Landovitz, Raphael J.; Smith, Davey M.; Jacobsen, Donna M.; Volberding, Paul A.

2016-01-01

IMPORTANCE New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. OBJECTIVE To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. EVIDENCE REVIEW A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. FINDINGS Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure. CONCLUSIONS AND RELEVANCE Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults. PMID:27404187

Identifying improvements to complex pathways: evidence synthesis and stakeholder engagement in infant congenital heart disease

PubMed Central

Crowe, Sonya; Knowles, Rachel; Wray, Jo; Tregay, Jenifer; Ridout, Deborah A; Utley, Martin; Franklin, Rodney; Bull, Catherine L; Brown, Katherine L

2016-01-01

Objectives Many infants die in the year following discharge from hospital after surgical or catheter intervention for congenital heart disease (3–5% of discharged infants). There is considerable variability in the provision of care and support in this period, and some families experience barriers to care. We aimed to identify ways to improve discharge and postdischarge care for this patient group. Design A systematic evidence synthesis aligned with a process of eliciting the perspectives of families and professionals from community, primary, secondary and tertiary care. Setting UK. Results A set of evidence-informed recommendations for improving the discharge and postdischarge care of infants following intervention for congenital heart disease was produced. These address known challenges with current care processes and, recognising current resource constraints, are targeted at patient groups based on the number of patients affected and the level and nature of their risk of adverse 1-year outcome. The recommendations include: structured discharge documentation, discharging certain high-risk patients via their local hospital, enhanced surveillance for patients with certain (high-risk) cardiac diagnoses and an early warning tool for parents and community health professionals. Conclusions Our recommendations set out a comprehensive, system-wide approach for improving discharge and postdischarge services. This approach could be used to address challenges in delivering care for other patient populations that can fall through gaps between sectors and organisations. PMID:27266768

Ophthalmology resident selection: current trends in selection criteria and improving the process.

PubMed

Nallasamy, Sudha; Uhler, Tara; Nallasamy, Nambi; Tapino, Paul J; Volpe, Nicholas J

2010-05-01

To document and assess current ophthalmology resident selection practices as well as to initiate discussion on how best to improve the process. Online survey comprising 56 questions. Program directors, chairpersons, or members of the resident selection committee representing 65 United States ophthalmology residency programs accredited by the Accreditation Council on Graduate Medical Education. Study participants completed an online, anonymous survey consisting primarily of multiple choice questions, with single or multiple answers. Ophthalmology resident selection practices were evaluated and included: screening of applications, interview processes, selection factors, and formation of rank lists; recommendations given to applicants; and respondent satisfaction with the current selection process. As a group, survey respondents deemed the following factors most important in resident selection: interview performance (95.4%), clinical course grades (93.9%), letters of recommendation (83.1%), and board scores (80%). Statistical analyses deemed that the best predictors of resident performance are interviews, clinical course grades, recommendation letters, and ophthalmology rotation performance. Ophthalmology resident selection is a relatively subjective process, continuing to rely heavily on cognitive factors. Because these factors are not always indicative of ultimate resident quality, it would be helpful if ophthalmology training programs improved selection practices to discern who most likely will become a successful resident and future ophthalmologist. Long-term studies correlating applicant attributes with residency and postresidency success are needed to recommend guidelines for a more standardized selection process. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs.

PubMed

Brosseau, Lucie; Taki, Jade; Desjardins, Brigit; Thevenot, Odette; Fransen, Marlene; Wells, George A; Imoto, Aline Mizusaki; Toupin-April, Karine; Westby, Marie; Gallardo, Inmaculada C Álvarez; Gifford, Wendy; Laferrière, Lucie; Rahman, Prinon; Loew, Laurianne; Angelis, Gino De; Cavallo, Sabrina; Shallwani, Shirin Mehdi; Aburub, Ala'; Bennell, Kim L; Van der Esch, Martin; Simic, Milena; McConnell, Sara; Harmer, Alison; Kenny, Glen P; Paterson, Gail; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; McLean, Linda

2017-05-01

To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

Rules and tools that improved vaccines for children vaccine-ordering practices in Oregon: a 2010 pilot project.

PubMed

Hewett, Rafe; VanCuren, Anne; Trocio, Loralee; Beaudrault, Sara; Gund, Anona; Luther, Mimi; Groom, Holly

2013-01-01

This project's objective was to enhance efforts to improve vaccine-ordering efficiencies among targeted clinics using publicly purchased vaccines. Using an assessment of ordering behavior developed by the Centers for Disease Control and Prevention, we selected and trained immunization providers and assessed improvements in ordering behavior by comparing ordering patterns before and after the intervention. A total of 144 Vaccines for Children program providers in Oregon. We assessed 144 providers trained in the Economic Order Quantity process between January and November 2010. INTERVENTION (IF APPLICABLE): Providers were invited to participate in regional trainings. Trainings included assignment of ordering frequency and dissemination of tools to support adherence to the recommended ordering frequency. The percent increase in targeted clinics ordering according to recommended order frequency and the resulting decrease in orders placed, as an outcome of training and ordering tools. Only 35% of targeted providers were ordering according to the recommended ordering frequency before the project began. After completing training, utilizing ordering tools and ordering over a 7-month period, 78% of the targeted clinics were ordering according to the recommended frequency, a 120% increase in the number of clinics ordering with the recommended frequency. At baseline, targeted clinics placed 915 total vaccine orders over a 7-month period. After completing training and participating in the Economic Order Quantity process, only 645 orders were placed, a reduction of 30% . The initiative was successful in reducing the number of orders placed by Vaccines for Children providers in Oregon. A previous effort to reduce ordering, without the use of training or tools, did not achieve the same levels of provider compliance, suggesting that the addition of staff and development of tools were helpful in supporting behavior change and improving providers' ability to adhere to assigned order frequencies. Reducing order frequency results in more efficient vaccine ordering patterns and benefits vaccine distributors, Oregon Immunization Program staff, and provider staff.

Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report.

PubMed

Chang, Anne B; Oppenheimer, John J; Weinberger, Miles M; Rubin, Bruce K; Grant, Cameron C; Weir, Kelly; Irwin, Richard S

2017-04-01

Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged ≤ 14 years) based on two key questions: (1) how effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? and (2) when should children be referred for further investigations? We used the CHEST expert cough panel's protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus for the recommendations/suggestions made. Combining data from the systematic reviews, we found high-quality evidence in children aged ≤ 14 years with chronic (> 4 weeks' duration) wet/productive cough that using appropriate antibiotics improves cough resolution, and further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be undertaken when specific cough pointers (eg, digital clubbing) are present. When the wet cough does not improve following 4 weeks of antibiotic treatment, there is moderate-quality evidence that further investigations should be considered to look for an underlying disease. New recommendations include the recognition of the clinical diagnostic entity of protracted bacterial bronchitis. Compared with the 2006 Cough Guidelines, there is now high-quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies (particularly in primary health) are required. Copyright © 2017 American College of Chest Physicians. All rights reserved.

Characteristics, Classification, and Prevention of Child Maltreatment Fatalities.

PubMed

McCarroll, James E; Fisher, Joscelyn E; Cozza, Stephen J; Robichaux, Renè J; Fullerton, Carol S

2017-01-01

Preventing child maltreatment fatalities is a critical goal of the U.S. society and the military services. Fatality review boards further this goal through the analysis of circumstances of child deaths, making recommendations for improvements in practices and policies, and promoting increased cooperation among the many systems that serve families. The purpose of this article is to review types of child maltreatment death, proposed classification models, risk and protective factors, and prevention strategies. This review is based on scientific and medical literature, national reports and surveys, and reports of fatality review boards. Children can be killed soon after birth or when older through a variety of circumstances, such as with the suicide of the perpetrator, or when the perpetrator kills the entire family. Death through child neglect may be the most difficult type of maltreatment death to identify as neglect can be a matter of opinion or societal convention. These deaths can occur as a result of infant abandonment, starvation, medical neglect, drowning, home fires, being left alone in cars, and firearms. Models of classification for child maltreatment deaths can permit definition and understanding of child fatalities by providing reference points that facilitate research and enhance clinical prediction. Two separate approaches have been proposed: the motives of the perpetrator and the circumstances of death of the child victim. The latter approach is broader and is founded on an ecological model focused on the nature and circumstances of death, child victim characteristics, perpetrator characteristics, family and environmental circumstances, and service provision and need. Many risk factors for maternal and paternal filicide have been found, but most often included are young maternal age, no prenatal care, low education level, mental health problems, family violence, and substance abuse. Many protective factors can be specified at the individual, family, and community level. Early interventions for children and families are facilitated by the increased awareness of service providers who understand the risk and protective factors for intentional and unintentional child death. There is currently no roadmap for the prevention of child maltreatment death, but increased awareness and improved fatality review are essential to improving policies and practices. Prevention strategies include improving fatality review recommendations, using psychological autopsies, serious case reviews, and conducting research. We recommend a public health approach to prevention, which includes a high level of collaboration between agencies, particularly between the military and civilian. The adoption of a public health model can promote better prevention strategies at individual, family, community, and societal levels to address and improve practices, policies, and public attitudes and beliefs about child maltreatment. The process of making recommendations on the basis of fatality review is important in terms of whether they will be taken seriously. Recommendations that are too numerous, impractical, expensive, lack relevance, and are out of step with social norms are unlikely to be implemented. They can be helpful if they are limited, focused, lead to definitive action, and include ways of measuring compliance. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

PubMed Central

Smolen, Josef S; Breedveld, Ferdinand C; Burmester, Gerd R; Bykerk, Vivian; Dougados, Maxime; Emery, Paul; Kvien, Tore K; Navarro-Compán, M Victoria; Oliver, Susan; Schoels, Monika; Scholte-Voshaar, Marieke; Stamm, Tanja; Stoffer, Michaela; Takeuchi, Tsutomu; Aletaha, Daniel; Andreu, Jose Louis; Aringer, Martin; Bergman, Martin; Betteridge, Neil; Bijlsma, Hans; Burkhardt, Harald; Combe, Bernard; Durez, Patrick; Fonseca, Joao Eurico; Gibofsky, Alan; Gomez-Reino, Juan J; Graninger, Winfried; Hannonen, Pekka; Haraoui, Boulos; Kouloumas, Marios; Landewe, Robert; Martin-Mola, Emilio; Nash, Peter; Ostergaard, Mikkel; Östör, Andrew; Richards, Pam; Sokka-Isler, Tuulikki; Thorne, Carter; Tzioufas, Athanasios G; van Vollenhoven, Ronald; de Wit, Martinus

2016-01-01

Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA. PMID:25969430

Demonstration of the Health Literacy Universal Precautions Toolkit: Lessons for Quality Improvement.

PubMed

Mabachi, Natabhona M; Cifuentes, Maribel; Barnard, Juliana; Brega, Angela G; Albright, Karen; Weiss, Barry D; Brach, Cindy; West, David

2016-01-01

The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements.

Enhanced Analysis of Falling Weight Deflectometer Data for Use With Mechanistic-Empirical Flexible Pavement Design and Analysis and Recommendations for Improvements to Falling Weight Deflectometers

DOT National Transportation Integrated Search

2017-03-01

This report describes the efforts undertaken to review the status of falling weight deflectometer (FWD) equipment, data collection, analysis, and interpretation, including dynamic backcalculation, as they relate to the models and procedures incorpora...

Educational Hegemony, Traumatic Stress, and African American and Latino American Students

ERIC Educational Resources Information Center

Goodman, Rachael D.; West-Olatunji, Cirecie A.

2010-01-01

The authors use traumatic stress theory to develop an ecosystemic understanding of hegemony and systemic barriers to educational success for culturally diverse students. Scholarship on trauma and systemic oppression are applied to students' academic experiences, and recommendations for improving educational outcomes include assessing for and…

An Integrative Conceptual Framework of Disability: New Directions for Research.

ERIC Educational Resources Information Center

Tate, Denise G.; Pledger, Constance

2003-01-01

Examines various disability paradigms across time, assessing the relative contribution of the socioecological perspective in guiding research designed to improve the lives of people with disabilities. Recommends new research directions that include a focus on life span issues, biomedicine, biotechnology, the efficacy and effectiveness of current…

Recommendations for improved assessment of noise impacts on wildlife

Treesearch

Larry L. Pater; Teryl G. Grubb; David K. Delaney

2009-01-01

Research to determine noise impacts on animals benefits from methodology that adequately describes the acoustical stimulus as well as the resulting biological responses. We present acoustical considerations and research techniques that we have found to be useful. These include acoustical definitions and noise measurement techniques that conform to standardized...

Development and Strengthening of Agricultural Education in St. Lucia. A Report.

ERIC Educational Resources Information Center

Meaders, O. Donald

A study examined present agricultural education programs in Saint Lucia and made recommendations for needed improvements. Data for the evauation were obtained from numerous documents and publications, field trips, and discussions with key officials in various ministries and institutions, including the Ministry of Agriculture, Ministry of…

The Words in My Pencil: Considering Children's Writing.

ERIC Educational Resources Information Center

Martin, Anne

Methods of eliciting writing from children are explored in this monograph, which includes samples of nine- and ten-year-old students' writing. The monograph offers four recommendations for improving writing skills: make writing a daily activity; take children's writing seriously; maintain flexible standards of form and language; and identify group…

Content Appraisal as a Method for Measuring the Effectiveness & Usability of Online Content

ERIC Educational Resources Information Center

Nadeau, Jenifer; Heidorn, Neely; Broady, Nick; Whittle, Jennifer

2012-01-01

Content appraisal is a simple, qualitative system to identify modifications to make website material more useful to clientele. This system provides a comprehensive evaluation of content, focuses on content strategy, identifies weaknesses, and provides recommendations for improvement. The criteria examined included knowledge level,…

The Use of Office Automation by Managers: A Survey.

ERIC Educational Resources Information Center

Fleischer, Mitchell; Morell, Jonathan A.

1988-01-01

Describes a survey that examined office automation use by managers and the impact on managerial roles. The factors discussed include the impact on decision making, changes in work activities, sources of support, training, and different uses between managerial ranks. Recommendations are offered for improving use of office automation. (13…

78 FR 66326 - Hazardous Materials: Rail Petitions and Recommendations To Improve the Safety of Railroad Tank...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

...., Monday through Friday, except Federal Holidays. Instructions: All submissions must include the agency... recent government shutdown prevented communication with DOT staff for review of the technical proposals... written communications and comments received into any of our dockets by the name of the individual...

Development and Strengthening of Agricultural Education in St. Vincent. A Report.

ERIC Educational Resources Information Center

Meaders, O. Donald

A study examined present agricultural education programs in Saint Vincent and made recommendations for needed improvements. Data for the evaluation were obtained from numerous documents and publications, field trips, and discussions with key officials in various ministries and institutions, including the Ministry of Agriculture, Ministry of…

Academic Day Camp.

ERIC Educational Resources Information Center

Akron Public Schools, OH.

This report of an academic day camp program for disadvantaged inner-city children includes a description of the program as well as an evaluation based on staff recommendations and standardized test scores. The program provides an all-day experience with an individualized approach to improvement in reading and mathematics skills; in the afternoon,…

The CEIC Review, 2001. A Catalyst for Merging Research, Policy, and Practice.

ERIC Educational Resources Information Center

Hartman, Bonnie, Ed.; Rohland, Mark, Ed.

2001-01-01

These three volumes contain articles related to (1) improving educational productivity (lessons from economics); (2) school-to-work (STW); and (3) reduced class size, offering recommendations from national invitational conferences. Topics include making schools work; tax revolts and school performance; market pressure and the impact on…

Development and Strengthening of Agricultural Education in Grenada. A Report.

ERIC Educational Resources Information Center

Meaders, O. Donald

A study examined present agricultural education programs in Grenada and made recommendations for needed improvements. Data for the evaluation were obtained from numerous documents and publications, field trips, and discussions with key officials in various ministries and institutions, including the Ministry of Agriculture, Ministry of Education,…

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.

Methodological standards in single-case experimental design: Raising the bar.

PubMed

Ganz, Jennifer B; Ayres, Kevin M

2018-04-12

Single-case experimental designs (SCEDs), or small-n experimental research, are frequently implemented to assess approaches to improving outcomes for people with disabilities, particularly those with low-incidence disabilities, such as some developmental disabilities. SCED has become increasingly accepted as a research design. As this literature base is needed to determine what interventions are evidence-based practices, the acceptance of SCED has resulted in increased critiques with regard to methodological quality. Recent trends include recommendations from a number of expert scholars and institutions. The purpose of this article is to summarize the recent history of methodological quality considerations, synthesize the recommendations found in the SCED literature, and provide recommendations to researchers designing SCEDs with regard to essential and aspirational standards for methodological quality. Conclusions include imploring SCED to increase the quality of their experiments, with particular consideration regarding the applied nature of SCED research to be published in Research in Developmental Disabilities and beyond. Copyright © 2018 Elsevier Ltd. All rights reserved.

Leveraging Multiactions to Improve Medical Personalized Ranking for Collaborative Filtering.

PubMed

Gao, Shan; Guo, Guibing; Li, Runzhi; Wang, Zongmin

2017-01-01

Nowadays, providing high-quality recommendation services to users is an essential component in web applications, including shopping, making friends, and healthcare. This can be regarded either as a problem of estimating users' preference by exploiting explicit feedbacks (numerical ratings), or as a problem of collaborative ranking with implicit feedback (e.g., purchases, views, and clicks). Previous works for solving this issue include pointwise regression methods and pairwise ranking methods. The emerging healthcare websites and online medical databases impose a new challenge for medical service recommendation. In this paper, we develop a model, MBPR (Medical Bayesian Personalized Ranking over multiple users' actions), based on the simple observation that users tend to assign higher ranks to some kind of healthcare services that are meanwhile preferred in users' other actions. Experimental results on the real-world datasets demonstrate that MBPR achieves more accurate recommendations than several state-of-the-art methods and shows its generality and scalability via experiments on the datasets from one mobile shopping app.

Leveraging Multiactions to Improve Medical Personalized Ranking for Collaborative Filtering

PubMed Central

2017-01-01

Nowadays, providing high-quality recommendation services to users is an essential component in web applications, including shopping, making friends, and healthcare. This can be regarded either as a problem of estimating users' preference by exploiting explicit feedbacks (numerical ratings), or as a problem of collaborative ranking with implicit feedback (e.g., purchases, views, and clicks). Previous works for solving this issue include pointwise regression methods and pairwise ranking methods. The emerging healthcare websites and online medical databases impose a new challenge for medical service recommendation. In this paper, we develop a model, MBPR (Medical Bayesian Personalized Ranking over multiple users' actions), based on the simple observation that users tend to assign higher ranks to some kind of healthcare services that are meanwhile preferred in users' other actions. Experimental results on the real-world datasets demonstrate that MBPR achieves more accurate recommendations than several state-of-the-art methods and shows its generality and scalability via experiments on the datasets from one mobile shopping app. PMID:29118963

Incorporating Exercise Into the Cancer Treatment Paradigm.

PubMed

Haas, Barbara K; Hermanns, Melinda; Kimmel, Gary

2016-12-01

The benefits of exercise for patients with cancer are well documented. However, exercise is still not a standard of care for this population. Several factors contribute to the lack of exercise prescriptions for patients with cancer, including challenges posed by treatment-related side effects, lack of knowledge among healthcare providers and the laypeople, and inadequate resources. This article reviews the benefits of exercise in general and specifically to patients with cancer, discusses the specific challenges and considerations required in recommending exercise to this population, and provides specific recommendations for healthcare providers to incorporate exercise into treatment plans. Using a case study exemplar, this article discusses the benefits and challenges to exercise while undergoing treatment for cancer and proposes specific solutions and recommendations. Oncology practitioners can provide the opportunity for patients to safely engage in exercise with the appropriate resources and trained personnel using a successful model of delivering exercise to patients undergoing treatment for cancer. Exercise improves quality of life in all patients, including those with advanced-stage cancers and those actively receiving treatment.

Situation, Background, Assessment, and Recommendation-Guided Huddles Improve Communication and Teamwork in the Emergency Department.

PubMed

Martin, Heather A; Ciurzynski, Susan M

2015-11-01

Thousands of people die annually in hospitals because of poor communication and teamwork between health care team members. Standardized tools and strategies help increase the amount and quality of communication. Two structured communication methods include implementing huddles and the use of the situation, background, assessment, and recommendation (SBAR) communication framework. To improve communication among nurse practitioners and registered nurses within a pediatric emergency department, a performance-improvement project with the structured processes of a joint patient evaluation and huddle was implemented. Data were gathered from 32 nurses and 2 nurse practitioners using structured observation and pre- and post-implementation surveys. The following outcomes were measured: presence or absence of joint patient evaluation and SBAR-guided huddle, verbalization of treatment plan, communication, teamwork, and nurse satisfaction. Eighty-three percent of patient encounters included a joint evaluation. A huddle structured with SBAR was conducted 86% of the time. Registered nurses and nurse practitioners verbalized patients' treatment plans in 89% of cases and 97% of cases, respectively. Improved teamwork, communication, and nursing satisfaction scores were demonstrated among the nurse practitioners and registered nurses. This project showed the feasibility of a simple and inexpensive joint nurse practitioner-registered nurse patient evaluation followed by a structured huddle, which improved communication, teamwork, and nurse satisfaction scores. This performance-improvement project has the potential to enhance efficiency by reducing redundancy, as well as to improve patient safety through the use of structured communication techniques. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Does a Simple Intervention Enhance Memory and Adherence for Neuropsychological Recommendations?

PubMed

Meth, Molly; Calamia, Matthew; Tranel, Daniel

2016-01-01

The variables that influence the extent to which patients and their families remember and follow neuropsychological recommendations after their appointments are unclear. There has been limited research on this topic. The current study was designed to address this knowledge gap. Patients (n = 79) and caregivers (n = 36) were randomized into 1 of 2 groups, letter or no-letter, to investigate whether providing a supplemental written reminder of the recommendations given (in addition to routine feedback procedures in our clinic) would improve memory for and adherence to recommendations. We found that recall of recommendations was better in the letter condition, although this effect was observed in the caregivers and not in the patients. Adherence to recommendations did not differ significantly between the letter and no-letter conditions. These findings show that a simple intervention can improve caregiver memory for recommendations. Future research could help determine how to translate improvements in memory into greater adherence.

Stakeholder Buy-In and Physician Education Improve Adherence to Guidelines for Down Syndrome.

PubMed

Santoro, Stephanie L; Martin, Lisa J; Pleatman, Stephen I; Hopkin, Robert J

2016-04-01

To assess adherence to the 2011 American Academy of Pediatrics (AAP) health supervision guidelines for Down syndrome, to determine whether pediatrician education improves adherence, and to evaluate stakeholder attitudes toward these guidelines. Twenty-two pediatric care sites participated in chart review of adherence to the components of the AAP guidelines for Down syndrome in this longitudinal cohort study. We analyzed universal recommendations which apply to all children with Down syndrome. Thirteen pediatric practices caring for 82 patients with Down syndrome received educational information. Frequency calculations with Bonferroni adjustment of the P value threshold (P = .05/9 = .0056) were performed. Adherence rates were compared between cohorts and within the individual before and after intervention using 2 × 2 contingency tables and goodness-of-fit tests. Pediatricians and parents of children with Down syndrome completed an anonymous survey regarding their attitudes toward the guidelines. Statistically significant increases in adherence were seen in 5 of the 8 universal recommendations following pediatrician education (P ≤ .002), including cardiology and genetics visits, rates of echocardiography, annual audiology testing, and sleep studies by age 4 years. Both physicians and parents reported generally positive views of the guidelines, yet baseline adherence rates were suboptimal. Pediatrician education preferences include directly integrating the guidelines into an electronic medical record system. Stakeholder attitudes reflect a willingness to follow the AAP guidelines for Down syndrome. Providing rapid access to simple, clear reminders of recommended assessments successfully improved adherence to the AAP guidelines for Down syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving the Care of Individuals with Schizophrenia and Substance Use Disorders: Consensus Recommendations

PubMed Central

ZIEDONIS, DOUGLAS M.; SMELSON, DAVID; ROSENTHAL, RICHARD N.; BATKI, STEVEN L.; GREEN, ALAN I.; HENRY, RENATA J.; MONTOYA, IVAN; PARKS, JOE; D. WEISS, ROGER

2008-01-01

National attention continues to focus on the need to improve care for individuals with co-occurring mental illnesses and substance use disorders, as emphasized in the 2003 President's New Freedom Commission Report on Mental Health and recent publications from the Substance Abuse and Mental Health Services Administration (SAMHSA). These reports document the need for best practice recommendations that can be translated into routine clinical care. Although efforts are underway to synthesize literature in this area, few focused recommendations are available that include expert opinion and evidence-based findings on the management of specific co-occurring disorders, such as schizophrenia and addiction. In response to the need for user-friendly recommendations on the treatment of schizophrenia and addiction, a consensus conference of experts from academic institutions and state mental health systems was organized to 1) frame the problem from clinical and systems-level perspectives; 2) identify effective and problematic psychosocial, pharmacological, and systems practices; and 3) develop a summary publication with recommendations for improving current practice. The results of the consensus meeting served as the foundation for this publication, which presents a broad set of recommendations for clinicians who treat individuals with schizophrenia. “Integrated treatment” is the new standard for evidence-based treatment for this population and recommendations are given to help clinicians implement such integrated treatment. Specific recommendations are provided concerning screening for substance use disorders in patients with schizophrenia, assessing motivation for change, managing medical conditions that commonly occur in patients with dual diagnoses (e.g., cardiovascular disease, liver complications, lung cancer, HIV, and hepatitis B or C infections) and selecting the most appropriate medications for such patients to maximize safety and minimize drug interactions, use of evidence-based psychosocial interventions for patients with dual diagnoses (e.g., Dual Recovery Therapy, modified cognitive-behavioral therapy, modified motivational enhancement therapy, and the Substance Abuse Management Module), and key pharmacotherapy principles for treating schizophrenia, substance use disorders, and comorbid anxiety, depression, and sleep problems in this population. Finally the article reviews programmatic and systemic changes needed to overcome treatment barriers and promote the best outcomes for this patient population. An algorithm summarizing the consensus recommendations is provided in an appendix to the article. PMID:16184072

Improving information filtering via network manipulation

NASA Astrophysics Data System (ADS)

Zhang, Fuguo; Zeng, An

2012-12-01

The recommender system is a very promising way to address the problem of overabundant information for online users. Although the information filtering for the online commercial systems has received much attention recently, almost all of the previous works are dedicated to design new algorithms and consider the user-item bipartite networks as given and constant information. However, many problems for recommender systems such as the cold-start problem (i.e., low recommendation accuracy for the small-degree items) are actually due to the limitation of the underlying user-item bipartite networks. In this letter, we propose a strategy to enhance the performance of the already existing recommendation algorithms by directly manipulating the user-item bipartite networks, namely adding some virtual connections to the networks. Numerical analyses on two benchmark data sets, MovieLens and Netflix, show that our method can remarkably improves the recommendation performance. Specifically, it not only improves the recommendations accuracy (especially for the small-degree items), but also helps the recommender systems generate more diverse and novel recommendations.

Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation.

PubMed

Plagge, Jane M; Lu, Mary W; Lovejoy, Travis I; Karl, Andrea I; Dobscha, Steven K

2013-08-01

We explore preliminary clinical effectiveness and feasibility of an intervention utilizing collaborative care components and behavioral activation (BA) to treat comorbid chronic pain and posttraumatic stress disorder (PTSD). Descriptive, including pre- and posttreatment assessment results. Portland Veterans Affairs Medical Center. Fifty-eight Iraq and Afghanistan veterans with chronic pain and PTSD symptoms. Veterans participated in a biopsychosocial evaluation and up to eight BA sessions using a collaborative approach involving primary care, mental health, and other clinicians. A physiatrist assisted the psychologist in providing recommendations to primary care providers. Participants were administered pre- and posttreatment measures of PTSD, pain severity, pain interference, mental health, quality of life, satisfaction, and global ratings of change with the purpose of assessing progress and improving quality. Of the 58 participants, 30 completed treatment. Common recommendations included physical therapy and exercise programs, pain medication or pain medication adjustments, and additional diagnostic workups, such as imaging. Participants who completed the program showed significant improvements on measures of PTSD, pain severity, and pain interference. Improvements were also evident on measures of mental health and quality of life. Overall, participants were satisfied with the program, and on average reported feeling "somewhat better." These findings suggest that a collaborative approach that includes BA is feasible and a potentially effective treatment for comorbid chronic pain and PTSD. Wiley Periodicals, Inc.

Quality of care after acute coronary syndromes in a prospective cohort with reasons for non-prescription of recommended medications.

PubMed

Auer, Reto; Gencer, Baris; Räber, Lorenz; Klingenberg, Roland; Carballo, Sebastian; Carballo, David; Nanchen, David; Cornuz, Jacques; Vader, John-Paul; Vogt, Pierre; Jüni, Peter; Matter, Christian M; Windecker, Stephan; Lüscher, Thomas Felix; Mach, François; Rodondi, Nicolas

2014-01-01

Adherence to guidelines is associated with improved outcomes of patients with acute coronary syndrome (ACS). Clinical registries developed to assess quality of care at discharge often do not collect the reasons for non-prescription for proven efficacious preventive medication in Continental Europe. In a prospective cohort of patients hospitalized for an ACS, we aimed at measuring the rate of recommended treatment at discharge, using pre-specified quality indicators recommended in cardiologic guidelines and including systematic collection of reasons for non-prescription for preventive medications. In a prospective cohort with 1260 patients hospitalized for ACS, we measured the rate of recommended treatment at discharge in 4 academic centers in Switzerland. Performance measures for medication at discharge were pre-specified according to guidelines, systematically collected for all patients and included in a centralized database. Six hundred and eighty eight patients(54.6%) were discharged with a main diagnosis of STEMI, 491(39%) of NSTEMI and 81(6.4%) of unstable angina. Mean age was 64 years and 21.3% were women. 94.6% were prescribed angiotensin converting enzyme inhibitors/angiotensin II receptor blockers at discharge when only considering raw prescription rates, but increased to 99.5% when including reasons non-prescription. For statins, rates increased from 98% to 98.6% when including reasons for non-prescription and for beta-blockers, from 82% to 93%. For aspirin, rates further increased from 99.4% to 100% and from to 99.8% to 100% for P2Y12 inhibitors. We found a very high adherence to ACS guidelines for drug prescriptions at discharge when including reasons for non-prescription to drug therapy. For beta-blockers, prescription rates were suboptimal, even after taking into account reason for non-prescription. In an era of improving quality of care to achieve 100% prescription rates at discharge unless contra-indicated, pre-specification of reasons for non-prescription for cardiovascular preventive medication permits to identify remaining gaps in quality of care at discharge. ClinicalTrials.gov NCT01000701.

Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East.

PubMed

Al Sayed, Nasreen; Al Waili, Khalid; Alawadi, Fatheya; Al-Ghamdi, Saeed; Al Mahmeed, Wael; Al-Nouri, Fahad; Al Rukhaimi, Mona; Al-Rasadi, Khalid; Awan, Zuhier; Farghaly, Mohamed; Hassanein, Mohamed; Sabbour, Hani; Zubaid, Mohammad; Barter, Philip

2016-12-15

Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Behavioral interventions to improve infection control practices.

PubMed

Kretzer, E K; Larson, E L

1998-06-01

No single intervention has been successful in improving and sustaining such infection control practices as universal precautions and handwashing by health care professionals. This paper examines several behavioral theories (Health Belief Model, Theory of Reasoned Action and Theory of Planned Behavior, self-efficacy, and the Transtheoretic Model) and relates them to individual factors, also considering interpersonal and organizational factors. Further, this article includes recommendations of individual and organizational components to be addressed when planning a theoretically based intervention for improving infection control practices. A hypothetic framework to enhance handwashing practice is proposed.

Factors affecting use of word-of-mouth by dental patients.

PubMed

Jung, Yun-Sook; Yang, Hae-Young; Choi, Youn-Hee; Kim, Eun-Kyong; Jeong, Seong-Hwa; Cho, Min-Jeong; Nam, Soon-Hyeun; Song, Keun-Bae

2018-03-23

Word-of-mouth (WOM) refers to communication among consumers, which greatly influences the marketing strategies of dental clinics. This study aimed to explore factors that affect use of WOM by dental patients and to analyse their pathways. The participants were 520 outpatients from four private dental clinics. Data were obtained from a survey using self-reported questionnaires, which included questions regarding seven latent variables: five exogenous variables, including medical service quality (physical environment, customer service, patient relationship quality) and individual characteristic variables (opinion leader tendency, social hub tendency); and two endogenous variables (intention to recommend, WOM experience). Statistical analysis was performed using structural equation modelling. Significant associations were found in the pathways between relationship quality and intention to recommend, intention to recommend and WOM, and opinion leader tendency and WOM (P < 0.001). Higher patient relationship quality and higher intention to recommend were related to positive WOM, as was higher opinion leader tendency. Improving patient relationship quality can promote positive WOM for dental clinics. Strategies are needed to promote a positive perception of dental clinics by effectively responding to the views of patients with strong opinion leader tendencies. © 2018 FDI World Dental Federation.

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations.

PubMed

Storr, Julie; Twyman, Anthony; Zingg, Walter; Damani, Nizam; Kilpatrick, Claire; Reilly, Jacqui; Price, Lesley; Egger, Matthias; Grayson, M Lindsay; Kelley, Edward; Allegranzi, Benedetta

2017-01-01

Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

Best practices in peri-operative management of patients with skeletal dysplasias.

PubMed

White, Klane K; Bompadre, Viviana; Goldberg, Michael J; Bober, Michael B; Cho, Tae-Joon; Hoover-Fong, Julie E; Irving, Melita; Mackenzie, William G; Kamps, Shawn E; Raggio, Cathleen; Redding, Gregory J; Spencer, Samantha S; Savarirayan, Ravi; Theroux, Mary C

2017-10-01

Patients with skeletal dysplasia frequently require surgery. This patient population has an increased risk for peri-operative complications related to the anatomy of their upper airway, abnormalities of tracheal-bronchial morphology and function; deformity of their chest wall; abnormal mobility of their upper cervical spine; and associated issues with general health and body habitus. Utilizing evidence analysis and expert opinion, this study aims to describe best practices regarding the peri-operative management of patients with skeletal dysplasia. A panel of 13 multidisciplinary international experts participated in a Delphi process that included a thorough literature review; a list of 22 possible care recommendations; two rounds of anonymous voting; and a face to face meeting. Those recommendations with more than 80% agreement were considered as consensual. Consensus was reached to support 19 recommendations for best pre-operative management of patients with skeletal dysplasia. These recommendations include pre-operative pulmonary, polysomnography; cardiac, and neurological evaluations; imaging of the cervical spine; and anesthetic management of patients with a difficult airway for intubation and extubation. The goals of this consensus based best practice guideline are to provide a minimum of standardized care, reduce perioperative complications, and improve clinical outcomes for patients with skeletal dysplasia. © 2017 Wiley Periodicals, Inc.

WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy-An Executive Summary.

PubMed

This article provides an executive summary of the recommendations from the Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy, published by the Wound, Ostomy and Continence Nurses Society (WOCN Society). It presents an overview of the process used to update and develop the guideline and lists specific recommendations from the guideline. We provide recommendations that include the following topics: stoma construction, preoperative education, stoma site marking, selection of an ostomy pouching system, postoperative education, postoperative management issues, follow-up care after discharge from the acute care setting, health-related quality of life, and stomal and peristomal complications. The intent of the guideline is to provide information that will assist healthcare providers to manage adult patients with ostomies, prevent or decrease complications, and improve patient outcomes. The full text of the published guideline, which includes available evidence supporting the recommendations and a complete reference list, is available in print and as a mobile application from the WOCN Society's online bookstore (http://www.wocn.org). Refer to Supplemental Digital Content 1 (available at: http://links.lww.com/JWOCN/A40) associated with this article for a complete reference list for the guideline.

Radiation Safety in Children With Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization From the Image Gently Alliance.

PubMed

Hill, Kevin D; Frush, Donald P; Han, B Kelly; Abbott, Brian G; Armstrong, Aimee K; DeKemp, Robert A; Glatz, Andrew C; Greenberg, S Bruce; Herbert, Alexander Sheldon; Justino, Henri; Mah, Douglas; Mahesh, Mahadevappa; Rigsby, Cynthia K; Slesnick, Timothy C; Strauss, Keith J; Trattner, Sigal; Viswanathan, Mohan N; Einstein, Andrew J

2017-07-01

There is a need for consensus recommendations for ionizing radiation dose optimization during multimodality medical imaging in children with congenital and acquired heart disease (CAHD). These children often have complex diseases and may be exposed to a relatively high cumulative burden of ionizing radiation from medical imaging procedures, including cardiac computed tomography, nuclear cardiology studies, and fluoroscopically guided diagnostic and interventional catheterization and electrophysiology procedures. Although these imaging procedures are all essential to the care of children with CAHD and have contributed to meaningfully improved outcomes in these patients, exposure to ionizing radiation is associated with potential risks, including an increased lifetime attributable risk of cancer. The goal of these recommendations is to encourage informed imaging to achieve appropriate study quality at the lowest achievable dose. Other strategies to improve care include a patient-centered approach to imaging, emphasizing education and informed decision making and programmatic approaches to ensure appropriate dose monitoring. Looking ahead, there is a need for standardization of dose metrics across imaging modalities, so as to encourage comparative effectiveness studies across the spectrum of CAHD in children. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

INCOG recommendations for management of cognition following traumatic brain injury, part II: attention and information processing speed.

PubMed

Ponsford, Jennie; Bayley, Mark; Wiseman-Hakes, Catherine; Togher, Leanne; Velikonja, Diana; McIntyre, Amanda; Janzen, Shannon; Tate, Robyn

2014-01-01

Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems. The experts selected recommendations from published guidelines and then reviewed literature to ensure that recommendations were current. Decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials were developed. The team then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to these best practices. The recommendations and discussion highlight that metacognitive strategy training focused on functional everyday activities is appropriate. Appropriate use of dual task training, environmental modifications, and cognitive behavioral therapy is also discussed. There is insufficient evidence to support mindfulness meditation and practice on de-contextualized computer-based tasks for attention. Administration of the medication methylphenidate should be considered to improve information-processing speed. The INCOG recommendations for rehabilitation of attention provide up-to-date guidance for clinicians treating people with traumatic brain injury.

Good Practices for Real-World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making.

PubMed

Berger, Marc L; Sox, Harold; Willke, Richard J; Brixner, Diana L; Eichler, Hans-Georg; Goettsch, Wim; Madigan, David; Makady, Amr; Schneeweiss, Sebastian; Tarricone, Rosanna; Wang, Shirley V; Watkins, John; Mullins, C Daniel

2017-09-01

Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders. Copyright © 2017. Published by Elsevier Inc.

Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology

PubMed Central

Buch, Maya H; Silva-Fernandez, Lucia; Carmona, Loreto; Aletaha, Daniel; Christensen, Robin; Combe, Bernard; Emery, Paul; Ferraccioli, Gianfranco; Guillemin, Francis; Kvien, Tore K; Landewe, Robert; Pavelka, Karel; Saag, Kenneth; Smolen, Josef S; Symmons, Deborah; van der Heijde, Désirée; Welling, Joep; Wells, George; Westhovens, Rene; Zink, Angela; Boers, Maarten

2015-01-01

Objectives Our initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports. Methods We formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A ‘0–10’ agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance. Results Seven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations. Conclusions This EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes. PMID:24827533

Inpatient management of children with severe acute malnutrition: a review of WHO guidelines

PubMed Central

Tickell, Kirkby D

2016-01-01

Abstract Objective To understand how the World Health Organization’s (WHO’s) guidelines on the inpatient care of children with complicated severe acute malnutrition may be strengthened to improve outcomes. Methods In December 2015, we searched Google scholar and WHO’s website for WHO recommendations on severe acute malnutrition management and evaluated the history and cited evidence behind these recommendations. We systematically searched WHO International Clinical Trials Registry Platform, clinicaltrials.gov and the Controlled Trials metaRegister until 10 August 2015 for recently completed, ongoing, or pending trials. Findings WHO’s guidelines provide 33 recommendations on the topic. However, 16 (48.5%) of these recommendations were based solely on expert opinion – unsupported by published evidence. Another 11 (33.3%) of the recommendations were supported by the results of directly relevant research – i.e. either randomized trials (8) or observational studies (3). The other six recommendations (18.2%) were based on studies that were not conducted among children with complicated severe malnutrition or studies of treatment that were not identical to the recommended intervention. Trials registries included 20 studies related to the topic, including nine trials of alternative feeding regimens. Acute medical management and follow-up care studies were minimally represented. Conclusion WHO’s guidelines on the topic have a weak evidence base and have undergone limited substantive adjustments over the past decades. More trials are needed to make that evidence base more robust. If the mortality associated with severe malnutrition is to be reduced, inpatient and post-discharge management trials, supported by studies on the causes of mortality, are needed. PMID:27708469

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments.

PubMed

Bakker, David; Kazantzis, Nikolaos; Rickwood, Debra; Rickard, Nikki

2016-03-01

The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

PubMed Central

Kazantzis, Nikolaos; Rickwood, Debra; Rickard, Nikki

2016-01-01

Background The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. Objective To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. Methods A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Results Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Conclusions Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems. PMID:26932350

[Immunisation schedule of the Spanish Association of Paediatrics: 2017 recommendations].

PubMed

Moreno-Pérez, David; Álvarez García, Francisco José; Arístegui Fernández, Javier; Cilleruelo Ortega, María José; Corretger Rauet, José María; García Sánchez, Nuria; Hernández Merino, Ángel; Hernández-Sampelayo Matos, Teresa; Merino Moína, Manuel; Ortigosa Del Castillo, Luis; Ruiz-Contreras, Jesús

2017-02-01

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV- AEP) annually publishes the immunisation schedule which, in our opinion, is considered optimal for children resident in Spain, taking into account the evidence available on current vaccines. Pneumococcal and varicella immunisation in early childhood is already included in all funded vaccines present in the regional immunisation programmes. Furthermore, this committee establishes recommendations on vaccines not included in official calendars (non-funded immunisations), such as rotavirus, meningococcal B, and meningococcal ACWY. As regards funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTaP-IPV-Hib-HB) and 13-valent pneumococcal vaccines is recommended. Administration of the 6-year booster dose with DTaP is recommended, as well as a poliomyelitis dose for children who had received the 2+1 scheme, with the Tdap vaccine for adolescents and pregnant women between 27 and 32 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 12 with a two-dose scheme (0, 6 months) should be improved. Information and recommendations for male adolescents about potential beneficial effects of the tetravalent HPV vaccine should also be provided. ACWY meningococcal vaccine is the optimal choice in adolescents. For recommended unfunded immunisations, the CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish community pharmacies, with a 3+1 scheme. CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

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

PubMed

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

2016-11-15

Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. A commentary on this article apears in this issue on page 1439. © 2016 American Academy of Sleep Medicine

Supportive and palliative care for metastatic breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

PubMed

Cleary, James; Ddungu, Henry; Distelhorst, Sandra R; Ripamonti, Carla; Rodin, Gary M; Bushnaq, Mohammad A; Clegg-Lamptey, Joe N; Connor, Stephen R; Diwani, Msemo B; Eniu, Alexandru; Harford, Joe B; Kumar, Suresh; Rajagopal, M R; Thompson, Beti; Gralow, Julie R; Anderson, Benjamin O

2013-10-01

Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available. The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care. The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Assessment and management of nutrition and growth in Rett syndrome

PubMed Central

Leonard, Helen; Ravikumara, Madhur; Baikie, Gordon; Naseem, Nusrat; Ellaway, Carolyn; Percy, Alan; Abraham, Suzanne; Geerts, Suzanne; Lane, Jane; Jones, Mary; Bathgate, Katherine; Downs, Jenny

2014-01-01

Objectives We developed recommendations for the clinical management of poor growth and weight gain in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. Methods Initial draft recommendations were created based upon literature review and 34 open-ended questions where the literature was lacking. Statements and questions were made available to an international, multi-disciplinary panel of clinicians in an online format and a Microsoft Word formatted version of the draft via email. Input was sought using a 2-stage modified Delphi process to reach consensus agreement. Items included clinical assessment of growth, anthropometry, feeding difficulties and management to increase caloric intake, decrease feeding difficulties and consideration of gastrostomy. Results Agreement was achieved on 101/112 statements. A comprehensive approach to the management of poor growth in Rett syndrome is recommended that takes into account factors such as feeding difficulties and nutritional needs. A BMI of approximately the 25th centile can be considered as a reasonable target in clinical practice. Gastrostomy is indicated for very poor growth, if there is risk of aspiration and if feeding times are prolonged. Conclusions These evidence- and consensus-based recommendations have the potential to improve care of nutrition and growth in a rare condition and stimulate research to improve the current limited evidence base. PMID:24084372

Improving Underrepresented Minority Student Persistence in STEM.

PubMed

Estrada, Mica; Burnett, Myra; Campbell, Andrew G; Campbell, Patricia B; Denetclaw, Wilfred F; Gutiérrez, Carlos G; Hurtado, Sylvia; John, Gilbert H; Matsui, John; McGee, Richard; Okpodu, Camellia Moses; Robinson, T Joan; Summers, Michael F; Werner-Washburne, Maggie; Zavala, MariaElena

2016-01-01

Members of the Joint Working Group on Improving Underrepresented Minorities (URMs) Persistence in Science, Technology, Engineering, and Mathematics (STEM)-convened by the National Institute of General Medical Sciences and the Howard Hughes Medical Institute-review current data and propose deliberation about why the academic "pathways" leak more for URM than white or Asian STEM students. They suggest expanding to include a stronger focus on the institutional barriers that need to be removed and the types of interventions that "lift" students' interests, commitment, and ability to persist in STEM fields. Using Kurt Lewin's planned approach to change, the committee describes five recommendations to increase URM persistence in STEM at the undergraduate level. These recommendations capitalize on known successes, recognize the need for accountability, and are framed to facilitate greater progress in the future. The impact of these recommendations rests upon enacting the first recommendation: to track successes and failures at the institutional level and collect data that help explain the existing trends. © 2016 M. Estrada et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Performance Audit of the U.S. Geological Survey, Energy Resource Program Inorganic Geochemistry Laboratory

USGS Publications Warehouse

Luppens, James A.; Janke, Louis G.; McCord, Jamey D.; Bullock, John H.; Brazeau, Lisa; Affronter, Ronald H.

2007-01-01

A performance audit of the U.S. Geological Survey (USGS), Energy Resource Program (ERP) Inorganic Geochemistry Laboratory (IGL) was conducted between August, 2003 and October, 2005. The goals were to ensure that a high level of analytical performance was maintained and identify any areas that could be enhanced. The audit was subdivided into three phases. Phase 1 was a preliminary assessment of current performance based on recent performance on CANSPEX samples. IGL performance was also compared to laboratories world-wide with similar scope. Phase 2 consisted of the implementation of the recommended changes made in Phase 1. Phase 3 of the audit consisted of a reassessment effort to evaluate the effectiveness of the recommendations made in the Phase 1 and an on-site audit of the laboratory facilities. Phases 1 and 3 required summary reports that are included in Appendices A and B of this report. The audit found that the IGL was one of the top two laboratories compared for trace element analyses. Several recommendations to enhance performance on major and minor elemental parameters were made and implemented. Demonstrated performance improvements as a result of the recommended changes were documented. Several initiatives to sustain the performance improvements gained from the audit have been implemented.

Benefits, barriers and opinions on multidisciplinary team meetings: a survey in Swedish cancer care.

PubMed

Rosell, Linn; Alexandersson, Nathalie; Hagberg, Oskar; Nilbert, Mef

2018-04-05

Case review and discussion at multidisciplinary team meetings (MDTMs) have evolved into standard practice in cancer care with the aim to provide evidence-based treatment recommendations. As a basis for work to optimize the MDTMs, we investigated participants' views on the meeting function, including perceived benefits and barriers. In a cross-sectional study design, 244 health professionals from south Sweden rated MDTM meeting structure and function, benefits from these meetings and barriers to reach a treatment recommendation. The top-ranked advantages from MDTMs were support for patient management and competence development. Low ratings applied to monitoring patients for clinical trial inclusion and structured work to improve the MDTM. Nurses and cancer care coordinators did less often than physicians report involvement in the case discussions. Major benefits from MDTM were reported to be more accurate treatment recommendations, multidisciplinary evaluation and adherence to clinical guidelines. Major barriers to a joint treatment recommendation were reported to be need for supplementary investigations and insufficient pathology reports. Health professionals' report multiple benefits from MDTMs, but also define areas for improvement, e.g. access to complete information and clarified roles for the different health professions. The emerging picture suggests that structures for regular MDTM evaluations and increased focus on patient-related perspectives should be developed and implemented.

Long-term effects of user preference-oriented recommendation method on the evolution of online system

NASA Astrophysics Data System (ADS)

Shi, Xiaoyu; Shang, Ming-Sheng; Luo, Xin; Khushnood, Abbas; Li, Jian

2017-02-01

As the explosion growth of Internet economy, recommender system has become an important technology to solve the problem of information overload. However, recommenders are not one-size-fits-all, different recommenders have different virtues, making them be suitable for different users. In this paper, we propose a novel personalized recommender based on user preferences, which allows multiple recommenders to exist in E-commerce system simultaneously. We find that output of a recommender to each user is quite different when using different recommenders, the recommendation accuracy can be significantly improved if each user is assigned with his/her optimal personalized recommender. Furthermore, different from previous works focusing on short-term effects on recommender, we also evaluate the long-term effect of the proposed method by modeling the evolution of mutual feedback between user and online system. Finally, compared with single recommender running on the online system, the proposed method can improve the accuracy of recommendation significantly and get better trade-offs between short- and long-term performances of recommendation.

Research priorities for gender nonconforming/transgender youth: gender identity development and biopsychosocial outcomes.

PubMed

Olson-Kennedy, Johanna; Cohen-Kettenis, Peggy T; Kreukels, Baudewijntje P C; Meyer-Bahlburg, Heino F L; Garofalo, Robert; Meyer, Walter; Rosenthal, Stephen M

2016-04-01

The review summarizes relevant research focused on prevalence and natural history of gender nonconforming/transgender youth, and outcomes of currently recommended clinical practice guidelines. This review identifies gaps in knowledge, and provides recommendations foci for future research. Increasing numbers of gender nonconforming youth are presenting for care. Clinically useful information for predicting individual psychosexual development pathways is lacking. Transgender youth are at high risk for poor medical and psychosocial outcomes. Longitudinal data examining the impact of early social transition and medical interventions are sparse. Existing tools to understand gender identity and quantify gender dysphoria need to be reconfigured to study a more diverse cohort of transgender individuals. Increasingly, biomedical data are beginning to change the trajectory of scientific investigation. Extensive research is needed to improve understanding of gender dysphoria, and transgender experience, particularly among youth. Recommendations include identification of predictors of persistence of gender dysphoria from childhood into adolescence, and a thorough investigation into the impact of interventions for transgender youth. Finally, examining the social environments of transgender youth is critical for the development of appropriate interventions necessary to improve the lives of transgender people.

Using the Journal Club to teach and assess competence in practice-based learning and improvement: a literature review and recommendation for implementation.

PubMed

Lee, Andrew G; Boldt, H Culver; Golnik, Karl C; Arnold, Anthony C; Oetting, Thomas A; Beaver, Hilary A; Olson, Richard J; Carter, Keith

2005-01-01

The traditional journal club has historically been used to teach residents about critically reading and reviewing the literature in order to improve patient care. The Accreditation Council for Graduate Medical Education competencies mandate requires that ophthalmology residency programs both teach and assess practice-based learning and improvement. A systematically conducted review of the literature regarding the use of the journal club in resident medical education was performed to define specific recommendations for implementation of a journal club tool. Selected best practices for a successful journal club were gleaned from the existing medical literature. These include the following: 1) the use of a structured review checklist, 2) explicit written learning objectives, and 3) a formalized meeting structure and process. The journal club might prove to be an excellent tool for the assessment of competencies like practice-based learning which may be difficult to assess by other means. Future study is necessary to determine if journal club can improve educational outcomes and promote lifelong competence in practice-based learning.

A new independent authority is needed to issue National Health Care guidelines.

PubMed

Keyhani, Salomeh; Kim, Azalea; Mann, Micah; Korenstein, Deborah

2011-02-01

Health experts emphasize that getting doctors to follow clinical guidelines can save both lives and money. Less attention has been paid to how the guidelines are developed and the variability in the recommendations they include. We examined the quality and content of screening guidelines as a proxy for guidelines in general and found that the source of the guidelines affects their quality. Guidelines with inconsistent recommendations are unlikely to serve patients or physicians well. The creation of an independent organization that would work with multiple stakeholders to develop guidelines holds the potential to improve their quality.

[Interpretation of 2018 guidelines for the early management of patients with acute ischemic stroke].

PubMed

Wang, Gang; Fang, Bangjiang; Yu, Xuezhong; Li, Zhijun

2018-04-01

In 2018, the American Heart Association/American Stroke Association (AHA/ASA) has developed the latest 2018 guidelines for the early management of patients with acute ischemic stroke (AIS), based on the latest evidences. The 2018 guidelines including recommendations on pre-hospital and in-hospital management treatment, has revised and add new recommendations from 2013 guideline. The major changes in 2018 guideline involve applications of brain imaging in early stage, intravenous thrombolysis and mechanical thrombectomy, et al. This review interprets the 2018 guidelines for clinicians to improve the clinical diagnosis, treatment and outcome of patients with AIS.

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

PubMed Central

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

2016-01-01

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

Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills: a systematic review.

PubMed

Lee, Tae Wha; Lee, Seon Heui; Kim, Hye Hyun; Kang, Soo Jin

2012-12-01

Systematic studies on the relationship between health literacy and health outcomes demonstrate that as health literacy declines, patients engage in fewer preventive health and self-care behaviors and have worse disease-related knowledge. The purpose of this study was to identify effective intervention strategies to improve health outcomes in patients with cardiovascular disease and low literacy skills. This study employs the following criteria recommended by Khan Kunz, Keijnen, and Antes (2003) for systematic review: framing question, identifying relevant literature, assessing quality of the literature, summarizing the evidence, and interpreting the finding. A total of 235 articles were reviewed by the research team, and 9 articles met inclusion criteria. Although nine studies were reviewed for their health outcomes, only six studies, which had a positive quality grade evaluation were used to recommend effective intervention strategies. Interventions were categorized into three groups: tailored counseling, self-monitoring, and periodic reminder. The main strategies used to improve health outcomes of low literacy patients included tailored counseling, improved provider-patient interactions, organizing information by patient preference, self-care algorithms, and self-directed learning. Specific strategies included written materials tailored to appropriate reading levels, materials using plain language, emphasizing key points with large font size, and using visual items such as icons or color codes. With evidence-driven strategies, health care professionals can use tailored interventions to provide better health education and counseling that meets patient needs and improves health outcomes. Copyright © 2012. Published by Elsevier B.V.

Increasing nursing treatment for pediatric procedural pain.

PubMed

Bice, April A; Gunther, Mary; Wyatt, Tami

2014-03-01

Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review.

PubMed

Chimen, M; Kennedy, A; Nirantharakumar, K; Pang, T T; Andrews, R; Narendran, P

2012-03-01

Physical activity improves well-being and reduces the risk of heart disease, cancer and type 2 diabetes mellitus in the general population. In individuals with established type 2 diabetes, physical activity improves glucose and lipid levels, reduces weight and improves insulin resistance. In type 1 diabetes mellitus, however, the benefits of physical activity are less clear. There is poor evidence for a beneficial effect of physical activity on glycaemic control and microvascular complications, and significant risk of harm through hypoglycaemia. Here we review the literature relating to physical activity and health in type 1 diabetes. We examine its effect on a number of outcomes, including glycaemic control, lipids, blood pressure, diabetic complications, well-being and overall mortality. We conclude that whilst there is sufficient evidence to recommend physical activity in the management of type 1 diabetes, it is still unclear as to what form, duration and intensity should be recommended and whether there is benefit for many of the outcomes examined.

Enhancing 'Whole-of-Government' Response to Biological Events in Korea: Able Response 2014.

PubMed

Tak, Sangwoo; Jareb, Anton; Choi, Suon; Sikes, Marvin; Choi, Yeon Hwa; Boo, Hyeong-Wook

2018-01-01

Since 2011, the Republic of Korea (ROK) and United States (U.S.) have been collaborating to conduct inter- and intra-governmental exercises to jointly respond to biological events in Korea. These exercises highlight U.S. interest in increasing its global biosurveillance capability and the ROK's interest in improving cooperation among ministries to respond to crises. With Able Response (AR) exercises, the ROK and U.S. have improved coordination among US and ROK government and defense agencies responding to potential bio-threats and identified additional areas on which to apply refinements in policies and practices. In 2014, the AR exercise employed a Biosurveillance Portal (BSP) to facilitate more effective communication among participating agencies and countries including Australia. In the present paper, we seek to provide a comprehensive assessment of the AR 2014 (AR14) exercise and make recommendations for future improvements. Incorporating a more realistic response in future scenarios by integrating a tactical response episode in the exercise is recommended.

Transformation of children's mental health services: the role of school mental health.

PubMed

Stephan, Sharon Hoover; Weist, Mark; Kataoka, Sheryl; Adelsheim, Steven; Mills, Carrie

2007-10-01

The New Freedom Commission has called for a transformation in the delivery of mental health services in this country. The commission's report and recommendations have highlighted the role of school mental health services in transforming mental health care for children and adolescents. This article examines the intersection of school mental health programs and the commission's recommendations in order to highlight the role of school mental health in the transformation of the child and adolescent mental health system. Schools are uniquely positioned to play a central role in improving access to child mental health services and in supporting mental health and wellness as well as academic functioning of youths. The New Freedom Commission report articulated several goals related to school mental health: reducing stigma, preventing suicide, improving screening and treating co-occurring disorders, and expanding school mental health programs. The authors suggest strategies for change, including demonstrating relevance to schools, developing consensus among stakeholders, enhancing community mental health-school connections, building quality assessment and improvement, and considering the organizational context of schools.

Enhancing ‘Whole-of-Government’ Response to Biological Events in Korea: Able Response 2014

PubMed Central

Tak, Sangwoo; Jareb, Anton; Choi, Suon; Sikes, Marvin; Choi, Yeon Hwa; Boo, Hyeong-wook

2018-01-01

Since 2011, the Republic of Korea (ROK) and United States (U.S.) have been collaborating to conduct inter- and intra-governmental exercises to jointly respond to biological events in Korea. These exercises highlight U.S. interest in increasing its global biosurveillance capability and the ROK’s interest in improving cooperation among ministries to respond to crises. With Able Response (AR) exercises, the ROK and U.S. have improved coordination among US and ROK government and defense agencies responding to potential bio-threats and identified additional areas on which to apply refinements in policies and practices. In 2014, the AR exercise employed a Biosurveillance Portal (BSP) to facilitate more effective communication among participating agencies and countries including Australia. In the present paper, we seek to provide a comprehensive assessment of the AR 2014 (AR14) exercise and make recommendations for future improvements. Incorporating a more realistic response in future scenarios by integrating a tactical response episode in the exercise is recommended. PMID:29503803

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery.

PubMed

Wei, A C; Devitt, K S; Wiebe, M; Bathe, O F; McLeod, R S; Urbach, D R

2014-04-01

Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery.

Outcomes of therapeutic TMD interventions on oral health related quality of life: A qualitative systematic review.

PubMed

Song, Yi Lin; Yap, Adrian U-Jin

2018-04-26

This systematic review aims to determine the impact of temporomandibular disorder (TMD) therapeutic interventions on patients' oral health related quality of life (OHRQoL) and to recommend approaches that improve QoL. A systematic search of the literature was performed between January 2007 and October 2017 to identify articles on TMD interventions and OHRQoL. Randomized controlled trials, and retrospective and prospective cohort studies that mentioned dedicated tools for measurement of OHRQoL changes in TMD patients after therapeutic interventions were included. Abstracts of studies that did not mention any form of measurement of OHRQoL in their treatment outcome were excluded. The initial screening yielded 171 articles. After evaluation of abstracts and full text articles, five articles fulfilled all selection criteria and were included. Most TMD treatment interventions seem to improve QoL to some extent, but no single treatment modality can be advocated as the sole approach to managing TMD. Psychotherapy, occlusal appliance therapy, arthrocentesis, and orthodontics/ orthognathic surgery (in subjects with severe malocclusion) appear to improve OHRQoL of TMD patients. Recommendation on the best TMD intervention for improving QoL could not be made due to the diverse TMD subtypes and non-disease specific OHRQoL instruments employed. More studies incorporating TMD-specific OHRQoL measures and targeting explicit TMD subtypes based on internationally accepted diagnostic criteria are warranted in this area of research.

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery

PubMed Central

Wei, A.C.; Devitt, K.S.; Wiebe, M.; Bathe, O.F.; McLeod, R.S.; Urbach, D.R.

2014-01-01

Background Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. Methods The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. Results The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Conclusions Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery. PMID:24764704

Re-examining health IT policy: what will it take to derive value from our investment?

PubMed

Riskin, Loren; Koppel, Ross; Riskin, Daniel

2015-03-01

Despite substantial investments in health information technology (HIT), the nation's goals of reducing cost and improving outcomes through HIT remain elusive. This period of transition, with new Office of National Coordinator for HIT leadership, upcoming Meaningful Use Stage III definitions, and increasing congressional oversight, is opportune to consider needed course corrections in HIT strategy. This article describes current problems and recommended changes in HIT policy, including approaches to usability, interoperability, and quality measurement. Recommendations refrain from interim measures, such as electronic health record adoption rates, and instead focus on measurable national value to benefit the economy, to reduce healthcare costs, and to improve clinical efficiency and care quality. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Media ratings for movies, music, video games, and television: a review of the research and recommendations for improvements.

PubMed

Gentile, Douglas A; Humphrey, Jeremy; Walsh, David A

2005-06-01

This article review is organized by studies that are relevant for testing the reliability and validity of ratings systems. Specifically, the interrater reliability, consistency, temporal stability, content validity, construct validity, and criterion validity of media ratings systems are reviewed. Data that are related to testing the "forbidden fruit" and "tainted fruit" hypotheses also are reviewed. Several changes are recommended to improve the ratings systems, including the creation of a universal ratings system that could be applied equally to all media. The research reviewed here can provide a guide for how to construct a reliable, valid, and more useful ratings system. This is important because the decisions that parents make regarding their children's media use can be only as good as the information to which the parents have access.

New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines with the 2014 National Lipid Association recommendations for patient-centered management of dyslipidemia.

PubMed

Adhyaru, Bhavin B; Jacobson, Terry A

2015-05-01

This review discusses the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and compares it with the 2014 National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia. The review discusses some of the distinctions between the guidelines, including how to determine a patient's atherosclerotic cardiovascular disease risk, the role of lipoprotein treatment targets, the importance of moderate- and high-intensity statin therapy, and the use of nonstatin therapy in light of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial. Copyright © 2015 Elsevier Inc. All rights reserved.

Final Report of the NASA Technology Readiness Assessment (TRA) Study Team

NASA Technical Reports Server (NTRS)

Hirshorn, Steven; Jefferies, Sharon

2016-01-01

The material in this report covers the results on the NASA-wide TRA team, who are responsible for ascertaining the full extent of issues and ambiguities pertaining to TRATRL and to provide recommendations for mitigation. The team worked for approximately 6 months to become knowledgeable on the current TRATRL process and guidance and to derive recommendations for improvement.The team reviewed the TRA processes of other government agencies (OGA), including international agencies, and found that while the high-level processes are similar, the NASA process has a greater level of detail. Finally, NASA’s HQ OCT continues to monitor the GAO’s efforts to produce a TRA Best Practices Guide, a draft of which was received in February 2016. This Guide could impact the recommendations of this report.

Variation in Treatment Recommendations for Dupuytren Disease.

PubMed

McMillan, Catherine; Yeung, Celine; Binhammer, Paul

2017-12-01

To examine agreement on Dupuytren disease (DD) treatment recommendations in an international sample of hand surgeons. A survey was developed to determine expertise in needle aponeurotomy, surgery, and collagenase injection to treat DD and to examine treatment recommendations for 16 case scenarios. Case scenarios were predeveloped using expert input. Each case represented a unique combination of 4 dichotomous variables including cord thickness, contracture severity, patient age, and joint involvement. Interrater reliability statistics were calculated and multinomial logistic regression modeling and analysis of variance were used to examine the impact of surgeon- and case-related variables on treatment recommendations. A total of 36 hand surgeons from 9 countries (mean experience, 17 years) participated. Average pairwise percent agreement and Krippendorff's alpha were 26% and .012, respectively. Predictors of a recommendation for surgery over multiple options were a total contracture of greater than 70°, a thick precentral cord, involvement of the metacarpophalangeal and proximal interphalangeal joints, and greater years in practice. A greater number of years in practice predicted recommendation for collagenase injection and the presence of a thick precentral cord predicted a recommendation for needle aponeurotomy. Little agreement exists on treatment recommendations for common presentations of DD in this sample. Further investigation into the sources of potential widespread discrepancies in the management of DD may improve the capacity to make evidence-based recommendations. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Evidence-based guidelines for supportive care of patients with Ebola virus disease.

PubMed

Lamontagne, François; Fowler, Robert A; Adhikari, Neill K; Murthy, Srinivas; Brett-Major, David M; Jacobs, Michael; Uyeki, Timothy M; Vallenas, Constanza; Norris, Susan L; Fischer, William A; Fletcher, Thomas E; Levine, Adam C; Reed, Paul; Bausch, Daniel G; Gove, Sandy; Hall, Andrew; Shepherd, Susan; Siemieniuk, Reed A; Lamah, Marie-Claude; Kamara, Rashida; Nakyeyune, Phiona; Soka, Moses J; Edwin, Ama; Hazzan, Afeez A; Jacob, Shevin T; Elkarsany, Mubarak Mustafa; Adachi, Takuya; Benhadj, Lynda; Clément, Christophe; Crozier, Ian; Garcia, Armando; Hoffman, Steven J; Guyatt, Gordon H

2018-02-17

The 2013-16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients' reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief. Copyright © 2018 Elsevier Ltd. All rights reserved.

Environmental perceptions and objective walking trail audits inform a community-based participatory research walking intervention

PubMed Central

2012-01-01

Background Given the documented physical activity disparities that exist among low-income minority communities and the increased focused on socio-ecological approaches to address physical inactivity, efforts aimed at understanding the built environment to support physical activity are needed. This community-based participatory research (CBPR) project investigates walking trails perceptions in a high minority southern community and objectively examines walking trails. The primary aim is to explore if perceived and objective audit variables predict meeting recommendations for walking and physical activity, MET/minutes/week of physical activity, and frequency of trail use. Methods A proportional sampling plan was used to survey community residents in this cross-sectional study. Previously validated instruments were pilot tested and appropriately adapted and included the short version of the validated International Physical Activity Questionnaire, trail use, and perceptions of walking trails. Walking trails were assessed using the valid and reliable Path Environmental Audit Tool which assesses four content areas including: design features, amenities, maintenance, and pedestrian safety from traffic. Analyses included Chi-square, one-way ANOVA's, multiple linear regression, and multiple logistic models. Results Numerous (n = 21) high quality walking trails were available. Across trails, there were very few indicators of incivilities and safety features rated relatively high. Among the 372 respondents, trail use significantly predicted meeting recommendations for walking and physical activity, and MET/minutes/week. While controlling for other variables, significant predictors of trail use included proximity to trails, as well as perceptions of walking trail safety, trail amenities, and neighborhood pedestrian safety. Furthermore, while controlling for education, gender, and income; for every one time per week increase in using walking trails, the odds for meeting walking recommendations increased 1.27 times, and the odds for meeting PA recommendation increased 3.54 times. Perceived and objective audit variables did not predict meeting physical activity recommendations. Conclusions To improve physical activity levels, intervention efforts are needed to maximize the use of existing trails, as well as improve residents' perceptions related to incivilities, safety, conditions of trail, and amenities of the walking trails. This study provides important insights for informing development of the CBPR walking intervention and informing local recreational and environmental policies in this southern community. PMID:22289653

Pharmacy travel health services: current perspectives and future prospects

PubMed Central

Houle, Sherilyn KD

2017-01-01

Rates of international travel are increasing annually, with particular growth observed in travel to Southeast Asia and to emerging economies. While all patients traveling across geographic regions are recommended to receive a pre-travel consultation to consider their individual risks, many do not, or receive care and recommendations that are not consistent with current evidence-based guidelines. As experts in drug therapy, and given the largely preventive nature of most travel health recommendations, pharmacists are well suited to help address this need. Pharmacists generally possess a high degree of knowledge and confidence with more commonly observed travel health topics in community practice such as travelers’ diarrhea; however, training in more specialized travel health topics such as travel vaccinations and traveling at altitude has generally been lacking from pharmacy curricula. Pharmacists with an interest in providing pre-travel consultations are encouraged to pursue additional training in this specialty and to consider Certificate in Travel Health designation from the International Society of Travel Medicine. Future roles for pharmacists to include the prescribing of medications and vaccines for travel and the in-pharmacy administration of travel vaccinations may improve patient access to pre-travel consultations and recommended preventive measures, improving the health of travelers and potentially reducing the burden of communicable disease worldwide. Pharmacists providing travel care to patients are also reminded to consider noninfectious risks of illness and injury abroad and to counsel patients on strategies to minimize these risks in addition to providing drug and vaccine recommendations. PMID:29721445

High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations.

PubMed

Nandiwada, Deepa Rani; Kohli, Amar; McNamara, Megan; Smith, Kenneth J; Zimmer, Shanta; McNeil, Melissa; Spagnoletti, Carla; Rubio, Doris; Berlacher, Kathryn

2017-10-01

In an era when value-based care is paramount, teaching trainees to explicitly communicate the evidence behind recommendations fosters high-value care (HVC) in the consultation process. To implement an HVC consult curriculum highlighting the need for clear consult questions, evidence-based recommendations to improve consult teaching, clinical decision-making, and the educational value of consults. A pilot curriculum was implemented for residents on cardiology consult electives utilizing faculty and fellows as evidence-based medicine (EBM) coaches. The curriculum included an online module, an EBM teaching point template, EBM presentations on rounds, and "coach" feedback on notes. A total of 15 residents and 4 fellows on cardiology consults participated, and 87% (13 of 15) of residents on consults felt the curriculum was educationally valuable. A total of 80% (72 of 90) of residents on general medicine rotations responded to the survey, and 25 of 72 residents (35%) had a consult with the EBM template. General medicine teams felt the EBM teaching points affected clinical decision-making (48%, 12 of 25) and favored dissemination of the curriculum (90%, 72 of 80). Checklist-guided chart review showed a 22% improvement in evidence-based summaries behind recommendations (7 of 36 precurriculum to 70 of 146 charts postcurriculum, P  = .015). The HVC consult curriculum during a cardiology elective was perceived by residents to influence clinical decision-making and evidence-based recommendations, and was found to be educationally valuable on both parties in the consult process.

The National Cancer Institute-American Society of Clinical Oncology Cancer Trial Accrual Symposium: summary and recommendations.

PubMed

Denicoff, Andrea M; McCaskill-Stevens, Worta; Grubbs, Stephen S; Bruinooge, Suanna S; Comis, Robert L; Devine, Peggy; Dilts, David M; Duff, Michelle E; Ford, Jean G; Joffe, Steven; Schapira, Lidia; Weinfurt, Kevin P; Michaels, Margo; Raghavan, Derek; Richmond, Ellen S; Zon, Robin; Albrecht, Terrance L; Bookman, Michael A; Dowlati, Afshin; Enos, Rebecca A; Fouad, Mona N; Good, Marjorie; Hicks, William J; Loehrer, Patrick J; Lyss, Alan P; Wolff, Steven N; Wujcik, Debra M; Meropol, Neal J

2013-11-01

Many challenges to clinical trial accrual exist, resulting in studies with inadequate enrollment and potentially delaying answers to important scientific and clinical questions. The National Cancer Institute (NCI) and the American Society of Clinical Oncology (ASCO) cosponsored the Cancer Trial Accrual Symposium: Science and Solutions on April 29-30, 2010 to examine the state of accrual science related to patient/community, physician/provider, and site/organizational influences, and identify new interventions to facilitate clinical trial enrollment. The symposium featured breakout sessions, plenary sessions, and a poster session including 100 abstracts. Among the 358 attendees were clinical investigators, researchers of accrual strategies, research administrators, nurses, research coordinators, patient advocates, and educators. A bibliography of the accrual literature in these three major areas was provided to participants in advance of the meeting. After the symposium, the literature in these areas was revisited to determine if the symposium recommendations remained relevant within the context of the current literature. Few rigorously conducted studies have tested interventions to address challenges to clinical trials accrual. Attendees developed recommendations for improving accrual and identified priority areas for future accrual research at the patient/community, physician/provider, and site/organizational levels. Current literature continues to support the symposium recommendations. A combination of approaches addressing both the multifactorial nature of accrual challenges and the characteristics of the target population may be needed to improve accrual to cancer clinical trials. Recommendations for best practices and for future research developed from the symposium are provided.

The benefits associated with volunteering among seniors: a critical review and recommendations for future research.

PubMed

Anderson, Nicole D; Damianakis, Thecla; Kröger, Edeltraut; Wagner, Laura M; Dawson, Deirdre R; Binns, Malcolm A; Bernstein, Syrelle; Caspi, Eilon; Cook, Suzanne L

2014-11-01

There is an urgent need to identify lifestyle activities that reduce functional decline and dementia associated with population aging. The goals of this article are to review critically the evidence on the benefits associated with formal volunteering among older adults, propose a theoretical model of how volunteering may reduce functional limitations and dementia risk, and offer recommendations for future research. Database searches identified 113 papers on volunteering benefits in older adults, of which 73 were included. Data from descriptive, cross-sectional, and prospective cohort studies, along with 1 randomized controlled trial, most consistently reveal that volunteering is associated with reduced symptoms of depression, better self-reported health, fewer functional limitations, and lower mortality. The extant evidence provides the basis for a model proposing that volunteering increases social, physical, and cognitive activity (to varying degrees depending on characteristics of the volunteer placement) which, through biological and psychological mechanisms, leads to improved functioning; we further propose that these volunteering-related functional improvements should be associated with reduced dementia risk. Recommendations for future research are that studies (a) include more objective measures of psychosocial, physical, and cognitive functioning; (b) integrate qualitative and quantitative methods in prospective study designs; (c) explore further individual differences in the benefits associated with volunteering; (d) include occupational analyses of volunteers' specific jobs in order to identify their social, physical, and cognitive complexity; (e) investigate the independent versus interactive health benefits associated with volunteering relative to engagement in other forms of activity; and (f) examine the relationship between volunteering and dementia risk. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

A Community Checklist for Health Sector Resilience Informed by Hurricane Sandy.

PubMed

Toner, Eric S; McGinty, Meghan; Schoch-Spana, Monica; Rose, Dale A; Watson, Matthew; Echols, Erin; Carbone, Eric G

This is a checklist of actions for healthcare, public health, nongovernmental organizations, and private entities to use to strengthen the resilience of their community's health sector to disasters. It is informed by the experience of Hurricane Sandy in New York and New Jersey and analyzed in the context of findings from other recent natural disasters in the United States. The health sector is defined very broadly, including-in addition to hospitals, emergency medical services (EMS), and public health agencies-healthcare providers, outpatient clinics, long-term care facilities, home health providers, behavioral health providers, and correctional health services. It also includes community-based organizations that support these entities and represent patients. We define health sector resilience very broadly, including all factors that preserve public health and healthcare delivery under extreme stress and contribute to the rapid restoration of normal or improved health sector functioning after a disaster. We present the key findings organized into 8 themes. We then describe a conceptual map of health sector resilience that ties these themes together. Lastly, we provide a series of recommended actions for improving health sector resilience at the local level. The recommended actions emphasize those items that individuals who experienced Hurricane Sandy deemed to be most important. The recommendations are presented as a checklist that can be used by a variety of interested parties who have some role to play in disaster preparedness, response, and recovery in their own communities. Following a general checklist are supplemental checklists that apply to specific parts of the larger health sector.

Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition.

PubMed

Alberts, Mark J; Latchaw, Richard E; Jagoda, Andy; Wechsler, Lawrence R; Crocco, Todd; George, Mary G; Connolly, E S; Mancini, Barbara; Prudhomme, Stephen; Gress, Daryl; Jensen, Mary E; Bass, Robert; Ruff, Robert; Foell, Kathy; Armonda, Rocco A; Emr, Marian; Warren, Margo; Baranski, Jim; Walker, Michael D

2011-09-01

The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.

Stakeholder-Driven Quality Improvement: A Compelling Force for Clinical Practice Guidelines.

PubMed

Rosenfeld, Richard M; Wyer, Peter C

2018-01-01

Clinical practice guideline development should be driven by rigorous methodology, but what is less clear is where quality improvement enters the process: should it be a priority-guiding force, or should it enter only after recommendations are formulated? We argue for a stakeholder-driven approach to guideline development, with an overriding goal of quality improvement based on stakeholder perceptions of needs, uncertainties, and knowledge gaps. In contrast, the widely used topic-driven approach, which often makes recommendations based only on randomized controlled trials, is driven by epidemiologic purity and evidence rigor, with quality improvement a downstream consideration. The advantages of a stakeholder-driven versus a topic-driven approach are highlighted by comparisons of guidelines for otitis media with effusion, thyroid nodules, sepsis, and acute bacterial rhinosinusitis. These comparisons show that stakeholder-driven guidelines are more likely to address the quality improvement needs and pressing concerns of clinicians and patients, including understudied populations and patients with multiple chronic conditions. Conversely, a topic-driven approach often addresses "typical" patients, based on research that may not reflect the needs of high-risk groups excluded from studies because of ethical issues or a desire for purity of research design.

Metabolic syndrome and hypertension: regular exercise as part of lifestyle management.

PubMed

Lackland, Daniel T; Voeks, Jenifer H

2014-11-01

The incorporation of physical activity and exercise represents a clinically important aspect in the management of metabolic syndrome, hypertension, and diabetes. While the benefit of exercise and active lifestyles is well documented for prevention and risk reduction of cardiovascular and stroke outcomes, the detailed regiment and recommendations are less clear. The components of a prescribed physical activity include consideration of activity type, frequency of an activity, activity duration, and intensity of a specific physical movement. The exercise parameters prescribed as part of the management of metabolic syndrome, diabetes, and elevated blood pressure are most often proposed as separate documents while the general recommendations are similar. The evidence is strong such that physical activity and exercise recommendations in disease management guidelines are considered high quality. The general recommendations for both blood pressure and glycemic management include a regiment of physical activity with moderate- to high-intensity exercise of 30-min bouts on multiple days with a desired goal of a total of 150 min of exercise per week. While additional research is needed to identify the specific exercise/activity mode, frequencies for exercise training, intensity levels, and duration of exercise that achieve maximal blood pressure and glycemic lowering, this general recommendation showed a consistent and significant benefit in risk reduction. Similarly, the current available evidence also indicates that aerobic exercise, dynamic resistance exercise, and isometric exercises can lower blood pressure and improve glycemic control.

Existing data on breast cancer in African-American women: what we know and what we need to know.

PubMed

Clarke, Christina A; West, Dee W; Edwards, Brenda K; Figgs, Larry W; Kerner, Jon; Schwartz, Ann G

2003-01-01

Much of what is known about breast cancer in African-American (AA) women is based on existing cancer surveillance data. Thus, it is important to consider the accuracy of these resources in describing the impact of breast cancer in AA populations. National cancer surveillance data bases are described, their most recent findings are presented, their limitations are outlined, and recommendations are made for improving their utility. Breast cancer characteristics have been studied well in urban (but not in rural) and Southern AA populations. The recent Surveillance, Epidemiology, and End Results (SEER) Program expansion and the continued improvement of state cancer registry operations will provide opportunities to study larger and more diverse AA subpopulations. Recommendations for improving the utility of surveillance data bases include adding new items to better describe correlates of advanced stage at diagnosis and reduced survival of AA women with breast cancer by linking surveillance data bases with other large data bases to provide area-level socioeconomic status, health insurance status, and retrieving new information about patient comorbidities and biomarkers from medical records; improving the completeness and accuracy of treatment and survival information already collected for all patients; working to improve the dissemination of appropriate cancer data to nonresearch consumer communities, including clinicians, patients, advocates, politicians, and health officials; and the development of new training programs for cancer registrars and researchers. The continued improvement of cancer surveillance systems should be considered important activities in this research agenda, because these data will play a far-reaching role in the prevention and control of breast cancer in AA women.

Sensation seekers as a healthcare marketing metasegment.

PubMed

Self, Donald R; Findley, Carolyn Sara

2010-01-01

This article discusses "sensation seekers" as a market segment for communication and prevention programs for various lifestyle and/or risk-related health problem areas such as alcohol abuse, drug abuse, suicide attempts, and sexually transmitted diseases. Although sensation seekers tend to be creative, artistic individuals, they are also prone to various negative health behaviors and many population-based prevention programs have over-looked these individuals as an important target. Various inputs to sensation-seeking causation are explored, including biological/chemical, psychological, and the impact of external characteristics. Using a combination for regulatory focus and risk homeostasis, propositions are provided for improving the effectiveness of the communications. Recommendations for prevention efforts focusing on reaching this subculture using television, along with other electronic media are proposed, including recommendations for message construction and presentation venues.

The Development of a Mindfulness-Based Music Therapy (MBMT) Program for Women Receiving Adjuvant Chemotherapy for Breast Cancer

PubMed Central

Lesiuk, Teresa

2016-01-01

Problems with attention and symptom distress are common clinical features reported by women who receive adjuvant chemotherapy for breast cancer. Mindfulness practice significantly improves attention and mindfulness programs significantly reduce symptom distress in patients with cancer, and, more specifically, in women with breast cancer. Recently, a pilot investigation of a music therapy program, built on core attitudes of mindfulness practice, reported significant benefits of enhanced attention and decreased negative mood and fatigue in women with breast cancer. This paper delineates the design and development of the mindfulness-based music therapy (MBMT) program implemented in that pilot study and includes clients’ narrative journal responses. Conclusions and recommendations, including recommendation for further exploration of the function of music in mindfulness practice are provided. PMID:27517966

Improving the Use of Technology in Schools: What We Are Learning. Research Bulletin #1.

ERIC Educational Resources Information Center

Center for the Study of Educational Technology, St. Paul, MN.

This bulletin summarizes six studies on the integration of technology into education. Information provided for each study includes the background or the problem statement, study goals, methodology, conclusions, and recommendations. The first three studies focus on the impact of technology on education: "The Effect of Computer Use and Student…

Creating a cryobank for germplasm of fruit and berry crops: methodological recommendations

USDA-ARS?s Scientific Manuscript database

Plant genetic resources are a national treasure in each country. They serve as a basis for developing new and improving existing varieties of plants. In Kazakhstan, a wide selection of cultivated and wild forms grow unique fruit and berry crops, including apple (Malus sieversii (Ledeb.) M. Roem., Ma...

Challenges in Improving Latino College Enrollment: Opportunities for Systemic Change Viewpoints from California

ERIC Educational Resources Information Center

Tomas Rivera Policy Institute, 2005

2005-01-01

This document includes presentation summaries and policy recommendations from the 2004 Tomas Rivera Policy Institute (TRPI) Education Conference: (1) The Present and Coming Crisis: Demography and Education (Dowell Myers and Estela Mara Bensimon); (2) A View from the Academic Community (Moderators: Jorge Haynes and Jamilah Moore; Presenters:…

75 FR 46909 - Solicitation of Input From Stakeholders Regarding Assessments Focused on Improving Food Aid and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-04

... implemented in the field to benefit highly vulnerable populations, including recommendations on the most cost... Institute of Food and Agriculture, USDA. ACTION: Notice; request for public comment. SUMMARY: The National... Extension Service (CSREES) requests input from the public regarding (1) the assessment of methods and tools...

Climate Change: Providing Equitable Access to a Rigorous and Engaging Curriculum

ERIC Educational Resources Information Center

Cardichon, Jessica; Roc, Martens

2013-01-01

This report examines how implementing rigorous and engaging curriculum aligned with college- and career-ready standards fosters positive school climates in which students are motivated to succeed, achievement gaps narrow, and learning and outcomes improve. It includes federal, state, and local recommendations for increasing access to high-quality,…

Railroad safety program, task 2

NASA Technical Reports Server (NTRS)

1983-01-01

Aspects of railroad safety and the preparation of a National Inspection Plan (NIP) for rail safety improvement are examined. Methodology for the allocation of inspection resources, preparation of a NIP instruction manual, and recommendations for future NIP, are described. A statistical analysis of regional rail accidents is presented with causes and suggested preventive measures included.

State of the Art in Early Childhood Music and Research.

ERIC Educational Resources Information Center

Zimmerman, Marilyn P.

This paper is mainly devoted to reviewing past research on music development. Some recommendations for future research on music development and for improving music education for preschool children are also included. The developmental theories of Jean Piaget are discussed in detail, with special attention being given to concepts important to…

Straight A's: Public Education Policy and Progress. Volume 5, Number 8

ERIC Educational Resources Information Center

Amos, Jason, Ed.

2005-01-01

"Straight A's: Public Education Policy and Progress" is a biweekly newsletter that focuses on education news and events both in Washington, DC and around the country. The following articles are included in this issue: (1) New Report Offers Recommendations for Defining and Improving Graduation Rates: Calls for New Federal Funding Stream…

The Search for Methods of Group Instruction as Effective as One-to-One Tutoring.

ERIC Educational Resources Information Center

Bloom, Benjamin S.

1984-01-01

Summarizes research exploring six solutions to the "2 sigma problem" of devising teaching-learning conditions that will enable the majority of students under group instruction to achieve at levels now possible only when students are tutored. Recommendations include using mastery learning, improving the home environment, and emphasizing higher…

A Study of College Professors' Perceptions of International Students in STEM Classrooms at a Technical University

ERIC Educational Resources Information Center

Abendschein, Barbara Feeney

2017-01-01

This study investigated the perceptions of STEM professors at a Southeastern technical college about the international students in their undergraduate classrooms, including impact on the learning environment, academic abilities and proficiency in meeting course goals, contribution to class activities and recommendations for improved preparation.…

Adapting to a Changing World--Challenges and Opportunities in Undergraduate Physics Education

ERIC Educational Resources Information Center

National Academies Press, 2013

2013-01-01

"Adapting to a Changing World" was commissioned by the National Science Foundation to examine the present status of undergraduate physics education, including the state of physics education research, and, most importantly, to develop a series of recommendations for improving physics education that draws from the knowledge we have about…

Toward an Improved U.S. Merchant Marine: A Recommended Program of Studies.

ERIC Educational Resources Information Center

National Academy of Sciences - National Research Council, Washington, DC.

This report describes the development and current status of the U.S. Merchant Marine with special emphasis on the influences of government, management, labor, and users. The report describes a wide spectrum of maritime activities, including the roles of various government agencies, the organization and effectiveness of U.S. Merchant Marine…

Evaluation of the Illinois High School to College Success Report: Technical Report

ERIC Educational Resources Information Center

Klostermann, Brenda; Cameron, Sean; Hamel, Rachel; Newberry, Melissa

2013-01-01

This report provides findings from an evaluation of the newly designed Illinois High School to College Success Report (HS2CSR). The evaluation study examined the dissemination, usefulness, and impact on collaborative efforts of the new HS2CSR. Education stakeholders' suggestions for improving the report are also included. Recommendations to…

A Projection of Maryland's Health Manpower Needs Through the 1980's.

ERIC Educational Resources Information Center

Coggeshall, Lowell T.; And Others

Recommendations for meeting health manpower and training facility needs in Maryland are made, based on the included Coggeshall report. Demand for health personnel is contrasted with estimated future supplies. A third medical school should be planned and dependence on foreign physicians reduced. Rural areas should improve their own health services.…

Assuring Rural Hospital Patient Safety: What Should Be the Priorities?

ERIC Educational Resources Information Center

Coburn, Andrew F.; Wakefield, Mary; Casey, Michelle; Moscovice, Ira; Payne, Susan; Loux, Stephenie

2004-01-01

Context: Since reports on patient safety were issued by the Institute of Medicine, a number of interventions have been recommended and standards designed to improve hospital patient safety, including the Leapfrog, evidence-based safety standards. These standards are based on research conducted largely in urban hospitals, and it may not be possible…

Further Actions Needed to Resolve VA's Educational Assistance Overpayment Problem. Report of the Comptroller General of the United States.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

Recommendations are made for the correction and collection of Veterans Administration overpayments of educational benefits. They include: improved compliance surveying; updates on overpayments balance reports to the states; identification of schools liable for overpayments; notification of veterans of their obligation to report training status…

Dynamics of resilience of wheat to drought in Australia from 1991-2010.

PubMed

Huai, Jianjun

2017-08-25

Although enhancing resilience is a well-recognized adaptation to climate change, little research has been undertaken on the dynamics of resilience. This occurs because complex relationships exist between adaptive capacity and resilience, and some issues also create challenges related to the construction, operation, and application of resilience. This study identified the dynamics of temporal, spatial changes of resilience found in a sample of wheat-drought resilience in Australia's wheat-sheep production zone during 1991-2010. I estimated resilience using principal component analysis, mapped resilience and its components, distinguished resilient and sensitive regions, and provided recommendations related to improving resilience. I frame that resilience is composed of social resilience including on- and off-site adaptive capacity as well as biophysical resilience including resistance and absorption. I found that resilience and its components have different temporal trends, spatial shifts and growth ratios in each region during different years, which results from complicated interactions, such as complementation and substitution among its components. In wheat-sheep zones, I recommend that identifying regional bottlenecks, science-policy engagement, and managing resilience components are the priorities for improving resilience.

Influenza in the Asia-Pacific region: Findings and recommendations from the Global Influenza Initiative.

PubMed

Cowling, Benjamin J; Caini, Saverio; Chotpitayasunondh, Tawee; Djauzi, Samsuridjal; Gatchalian, Salvacion R; Huang, Q Sue; Koul, Parvaiz A; Lee, Ping-Ing; Muttalif, Abdul Razak; Plotkin, Stanley

2017-02-07

The fourth roundtable meeting of the Global Influenza Initiative (GII) was held in Hong Kong, China, in July 2015. An objective of this meeting was to gain a broader understanding of the epidemiology, surveillance, vaccination policies and programs, and obstacles to vaccination of influenza in the Asia-Pacific region through presentations of data from Australia, Hong Kong, India, Indonesia, Malaysia, New Zealand, the Philippines, Taiwan, Thailand, and Vietnam. As well as a need for improved levels of surveillance in some areas, a range of factors were identified that act as barriers to vaccination in some countries, including differences in climate and geography, logistical challenges, funding, lack of vaccine awareness and education, safety concerns, perceived lack of vaccine effectiveness, and lack of inclusion in national guidelines. From the presentations at the meeting, the GII discussed a number of recommendations for easing the burden of influenza and overcoming the current challenges in the Asia-Pacific region. These recommendations encompass the need to improve surveillance and availability of epidemiological data; the development and publication of national guidelines, where not currently available and/or that are in line with those proposed by the World Health Organization; the requirement for optimal timing of vaccination programs according to local or country-specific epidemiology; and calls for advocacy and government support of vaccination programs in order to improve availability and uptake and coverage. In conclusion, in addition to the varied epidemiology of seasonal influenza across this diverse region, there are a number of logistical and resourcing issues that present a challenge to the development of optimally effective vaccination strategies and that need to be overcome to improve access to and uptake of seasonal influenza vaccines. The GII has developed a number of recommendations to address these challenges and improve the control of influenza. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Prototype Indicators System for U.S. Climate Changes, Impacts, Vulnerabilities, and Responses

NASA Astrophysics Data System (ADS)

Kenney, M. A.; Janetos, A.; Gerst, M.; Lloyd, A.; Wolfinger, J. F.; Reyes, J. J.; Anderson, S. M.; Pouyat, R. V.

2015-12-01

Indicators are observations or calculations that are used to systematically report or forecast social and biophysical conditions over time. When the purpose of indicators is to, in part, provide complex scientific information that is understood by non-scientists and included in decision processes, the choice of indicators requires a structured process that includes co-production among a range of actors, including scientists, decision-makers, and a range of stakeholders. Here we describe recommendations on a vision and a prototype created for an indicators system, we term the National Climate Indicators System (NCIS). The goal of the NCIS is to create a system of physical, natural, and societal indicators to communicate and inform decisions about climate changes, impacts, vulnerabilities, and responses. The process of generating the indicator system involved input from over 200 subject-matter experts. Organized into 13 teams, experts created conceptual models of their respective sectors to generate an initial recommended set of indicators. A subset of indicators, which could be immediately implemented, were prototyped for the U.S. Global Change Research Program (USGCRP) a Federal program that coordinates and supports integration of global change research across the government. USGCRP reviewed the recommendations (Kenney et al., 2014) and prototypes provided by the scientific experts, and recently launched 14 indicators as proof-of-concept in support of a sustained National Climate Assessment and to solicit feedback from the users. Social science research is currently being undertaken in order to evaluate how well the prototype indicators communicate science to non-scientists, the usability of indicator system portal by scientists and decision-makers, and the development of information visualization guidelines to improve visual communication effectiveness. The goal of such efforts would be to provide input into the development of a more comprehensive USGCRP indicator set, building on recommendations from Kenney et al. (2014), and improve our understanding of the comprehension and use of indicators by non-scientists.

Improved personalized recommendation based on a similarity network

NASA Astrophysics Data System (ADS)

Wang, Ximeng; Liu, Yun; Xiong, Fei

2016-08-01

A recommender system helps individual users find the preferred items rapidly and has attracted extensive attention in recent years. Many successful recommendation algorithms are designed on bipartite networks, such as network-based inference or heat conduction. However, most of these algorithms define the resource-allocation methods for an average allocation. That is not reasonable because average allocation cannot indicate the user choice preference and the influence between users which leads to a series of non-personalized recommendation results. We propose a personalized recommendation approach that combines the similarity function and bipartite network to generate a similarity network that improves the resource-allocation process. Our model introduces user influence into the recommender system and states that the user influence can make the resource-allocation process more reasonable. We use four different metrics to evaluate our algorithms for three benchmark data sets. Experimental results show that the improved recommendation on a similarity network can obtain better accuracy and diversity than some competing approaches.

Obtaining consumer perspectives using a citizens' jury: does the current country of origin labelling in Australia allow for informed food choices?

PubMed

Withall, Elizabeth; Wilson, Annabelle M; Henderson, Julie; Tonkin, Emma; Coveney, John; Meyer, Samantha B; Clark, Jacinta; McCullum, Dean; Ankeny, Rachel; Ward, Paul R

2016-12-09

Contemporary food systems are vast and complex, creating greater distance between consumers and their food. Consequently, consumers are required to put faith in a system of which they have limited knowledge or control. Country of origin labelling (CoOL) is one mechanism that theoretically enables consumer knowledge of provenance of food products. However, this labelling system has recently come under Australian Government review and recommendations for improvements have been proposed. Consumer engagement in this process has been limited. Therefore this study sought to obtain further consumer opinion on the issue of CoOL and to identify the extent to which Australian consumers agree with Australian Government recommendations for improvements. A citizens' jury was conducted with a sample of 14 South Australian consumers to explore their perceptions on whether the CoOL system allows them to make informed food choices, as well as what changes (if any) need to be made to enable informed food choices (recommendations). Overall, jurors' perception of usefulness of CoOL, including its ability to enable consumers to make informed food choices, fluctuated throughout the Citizens' Jury. Initially, the majority of the jurors indicated that the labels allowed informed food choice, however by the end of the session the majority disagreed with this statement. Inconsistencies within jurors' opinions were observed, particularly following delivery of information from expert witnesses and jury deliberation. Jurors provided recommendations for changes to be made to CoOL, which were similar to those provided in the Australian Government inquiry. Consumers in this study engaged with the topical issue of CoOL and provided their opinions. Overall, consumers do not think that the current CoOL system in Australia enables consumers to make informed choices. Recommendations for changes, including increasing the size of the label and the label's font, and standardising its position, were made.

Colonoscopy: practice variation among 69 hospital-based endoscopists.

PubMed

Cotton, Peter B; Connor, Patrick; McGee, Daniel; Jowell, Paul; Nickl, Nick; Schutz, Steve; Leung, Joseph; Lee, John; Libby, Eric

2003-03-01

The medical profession, payers, and patients are interested increasingly in the quality of endoscopic procedures, including colonoscopy. The American Society for Gastrointestinal Endoscopy has recommended "report cards" by which endoscopists may keep track of certain key elements of their practice including indications, findings, duration, technical end points, complications, and patient satisfaction. The GI-Trac endoscopy reporting database includes many of the data points recommended by ASGE for report cards. Seven hospital centers in North America have been collecting data prospectively for varying periods since 1994. These data were aggregated and analyzed by individual endoscopist. A total of 69 endoscopists performed 17,868 colonoscopies. Twelve percent of the endoscopists reported that more than 20% of procedures they performed were completely normal. The average time taken by 27% of endoscopists was more than 40 minutes (without trainees involved), and only 55% achieved a cecal intubation rate of over 90%; for 9% the rate was less than 80%. Complication rates were too low for individual comparisons. These data provide an idea of colonoscopy performance by individual endoscopists in mainly academic centers. Incorporating all recommended data elements in future reporting databases will contribute to meaningful bench marking and to quality improvement efforts.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

PubMed Central

Smolen, Josef S; Landewé, Robert; Breedveld, Ferdinand C; Buch, Maya; Burmester, Gerd; Dougados, Maxime; Emery, Paul; Gaujoux-Viala, Cécile; Gossec, Laure; Nam, Jackie; Ramiro, Sofia; Winthrop, Kevin; de Wit, Maarten; Aletaha, Daniel; Betteridge, Neil; Bijlsma, Johannes W J; Boers, Maarten; Buttgereit, Frank; Combe, Bernard; Cutolo, Maurizio; Damjanov, Nemanja; Hazes, Johanna M W; Kouloumas, Marios; Kvien, Tore K; Mariette, Xavier; Pavelka, Karel; van Riel, Piet L C M; Rubbert-Roth, Andrea; Scholte-Voshaar, Marieke; Scott, David L; Sokka-Isler, Tuulikki; Wong, John B; van der Heijde, Désirée

2014-01-01

In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches. 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) were determined. Fourteen recommendations were developed (instead of 15 in 2010). Some of the 2010 recommendations were deleted, and others were amended or split. The recommendations cover general aspects, such as attainment of remission or low disease activity using a treat-to-target approach, and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting DMARD therapy using a conventional sDMARD (csDMARD) strategy in combination with glucocorticoids, followed by the addition of a bDMARD or another csDMARD strategy (after stratification by presence or absence of adverse risk factors) if the treatment target is not reached within 6 months (or improvement not seen at 3 months). Tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, biosimilars), abatacept, tocilizumab and, under certain circumstances, rituximab are essentially considered to have similar efficacy and safety. If the first bDMARD strategy fails, any other bDMARD may be used. The recommendations also address tofacitinib as a targeted sDMARD (tsDMARD), which is recommended, where licensed, after use of at least one bDMARD. Biosimilars are also addressed. These recommendations are intended to inform rheumatologists, patients, national rheumatology societies and other stakeholders about EULAR's most recent consensus on the management of RA with sDMARDs, glucocorticoids and bDMARDs. They are based on evidence and expert opinion and intended to improve outcome in patients with RA. PMID:24161836

Improving the Effectiveness and Acquisition Management of Selected Weapon Systems: A Summary of Major Issues and Recommended Actions.

DTIC Science & Technology

1982-05-14

need for effective training--a situation which will be impaired until the AH-64 combat mission simulator , now under development, becomes available in...antisubmarine warfare system includes the capability to detect, classify, localize, and destroy the enemy. This capability includes multimillion dollar...to simulate combat situations will simulate only air-to-air activity. Air-to-ground and electronic counter countermeasures simulations were deleted

iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention.

PubMed

Wearing, Jessica R; Nollen, Nikki; Befort, Christie; Davis, Ann M; Agemy, Carolina K

2014-04-01

Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps. Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity. App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed. Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies.

iPhone App Adherence to Expert-Recommended Guidelines for Pediatric Obesity Prevention

PubMed Central

Wearing, Jessica R.; Befort, Christie; Davis, Ann M.; Agemy, Carolina K.

2014-01-01

Abstract Background: Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps. Method: Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity. Results: App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed. Conclusions: Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies. PMID:24655230

A bottom-up approach to MEDLINE indexing recommendations.

PubMed

Jimeno-Yepes, Antonio; Wilkowski, Bartłomiej; Mork, James G; Van Lenten, Elizabeth; Fushman, Dina Demner; Aronson, Alan R

2011-01-01

MEDLINE indexing performed by the US National Library of Medicine staff describes the essence of a biomedical publication in about 14 Medical Subject Headings (MeSH). Since 2002, this task is assisted by the Medical Text Indexer (MTI) program. We present a bottom-up approach to MEDLINE indexing in which the abstract is searched for indicators for a specific MeSH recommendation in a two-step process. Supervised machine learning combined with triage rules improves sensitivity of recommendations while keeping the number of recommended terms relatively small. Improvement in recommendations observed in this work warrants further exploration of this approach to MTI recommendations on a larger set of MeSH headings.

Recommendations for Constructing Roadside Vegetation Barriers to Improve Near-Road Air Quality

EPA Pesticide Factsheets

The EPA report, Recommendations for Constructing Roadside Vegetation Barriers to Improve Near-Road Air Quality, summarizes the research findings on the best practices for building roadside vegetative barriers to improve air quality. This fact sheet describ

Course Development Cycle Time: A Framework for Continuous Process Improvement.

ERIC Educational Resources Information Center

Lake, Erinn

2003-01-01

Details Edinboro University's efforts to reduce the extended cycle time required to develop new courses and programs. Describes a collaborative process improvement framework, illustrated data findings, the team's recommendations for improvement, and the outcomes of those recommendations. (EV)

Cardiac Rehabilitation: Unraveling the Complexity of Referral and Current Models of Delivery.

PubMed

Astley, Carolyn M; Neubeck, Lis; Gallagher, Robyn; Berry, Narelle; Du, Huiyun; Hill, Martha N; Clark, Robyn A

Evidence-based guidelines recommend strategies for reducing risk factors for secondary prevention of acute coronary syndromes, yet referral to and completion of programs to deliver this advice are poor. In this article we describe the complexity of factors that influence referral and delivery of evidence-based cardiac rehabilitation (CR) programs through an Australian context and provide direction for solutions for clinicians and policy makers to consider. The Ecological Approach is used as a framework to synthesize evidence. The approach has 5 categories, the characteristics of which may act as barriers and enablers to the promotion and adoption of health behaviors and includes (a) interpersonal factors, (b) interpersonal factors, (c) institutional factors, (d) community networks, and (e) public policy. Despite the context of strong evidence for efficacy, this review highlights systematic flaws in the implementation of CR, an important intervention that has been shown to improve patient outcomes and prevent cardiac events. Recommendations from this review include standardization of program delivery, improvement of data capture, use of technological innovations and social networks to facilitate delivery of information and support, and establishment of a cohesive, consistent message through interorganizational collaboration involved in CR. These avenues provide direction for potential solutions to improve the uptake of CR and secondary prevention.

Compliance with behavioral guidelines for diet, physical activity and sedentary behaviors is related to insulin resistance among overweight and obese youth.

PubMed

Huang, Jeannie S; Gottschalk, Michael; Norman, Gregory J; Calfas, Karen J; Sallis, James F; Patrick, Kevin

2011-02-01

Overweight and obesity are established risk factors for insulin resistance in youth. A number of behavioral recommendations have been publicized with the goal of improving glycemic control. However, there is limited information about whether meeting these behavioral recommendations actually reduces insulin resistance. 92 youths 11 - 16 years with BMI ≥ 85% underwent oral glucose tolerance testing. HOMA-IR and AUCInsulin/AUCGlucose were calculated as measures of insulin resistance. Dietary and physical activity (PA) measures were performed. Assessments included whether or not participants met recommended levels of diet, PA and sedentary behaviors.62% youths met criteria for insulin resistance. 82% (75/92) met at least one behavioral recommendation. Participants who met ≥ 1 dietary, sedentary, or PA recommendations had significantly reduced insulin resistance as compared with youth who did not. This relationship remained significant in multivariate modeling of insulin resistance adjusting for age, sex, and BMI. Even relatively minor behavior change may reduce insulin resistance in youth at risk for diabetes. Our findings support the relevance of current behavioral interventions for glycemic control. Clinical Trials #NCT00412165.

Evidence-based guideline: Management of an unprovoked first seizure in adults

PubMed Central

Krumholz, Allan; Wiebe, Samuel; Gronseth, Gary S.; Gloss, David S.; Sanchez, Ana M.; Kabir, Arif A.; Liferidge, Aisha T.; Martello, Justin P.; Kanner, Andres M.; Shinnar, Shlomo; Hopp, Jennifer L.; French, Jacqueline A.

2015-01-01

Objective: To provide evidence-based recommendations for treatment of adults with an unprovoked first seizure. Methods: We defined relevant questions and systematically reviewed published studies according to the American Academy of Neurology's classification of evidence criteria; we based recommendations on evidence level. Results and recommendations: Adults with an unprovoked first seizure should be informed that their seizure recurrence risk is greatest early within the first 2 years (21%–45%) (Level A), and clinical variables associated with increased risk may include a prior brain insult (Level A), an EEG with epileptiform abnormalities (Level A), a significant brain-imaging abnormality (Level B), and a nocturnal seizure (Level B). Immediate antiepileptic drug (AED) therapy, as compared with delay of treatment pending a second seizure, is likely to reduce recurrence risk within the first 2 years (Level B) but may not improve quality of life (Level C). Over a longer term (>3 years), immediate AED treatment is unlikely to improve prognosis as measured by sustained seizure remission (Level B). Patients should be advised that risk of AED adverse events (AEs) may range from 7% to 31% (Level B) and that these AEs are likely predominantly mild and reversible. Clinicians' recommendations whether to initiate immediate AED treatment after a first seizure should be based on individualized assessments that weigh the risk of recurrence against the AEs of AED therapy, consider educated patient preferences, and advise that immediate treatment will not improve the long-term prognosis for seizure remission but will reduce seizure risk over the subsequent 2 years. PMID:25901057

Social support and the likelihood of maintaining and improving levels of physical activity: the Whitehall II Study.

PubMed

Kouvonen, Anne; De Vogli, Roberto; Stafford, Mai; Shipley, Martin J; Marmot, Michael G; Cox, Tom; Vahtera, Jussi; Väänänen, Ari; Heponiemi, Tarja; Singh-Manoux, Archana; Kivimäki, Mika

2012-08-01

Evidence on the association between social support and leisure time physical activity (LTPA) is scarce and mostly based on cross-sectional data with different types of social support collapsed into a single index. The aim of this study was to investigate whether social support from the closest person was associated with LTPA. Prospective cohort study of 5395 adults (mean age 55.7 years, 3864 men) participating in the British Whitehall II study. Confiding/emotional support and practical support were assessed at baseline in 1997-99 using the Close Persons Questionnaire. LTPA was assessed at baseline and follow-up in (2002-04). Baseline covariates included socio-demographics, self-rated health, long-standing illnesses, physical functioning and common mental disorders. Among participants who reported recommended levels of LTPA at baseline, those who experienced high confiding/emotional support were more likely to report recommended levels of LTPA at follow-up [odds ratio (OR): 1.39, 95% confidence interval (CI): 1.12-1.70 in a model adjusted for baseline covariates]. Among those participants who did not meet the recommended target of LTPA at baseline, high confiding/emotional support was not associated with improvement in activity levels. High practical support was associated with both maintaining (OR: 1.34, 95% CI: 1.10-1.63) and improving (OR: 1.25, 95% CI: 1.02-1.53) LTPA levels. These findings suggest that emotional and practical support from the closest person may help the individual to maintain the recommended level of LTPA. Practical support also predicted a change towards a more active lifestyle.

Preventing skin cancer: findings of the Task Force on Community Preventive Services On reducing Exposure to Ultraviolet Light.

PubMed

Saraiya, Mona; Glanz, Karen; Briss, Peter; Nichols, Phyllis; White, Cornelia; Das, Debjani

2003-10-17

Rates of skin cancer, the most common cancer in the United States, are increasing. The most preventable risk factor for skin cancer is unprotected ultraviolet (UV) exposure. Seeking to identify effective approaches to reducing the incidence of skin cancer by improving individual and community efforts to reduce unprotected UV exposure, the Task Force on Community Preventive Services conducted systematic reviews of community interventions to reduce exposure to ultraviolet light and increase protective behaviors. The Task Force found sufficient evidence to recommend two interventions that are based on improvements in sun protective or "covering-up" behavior (wearing protective clothing including long-sleeved clothing or hats): educational and policy approaches in two settings--primary schools and recreational or tourism sites. They found insufficient evidence to determine the effectiveness of a range of other population-based interventions and recommended additional research in these areas: educational and policy approaches in child care centers, secondary schools and colleges, recreational or tourism sites for children, and workplaces; interventions conducted in health-care settings and targeted to both providers and children's parents or caregivers; media campaigns alone; and community wide multicomponent interventions. This report also presents additional information regarding the recommended community interventions, briefly describes how the reviews were conducted, provides resources for further information, and provides information that can help in applying the interventions locally. The U.S. Preventive Services Task Force conducted a systematic review of counseling by primary care clinicians to prevent skin cancer (CDC. Counseling to prevent skin cancer: recommendation and rationale of the U.S. Preventive Services Task Force. MMWR 2003;52[No. RR-15]:13-17), which is also included in this issue, the first jointly released findings from the Task Force on Community Preventive Services and the U.S. Preventive Services Task Force.

Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes?

PubMed Central

Redler, Lauren H; Degen, Ryan M; McDonald, Lucas S; Altchek, David W; Dines, Joshua S

2016-01-01

Injury to the ulnar collateral ligament (UCL) most commonly occurs in the overhead throwing athlete. Knowledge surrounding UCL injury pathomechanics continues to improve, leading to better preventative treatment strategies and rehabilitation programs. Conservative treatment strategies for partial injuries, improved operative techniques for reconstruction in complete tears, adjunctive treatments, as well as structured sport specific rehabilitation programs including resistive exercises for the entire upper extremity kinetic chain are all important factors in allowing for a return to throwing in competitive environments. In this review, we explore each of these factors and provide recommendations based on the available literature to improve outcomes in UCL injuries in athletes. PMID:27114930

Do quality improvement systems improve health library services? A systematic review.

PubMed

Gray, Hannah; Sutton, Gary; Treadway, Victoria

2012-09-01

A turbulent financial and political climate requires health libraries to be more accountable than ever. Quality improvement systems are widely considered a 'good thing to do', but do they produce useful outcomes that can demonstrate value? To undertake a systematic review to identify which aspects of health libraries are being measured for quality, what tools are being used and what outcomes are reported following utilisation of quality improvement systems. Many health libraries utilise quality improvement systems without translating the data into service improvements. Included studies demonstrate that quality improvement systems produce valuable outcomes including a positive impact on strategic planning, promotion, new and improved services and staff development. No impact of quality improvement systems on library users or patients is reported in the literature. The literature in this area is sparse and requires updating. We recommend further primary research is conducted in health libraries focusing upon the outcomes of utilising quality improvement systems. An exploration of quality improvement systems in other library sectors may also provide valuable insight for health libraries. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Physical activity counseling in medical school education: a systematic review

PubMed Central

Dacey, Marie L.; Kennedy, Mary A.; Polak, Rani; Phillips, Edward M.

2014-01-01

Background Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. Methods The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Results Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Conclusions Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs. PMID:25062944

Using routinely recorded data in the UK to assess outcomes in a randomised controlled trial: The Trials of Access.

PubMed

Powell, G A; Bonnett, L J; Tudur-Smith, C; Hughes, D A; Williamson, P R; Marson, A G

2017-08-23

In the UK, routinely recorded data may benefit prospective studies including randomised controlled trials (RCTs). In an on-going study, we aim to assess the feasibility of access and agreement of routinely recorded clinical and non-clinical data compared to data collected during a RCT using standard prospective methods. This paper will summarise available UK routinely recorded data sources and discuss our experience with the feasibility of accessing routinely recorded data for participants of a RCT before finally proposing recommendations for improving the access and implementation of routinely recorded data in RCTs. Setting: the case study RCT is the Standard and New Antiepileptic Drugs II (SANAD II) trial, a pragmatic, UK, multicentre, phase IV RCT assessing the clinical and cost-effectiveness of antiepileptic drug treatments for newly diagnosed epilepsy. 98 participants have provided written consent to permit the request of routinely recorded data. Study procedures: routinely recorded clinical and non-clinical data were identified and data requested through formal applications from available data holders for the duration that participants have been recruited into SANAD II. The feasibility of accessing routinely recorded data during a RCT is assessed and recommendations for improving access proposed. Secondary-care clinical and socioeconomic data is recorded on a national basis and can be accessed, although there are limitations in the application process. Primary-care data are recorded by a number of organisations on a de-identified basis but access for specific individuals has not been feasible. Access to data recorded by non-clinical sources, including The Department for Work and Pensions and The Driving and Vehicle Licensing Agency, was not successful. Recommendations discussed include further research to assess the attributes of routinely recorded data, an assessment of public perceptions and the development of strategies to collaboratively improve access to routinely recorded data for research. International Standard Randomised Controlled Trials, ISRCTN30294119 . Registered on 3 July 2012. EudraCT No: 2012-001884-64. Registered on 9 May 2012.

The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

PubMed

Dhaliwal, Rupinder; Cahill, Naomi; Lemieux, Margot; Heyland, Daren K

2014-02-01

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.

Colonoscopy quality assurance in Ontario: Systematic review and clinical practice guideline

PubMed Central

Tinmouth, Jill; Kennedy, Erin B; Baron, David; Burke, Mae; Feinberg, Stanley; Gould, Michael; Baxter, Nancy; Lewis, Nancy

2014-01-01

Colonoscopy is fundamental to the diagnosis and management of digestive diseases and plays a key role in colorectal cancer (CRC) screening and diagnosis. Therefore, it is important to ensure that colonoscopy is of high quality. The present guidance document updates the evidence and recommendations in Cancer Care Ontario’s 2007 Colonoscopy Standards, and was conducted under the aegis of the Program in Evidence-Based Care. It is intended to support quality improvement for colonoscopies for all indications, including follow-up to a positive fecal occult blood test, screening for individuals who have a family history of CRC and those at average risk, investigation for symptomatic patients, and surveillance of those with a history of adenomatous polyps or CRC. A systematic review was performed to evaluate the existing evidence concerning the following three key aspects of colonoscopy: physician endoscopist training and maintenance of competency; institutional quality assurance parameters; and colonoscopy quality indicators and auditable outcomes. Where appropriate, indicators were designated quality indicators (where there was sufficient evidence to recommend a specific target) and auditable outcomes (insufficient evidence to recommend a specific target, but which should be monitored for quality assurance purposes). The guidance document may be used to support colonoscopy quality assurance programs to improve the quality of colonoscopy regardless of indication. Improvements in colonoscopy quality are anticipated to improve important outcomes in digestive diseases, such as reduction of the incidence of and mortality from CRC. PMID:24839621

Improving Physician Recommendations for Human Papillomavirus Vaccination: The Role of Professional Organizations.

PubMed

Hswen, Yulin; Gilkey, Melissa B; Rimer, Barbara K; Brewer, Noel T

2017-01-01

To address low human papillomavirus (HPV) vaccination coverage, the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have launched national campaigns encouraging physicians to deliver strong HPV vaccine recommendations. We surveyed family physicians and pediatricians to examine the impact of these efforts on physicians' recommendation practices. A national sample of family physicians and pediatricians (n = 776) completed our online survey in 2014. The survey assessed reach, content, and influence of AAFP and AAP communications about HPV vaccination. The survey also assessed quality of physicians' communication practices for recommending HPV vaccination. Forty-seven percent of family physicians reported receiving information on HPV vaccination from AAFP, whereas 62% of pediatricians reported receiving information from AAP. Among physicians reached by AAFP or AAP, most reported receiving the message to give strong recommendations to adolescent boys (71%) and girls (78%). Although receiving information was not associated with HPV vaccine recommendation quality, receiving the message to give strong recommendations correlated with delivering higher-quality recommendations for boys (odds ratio, 4.19, 95% confidence interval, 2.64-6.64) and girls (odds ratio, 3.15, 95% confidence interval, 1.91-5.18). Over half of physicians reported improving their HPV vaccine communication after receiving information from AAFP (69%) or AAP (53%). Our findings suggest that it is important for AAFP and AAP to communicate the need for strong HPV vaccine recommendations. Given that many physicians reported improving their recommendation practices, professional organizations stand to contribute to increasing HPV vaccination coverage, but they will likely need to increase the intensity of quality improvement efforts to do so.

Manager impact on retention of hospital staff: Part 2.

PubMed

Taunton, R L; Krampitz, S D; Woods, C Q

1989-04-01

This is the second article in a two-part series based on a study of the impact of middle managers on retention of 71 hospital professionals. Research design, methods, and descriptive results were presented in Part 1 (March 1989). In Part 2, the impact of managers' motivation to manage, power, influence, and leadership style on retention is detailed. Recommendations for improving retention include interventions to increase employee job satisfaction and intent to stay, and to improve managers' performance and leadership.

Interventions to improve immigrant health. A scoping review

PubMed Central

Ortiz-Barreda, Gaby; Ben-Shlomo, Yoav; Holdsworth, Michelle; Salami, Bukola; Rammohan, Anu; Chung, Roger Yat-Nork; Padmadas, Sabu S.; Krafft, Thomas

2017-01-01

Abstract Background: Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. Aims: To conduct a systematic search of the literature evaluating health interventions for immigrants; to map the characteristics of identified studies including range of interventions, immigrant populations and their host countries, clinical areas targeted and reported evaluations, challenges and limitations of the interventions identified. Following the results, to develop recommendations for research in the field. Methods: A scoping review approach was chosen to provide an overview of the type, extent and quantity of research available. Studies were included if they empirically evaluated health interventions targeting immigrants and/or their descendants, included a control group, and were published in English (PubMed and Embase from 1990 to 2015). Results: Most of the 83 studies included were conducted in the USA, encompassed few immigrant groups and used a randomized controlled trial (RCT) or cluster RCT design. Most interventions addressed chronic and non-communicable diseases and attendance at cancer screening services, used individual targeted approaches, targeted adult women and recruited participants from health centres. Outcome measures were often subjective, with the exception of interventions for cardiovascular risk and diabetes. Generally, authors claimed that interventions were beneficial, despite a number of reported limitations. Conclusions: Recommendations for enhancing interventions to improve immigrant health are provided to help researchers, funders and health care commissioners when deciding upon the scope, nature and design of future research in this area. PMID:28339883

Effect of recent popularity on heat-conduction based recommendation models

NASA Astrophysics Data System (ADS)

Li, Wen-Jun; Dong, Qiang; Shi, Yang-Bo; Fu, Yan; He, Jia-Lin

2017-05-01

Accuracy and diversity are two important measures in evaluating the performance of recommender systems. It has been demonstrated that the recommendation model inspired by the heat conduction process has high diversity yet low accuracy. Many variants have been introduced to improve the accuracy while keeping high diversity, most of which regard the current node-degree of an item as its popularity. However in this way, a few outdated items of large degree may be recommended to an enormous number of users. In this paper, we take the recent popularity (recently increased item degrees) into account in the heat-conduction based methods, and propose accordingly the improved recommendation models. Experimental results on two benchmark data sets show that the accuracy can be largely improved while keeping the high diversity compared with the original models.

Newborn screening: A disease-changing intervention for glutaric aciduria type 1.

PubMed

Boy, Nikolas; Mengler, Katharina; Thimm, Eva; Schiergens, Katharina A; Marquardt, Thorsten; Weinhold, Natalie; Marquardt, Iris; Das, Anibh M; Freisinger, Peter; Grünert, Sarah C; Vossbeck, Judith; Steinfeld, Robert; Baumgartner, Matthias R; Beblo, Skadi; Dieckmann, Andrea; Näke, Andrea; Lindner, Martin; Heringer, Jana; Hoffmann, Georg F; Mühlhausen, Chris; Maier, Esther M; Ensenauer, Regina; Garbade, Sven F; Kölker, Stefan

2018-05-01

Untreated individuals with glutaric aciduria type 1 (GA1) commonly present with a complex, predominantly dystonic movement disorder (MD) following acute or insidious onset striatal damage. Implementation of GA1 into newborn screening (NBS) programs has improved the short-term outcome. It remains unclear, however, whether NBS changes the long-term outcome and which variables are predictive. This prospective, observational, multicenter study includes 87 patients identified by NBS, 4 patients missed by NBS, and 3 women with GA1 identified by positive NBS results of their unaffected children. The study population comprises 98.3% of individuals with GA1 identified by NBS in Germany during 1999-2016. Overall, cumulative sensitivity of NBS is 95.6%, but it is lower (84%) for patients with low excreter phenotype. The neurologic outcome of patients missed by NBS is as poor as in the pre-NBS era, and the clinical phenotype of diagnosed patients depends on the quality of therapeutic interventions rather than noninterventional variables. Presymptomatic start of treatment according to current guideline recommendations clearly improves the neurologic outcome (MD: 7% of patients), whereas delayed emergency treatment results in acute onset MD (100%), and deviations from maintenance treatment increase the risk of insidious onset MD (50%). Independent of the neurologic phenotype, kidney function tends to decline with age, a nonneurologic manifestation not predicted by any variable included in this study. NBS is a beneficial, disease-changing intervention for GA1. However, improved neurologic outcome critically depends on adherence to recommended therapy, whereas kidney dysfunction does not appear to be impacted by recommended therapy. Ann Neurol 2018;83:970-979. © 2018 American Neurological Association.

Reflections on bird and mammal risk assessment for plant protection products in the European Union: Past, present, and future.

PubMed

Brooks, Amy C; Fryer, Mike; Lawrence, Alan; Pascual, Juan; Sharp, Rachel

2017-03-01

The use of plant protection products on agricultural crops can result in exposure of birds and mammals to toxic chemicals. In the European Union, the risks from such exposures are assessed under the current (2009) guidance document from the European Food Safety Authority (EFSA), designed to increase the realism of the theoretical risk assessments in comparison to its predecessor (SANCO/4145/2000). Since its adoption over 7 yr ago, many plant protection products have been evaluated successfully using the 2009 EFSA guidance document. However, there are still significant areas of improvement recommended for future revisions of this guidance. The present Focus article discusses experiences to date with the current scheme, including levels of conservatism in input parameters and interpretation by regulatory authorities together with proposals for how the guidance document could be improved when it is revised in the not too distant future. Several areas for which further guidance is recommended have been identified, such as the derivation of ecologically relevant bird and mammal reproductive endpoints and the use of modeling approaches to contextualize risk assessments. Areas where existing databases could be improved were also highlighted, including the collation of relevant focal species across Europe and expansion of the residue database for food items. To produce a realistic and useable guidance document in the future, it is strongly recommended that there is open and constructive communication between industry, regulatory authorities, and the EFSA. Such collaboration would also encourage harmonization between member states, thus reducing workloads for both industry and regulatory authorities. Environ Toxicol Chem 2017;36:565-575. © 2017 SETAC. © 2017 SETAC.

Androgen deprivation therapy for prostate cancer: recommendations to improve patient and partner quality of life.

PubMed

Elliott, Stacy; Latini, David M; Walker, Lauren M; Wassersug, Richard; Robinson, John W

2010-09-01

Because of improved prostate cancer detection, more patients begin androgen deprivation therapy (ADT) earlier and remain on it longer than before. Patients now may be androgen deprived for over a decade, even when they are otherwise free of cancer symptoms. An ADT Survivorship Working Group was formed to develop and evaluate interventions to limit the physiological and emotional trauma patients and their partners experience from this treatment. The multidisciplinary Working Group met for 2 days to define the challenges couples face when patients commence ADT. A writing sub-group was formed. It compiled the meeting's proceedings, reviewed the literature and, in consultation with the other members of the working group, wrote the manuscript. Expert opinion of the side effects of ADT that affect the quality of life (QOL) of patients and their partners and the recommendations for managing ADT to optimize QOL were based on the best available literature, clinical experience, and widespread internal discussions among Working Group members. Side effects identified as particularly challenging include: (i) body feminization; (ii) changes in sexual performance; (iii) relationship changes; (iv) cognitive and affective symptoms; and (v) fatigue, sleep disturbance, and depression. Recommendations for managing ADT include providing information about ADT side effects before administration of ADT, and, where appropriate, providing referrals for psychosocial support. Sexual rehabilitation principles for persons with chronic illness may prove useful. Psychological interventions for sexual sequelae need to be offered and individualized to patients, regardless of their age or partnership. Support should also be offered to partners. Our hope is that this plan will serve as a guide for optimizing how ADT is carried out and improve the lives of androgen-deprived men and their intimate partners. © 2010 International Society for Sexual Medicine.

Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology.

PubMed

Buch, Maya H; Silva-Fernandez, Lucia; Carmona, Loreto; Aletaha, Daniel; Christensen, Robin; Combe, Bernard; Emery, Paul; Ferraccioli, Gianfranco; Guillemin, Francis; Kvien, Tore K; Landewe, Robert; Pavelka, Karel; Saag, Kenneth; Smolen, Josef S; Symmons, Deborah; van der Heijde, Désirée; Welling, Joep; Wells, George; Westhovens, Rene; Zink, Angela; Boers, Maarten

2015-06-01

Our initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports. We formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A '0-10' agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance. Seven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations. This EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Professionals’ Recommended Strategies to Improve Australian Adolescents’ Knowledge of Nutrition and Food Systems

PubMed Central

Sadegholvad, Sanaz; Yeatman, Heather; Parrish, Anne-Maree; Worsley, Anthony

2017-01-01

Background: Education and policy measures within schools are valuable strategies to promote health. This study explored views of experienced food-related educators, researchers and policy-makers regarding their recommended strategies to improve Australian adolescents’ knowledge of nutrition and food systems (N&FS). Methods: Semi-structured interviews were conducted with twenty-one experienced food-related experts from across Australia. Interviews were conducted either by telephone or face-to-face. Recorded interviews were transcribed verbatim and analyzed thematically. Results: Five central themes and five sub-themes were identified from food professionals’ suggestions for best strategies to improve adolescents’ knowledge of N&FS. The central themes included: (1) specific improvements in schools’ core curricula; (2) pre-service and in-service training of school teachers about N&FS; (3) training students to develop a critical mind about N&FS issues; (4) multidisciplinary collaborations to improve school-based N&FS education; and (5) a supportive N&FS education environment for students. Conclusion and implication: These findings provide a guide for curriculum developers, educational policy developers, and food educators to incorporate the suggested N&FS strategies into Australian education programs in order to improve Australian adolescents’ knowledge and skills of N&FS issues. The results of this investigation also may assist the development of international N&FS curricula guides. PMID:28783108

Professionals' Recommended Strategies to Improve Australian Adolescents' Knowledge of Nutrition and Food Systems.

PubMed

Sadegholvad, Sanaz; Yeatman, Heather; Parrish, Anne-Maree; Worsley, Anthony

2017-08-07

Education and policy measures within schools are valuable strategies to promote health. This study explored views of experienced food-related educators, researchers and policy-makers regarding their recommended strategies to improve Australian adolescents' knowledge of nutrition and food systems (N&FS). Semi-structured interviews were conducted with twenty-one experienced food-related experts from across Australia. Interviews were conducted either by telephone or face-to-face. Recorded interviews were transcribed verbatim and analyzed thematically. Five central themes and five sub-themes were identified from food professionals' suggestions for best strategies to improve adolescents' knowledge of N&FS. The central themes included: (1) specific improvements in schools' core curricula; (2) pre-service and in-service training of school teachers about N&FS; (3) training students to develop a critical mind about N&FS issues; (4) multidisciplinary collaborations to improve school-based N&FS education; and (5) a supportive N&FS education environment for students. These findings provide a guide for curriculum developers, educational policy developers, and food educators to incorporate the suggested N&FS strategies into Australian education programs in order to improve Australian adolescents' knowledge and skills of N&FS issues. The results of this investigation also may assist the development of international N&FS curricula guides.

Quality improvement in breast cancer project: compliance with antiresorptive agents and changing patterns of drug use.

PubMed

Borden, Charles P; Shapiro, Charles L; Ramirez, Maria Teresa; Kotur, Linda; Farrar, William

2014-02-01

The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute participated in NCCN's Quality Improvement in Breast Cancer initiative. The Opportunities for Improvement (OFI) team elected to improve concordance with the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer recommendation that all patients diagnosed with skeletal metastases receive bisphosphonates. Assembling a multidisciplinary team of clinicians, researchers, and administrative stakeholders, the OFI team followed Six Sigma's approach to problem-solving known as DMAIC (define, measure, analyze, improve, and control). Baseline concordance was 79%, which was below the recommended target range. Initial analysis quickly revealed that 5 cases were concordant, resulting in a new baseline of 89%. The key root cause identified for the remaining gap was lack of documentation. The solution included education regarding documentation for existing staff, in addition to hard-wiring the material into new physician orientation, discussion of all patients with bone disease at tumor board meetings, and improved consistency with use of the new electronic medical record system. After implementation, the reported concordance was 92%, and the lack of documentation problem decreased from 11% in the baseline study to 6%. The team concluded that use of the NCCN Oncology Outcomes Database as an opportunity for clinical quality improvement initiatives not only is possible but also should be an essential element of any clinical program looking to continuously improve.

Synthesis: Deriving a Core Set of Recommendations to Optimize Diabetes Care on a Global Scale.

PubMed

Mechanick, Jeffrey I; Leroith, Derek

2015-01-01

Diabetes afflicts 382 million people worldwide, with increasing prevalence rates and adverse effects on health, well-being, and society in general. There are many drivers for the complex presentation of diabetes, including environmental and genetic/epigenetic factors. The aim was to synthesize a core set of recommendations from information from 14 countries that can be used to optimize diabetes care on a global scale. Information from 14 papers in this special issue of Annals of Global Health was reviewed, analyzed, and sorted to synthesize recommendations. PubMed was searched for relevant studies on diabetes and global health. Key findings are as follows: (1) Population-based transitions distinguish region-specific diabetes care; (2) biological drivers for diabetes differ among various populations and need to be clarified scientifically; (3) principal resource availability determines quality-of-care metrics; and (4) governmental involvement, independent of economic barriers, improves the contextualization of diabetes care. Core recommendations are as follows: (1) Each nation should assess region-specific epidemiology, the scientific evidence base, and population-based transitions to establish risk-stratified guidelines for diagnosis and therapeutic interventions; (2) each nation should establish a public health imperative to provide tools and funding to successfully implement these guidelines; and (3) each nation should commit to education and research to optimize recommendations for a durable effect. Systematic acquisition of information about diabetes care can be analyzed, extrapolated, and then used to provide a core set of actionable recommendations that may be further studied and implemented to improve diabetes care on a global scale. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

BWR Servicing and Refueling Improvement Program: Phase I summary report

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

Perry, D.R.

1978-09-01

Under the U.S. Department of Energy sponsorship, General Electric Co. (GE) undertook a study of boiling water reactor (BWR) refueling outages for the purpose of recommending the development and demonstration of critical path time savings improvements. The Tennessee Valley Authority (TVA) joined the study as a subcontractor, providing monitoring assistance and making the Browns Ferry Site available for improvement demonstrations. Agreement was also reached with Georgia Power Co., Power Authority of the State of New York, and Commonwealth Edison Co. for monitoring and data collection at Hatch 1, FitzPatrick, and Quad Cities 1 nuclear plants, respectively. The objective was tomore » identify, develop, and demonstrate improved refueling, maintenance, and inspection procedures and equipment. The improvements recommended in this study are applicable to BWR nuclear plants currently in operation as well as those in the design and construction phases. The recommendations and outage information can be used as a basis to plan and conduct the first outages of new plants and to improve the planning and facilities of currently operating plants. Many of the recommendations can readily be incorporated in plants currently in the design and construction phases as well as in the design of future plants. Many of these recommended improvements can be implemented immediately by utilities without further technical development.« less

ÉPICO project. Development of educational recommendations using the DELPHI technique on invasive candidiasis in non-neutropenic critically ill adult patients.

PubMed

Zaragoza, R; Llinares, P; Maseda, E; Ferrer, R; Rodríguez, A

2013-01-01

Although there has been an improved management of invasive candidiasis in the last decade, controversial issues still remain, especially in the diagnostic and therapeutic approaches. We sought to identify the core clinical knowledge and to achieve high level agreement recommendations required to care for critically ill adult patients with invasive candidiasis. A prospective Spanish survey reaching consensus by the DELPHI technique was made. It was anonymously conducted by electronic mail in a first term to 25 national multidisciplinary experts in invasive fungal infections from five national scientific societies, including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious diseases specialists, who answered to 47 questions prepared by a coordination group after a strict review of the literature in the last five years. The educational objectives spanned five categories, including epidemiology, diagnostic tools, prediction rules, and treatment and de-escalation approaches. The level of agreement achieved among the panel experts in each item should exceed 75% to be selected. In a second term, after extracting recommendations from the selected items, a face to face meeting was performed where more than 80 specialists in a second round were invited to validate the preselected recommendations. In the first term, 20 recommendations were preselected (Epidemiology 4, Scores 3, Diagnostic tools 4, Treatment 6 and De-escalation approaches 3). After the second round, the following 12 were validated: (1) Epidemiology (2 recommendations): think about candidiasis in your Intensive Care Unit (ICU) and do not forget that non-Candida albicans-Candida species also exist. (2) Diagnostic tools (4 recommendations): blood cultures should be performed under suspicion every 2-3 days and, if positive, every 3 days until obtaining the first negative result. Obtain sterile fluid and tissue, if possible (direct examination of the sample is important). Use non-culture based methods as microbiological tools, whenever possible. Determination of antifungal susceptibility is mandatory. (3) Scores (1 recommendation): as screening tool, use the Candida Score and determine multicolonization in high risk patients. (4) Treatment (4 recommendations): start early. Choose echinocandins. Withdraw any central venous catheter. Fundoscopy is needed. (5) De-escalation (1 recommendation): only applied when knowing susceptibility determinations and after 3 days of clinical stability. The higher rate of agreement was achieved in the optimization of microbiological tools and the withdrawal of the catheter, whereas the lower rate corresponded to de-escalation therapy and the use of scores. The management of invasive candidiasis in ICU patients requires the application of a broad range of knowledge and skills that we summarize in our recommendations. These recommendations may help to identify the potential patients, standardize their global management and improve their outcomes, based on the DELPHI methodology. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

[Épico project: Development of educational recommendations using the DELPHI technique on invasive candidiasis in non-neutropenic critically ill adult patients. Grupo Proyecto Épico].

PubMed

Zaragoza, Rafael; Llinares, Pedro; Maseda, Emilio; Ferrer, Ricard; Rodríguez, Alejandro

2013-01-01

Although there has been an improved management of invasive candidiasis in the last decade, controversial issues still remain, especially in the diagnostic and therapeutic approaches. We sought to identify the core clinical knowledge and to achieve high level agreement recommendations required to care for critically ill adult patients with invasive candidiasis. A prospective Spanish survey reaching consensus by the DELPHI technique was made. It was anonymously conducted by electronic mail in a first term to 25 national multidisciplinary experts in invasive fungal infections from five national scientific societies, including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious diseases specialists, who answered to 47 questions prepared by a coordination group after a strict review of the literature in the last five years. The educational objectives spanned five categories, including epidemiology, diagnostic tools, prediction rules, and treatment and de-escalation approaches. The level of agreement achieved among the panel experts in each item should exceed 75% to be selected. In a second term, after extracting recommendations from the selected items, a face to face meeting was performed where more than 80 specialists in a second round were invited to validate the preselected recommendations. In the first term, 20 recommendations were preselected (Epidemiology 4, Scores 3, Diagnostic tools 4, Treatment 6 and De-escalation approaches 3). After the second round, the following 12 were validated: (1) Epidemiology (2 recommendations): think about candidiasis in your Intensive Care Unit (ICU) and do not forget that non-Candida albicans-Candida species also exist. (2) Diagnostic tools (4 recommendations): blood cultures should be performed under suspicion every 2-3 days and, if positive, every 3 days until obtaining the first negative result. Obtain sterile fluid and tissue, if possible (direct examination of the sample is important). Use non-culture based methods as microbiological tools, whenever possible. Determination of antifungal susceptibility is mandatory. (3) Scores (1 recommendation): as screening tool, use the Candida Score and determine multicolonization in high risk patients. (4) Treatment (4 recommendations): start early. Choose echinocandins. Withdraw any central venous catheter. Fundoscopy is needed. (5) De-escalation (1 recommendation): only applied when knowing susceptibility determinations and after 3 days of clinical stability. The higher rate of agreement was achieved in the optimization of microbiological tools and the withdrawal of the catheter, whereas the lower rate corresponded to de-escalation therapy and the use of scores. The management of invasive candidiasis in ICU patients requires the application of a broad range of knowledge and skills that we summarize in our recommendations. These recommendations may help to identify the potential patients, standardize their global management and improve their outcomes, based on the DELPHI methodology. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

Épico Project. Development of educational recommendations using the DELPHI technique on invasive candidiasis in non-neutropenic critically ill adult patients.

PubMed

Zaragoza, Rafael; Llinares, Pedro; Maseda, Emilio; Ferrer, Ricard; Rodríguez, Alejandro

2013-01-01

Although there has been an improved management of invasive candidiasis in the last decade, controversial issues still remain, especially in the diagnostic and therapeutic approaches. We sought to identify the core clinical knowledge and to achieve high level agreement recommendations required to care for critically ill adult patients with invasive candidiasis. A prospective Spanish survey reaching consensus by the DELPHI technique was made. It was anonymously conducted by electronic mail in a first term to 25 national multidisciplinary experts in invasive fungal infections from five national scientific societies, including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious diseases specialists, who answered to 47 questions prepared by a coordination group after a strict review of the literature in the last five years. The educational objectives spanned five categories, including epidemiology, diagnostic tools, prediction rules, and treatment and de-escalation approaches. The level of agreement achieved among the panel experts in each item should exceed 75% to be selected. In a second term, after extracting recommendations from the selected items, a face to face meeting was performed where more than 80 specialists in a second round were invited to validate the preselected recommendations. In the first term, 20 recommendations were preselected (Epidemiology 4, Scores 3, Diagnostic tools 4, Treatment 6 and De-escalation approaches 3). After the second round, the following 12 were validated: (1) Epidemiology (2 recommendations): think about candidiasis in your Intensive Care Unit (ICU) and do not forget that non-Candida albicans-Candida species also exist. (2) Diagnostic tools (4 recommendations): blood cultures should be performed under suspicion every 2-3 days and, if positive, every 3 days until obtaining the first negative result. Obtain sterile fluid and tissue, if possible (direct examination of the sample is important). Use non-culture based methods as microbiological tools, whenever possible. Determination of antifungal susceptibility is mandatory. (3) Scores (1 recommendation): as screening tool, use the Candida Score and determine multicolonization in high risk patients. (4) Treatment (4 recommendations): start early. Choose echinocandins. Withdraw any central venous catheter. Fundoscopy is needed. (5) De-escalation (1 recommendation): only applied when knowing susceptibility determinations and after 3 days of clinical stability. The higher rate of agreement was achieved in the optimization of microbiological tools and the withdrawal of the catheter, whereas the lower rate corresponded to de-escalation therapy and the use of scores. The management of invasive candidiasis in ICU patients requires the application of a broad range of knowledge and skills that we summarize in our recommendations. These recommendations may help to identify the potential patients, standardize their global management and improve their outcomes, based on the DELPHI methodology. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

Omission of Dysphagia Therapies in Hospital Discharge Communications

PubMed Central

Kind, Amy; Anderson, Paul; Hind, Jacqueline; Robbins, JoAnne; Smith, Maureen

2009-01-01

Background Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. Objective To examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk sub-acute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. Design Retrospective cohort study Subjects All stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to sub-acute care in 2003-2005 from a single large academic medical center (N=187). Measurements Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included: dietary (food and liquid), postural/compensatory techniques (e.g., chin-tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Results 45% of discharge summaries omitted all SLP dysphagia recommendations. 47%(88/186) of patients with SLP dietary recommendations, 82%(93/114) with postural, 100%(16/16) with rehabilitation, 90%(69/77) with meal pacing, 95%(21/22) with medication, and 79%(96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Conclusions Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to sub-acute care. PMID:20098999

Good practices for real-world data studies of treatment and/or comparative effectiveness: Recommendations from the joint ISPOR-ISPE Special Task Force on real-world evidence in health care decision making.

PubMed

Berger, Marc L; Sox, Harold; Willke, Richard J; Brixner, Diana L; Eichler, Hans-Georg; Goettsch, Wim; Madigan, David; Makady, Amr; Schneeweiss, Sebastian; Tarricone, Rosanna; Wang, Shirley V; Watkins, John; Daniel Mullins, C

2017-09-01

Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders. © 2017 The Authors. Pharmacoepidemiology & Drug Safety published by John Wiley & Sons Ltd.

Policy Interpretation Network on Children's Health and Environment.

PubMed

van den Hazel, Peter; Zuurbier, Moniek; Bistrup, Marie Louise

2006-10-01

The main objective of PINCHE is to provide policy recommendations aiming at protecting children's health and environment based on completed scientific research. The project focused on four themes: indoor and outdoor air pollutants, carcinogens, neurotoxicants, and noise. The data were evaluated in workpackages on exposure assessment, epidemiology, toxicology, and risk and health impact assessment. The data were analysed according to a framework of questions. The workpackage on socioeconomic factors studied the influence of socioeconomic status on exposures and on health effects. In the workpackage on science-policy interface, recommendations on how to improve children's environmental health were formulated. The policy recommendations resulting from the analysis were grouped according to relevant policy levels: European Commission or the European Parliament, member states and other stakeholders at regional or local level. These recommendations are general guidelines for taking action. Regional differences and variation must be reflected when policy is actually implemented. In addition, recommendations related to education and personal behaviour are presented in the reports. The policy recommendations are important input for policy advisers, policy makers and public health authorities at all policy levels. The recommendations are also of direct relevance to interest groups, such as environmental NGOs including child health and advocacy groups. The policy recommendations for each policy level were prioritized. High priorities were given to reduce exposure to environmental tobacco smoke, transport related air pollution, indoor air and mercury.

Applications of fuzzy ranking methods to risk-management decisions

NASA Astrophysics Data System (ADS)

Mitchell, Harold A.; Carter, James C., III

1993-12-01

The Department of Energy is making significant improvements to its nuclear facilities as a result of more stringent regulation, internal audits, and recommendations from external review groups. A large backlog of upgrades has resulted. Currently, a prioritization method is being utilized which relies on a matrix of potential consequence and probability of occurrence. The attributes of the potential consequences considered include likelihood, exposure, public health and safety, environmental impact, site personnel safety, public relations, legal liability, and business loss. This paper describes an improved method which utilizes fuzzy multiple attribute decision methods to rank proposed improvement projects.

Demonstration of the Health Literacy Universal Precautions Toolkit

PubMed Central

Mabachi, Natabhona M.; Cifuentes, Maribel; Barnard, Juliana; Brega, Angela G.; Albright, Karen; Weiss, Barry D.; Brach, Cindy; West, David

2016-01-01

The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements. PMID:27232681

Where we are today: prioritizing women's health services and health policy. A report by the Women's Health Expert Panel of the American Academy of Nursing.

PubMed

Berg, Judith A; Taylor, Diana; Woods, Nancy Fugate

2013-01-01

There has been a recent resurgence of interest in women's health as evidenced by several federal and international policy-shaping reports that will impact women's health services. These reports include the 2010 Affordable Care Act, the formation of the National Prevention Council and Strategy, the 2011 IOM report on clinical preventives services for women, and the World Health Organization strategic plan for 2010-2015. In this paper, we summarize and discuss these reports and discuss implications of enacting the suggested health policies. We highlight policy strategies and recommendations that will extend national and global recommendations to improve women's health and wellness across the lifespan and emphasize the urgent need for preventive services. We conclude this paper by detailing our broad recommendations for putting prevention into practice illustrated by specific recommendations related to unintended pregnancy prevention and management. Copyright © 2013 Elsevier Inc. All rights reserved.

The Global Engagement in Care Convening: Recommended Actions to Improve Health Outcomes for People Living With HIV.

PubMed

Maulsby, C; Valdiserri, R O; Kim, J J; Mahon, N; Flynn, A; Eriksson, E; Jain, K M; Enobun, Blessing; Holtgrave, D R

2016-10-01

The National HIV AIDS Strategy (NHAS) calls for a more coordinated response to the HIV epidemic. The Global Engagement in Care Convening created a forum for domestic and international experts to identify best practices in HIV care. This manuscript summarizes the meeting discussions and recommendations from meeting notes and an audio recording of the meeting. Recommendations include: further standardization of performance goals and performance measures; additional research; a more robust system to support competing needs of clients receiving services; electronic information exchanges for HIV-related data; an expansion of the role of other health professionals to extend the capacity of physicians and other members of the care team; and revisions to current financing systems to increase reimbursement for and access to services that promote linkage to and retention in HIV care. The recommendations provide a unique example of "reverse technical assistance" and will inform U.S. program development, research, and policy.

Information Filtering via a Scaling-Based Function

PubMed Central

Qiu, Tian; Zhang, Zi-Ke; Chen, Guang

2013-01-01

Finding a universal description of the algorithm optimization is one of the key challenges in personalized recommendation. In this article, for the first time, we introduce a scaling-based algorithm (SCL) independent of recommendation list length based on a hybrid algorithm of heat conduction and mass diffusion, by finding out the scaling function for the tunable parameter and object average degree. The optimal value of the tunable parameter can be abstracted from the scaling function, which is heterogeneous for the individual object. Experimental results obtained from three real datasets, Netflix, MovieLens and RYM, show that the SCL is highly accurate in recommendation. More importantly, compared with a number of excellent algorithms, including the mass diffusion method, the original hybrid method, and even an improved version of the hybrid method, the SCL algorithm remarkably promotes the personalized recommendation in three other aspects: solving the accuracy-diversity dilemma, presenting a high novelty, and solving the key challenge of cold start problem. PMID:23696829

[Hygiene in otorhinolaryngology: Requirements and reality].

PubMed

Jager, E; Heudorf, U

2015-12-01

Considering the physiological contamination of skin and mucous membranes in the ear, nose, and throat region by facultative pathogen microorganisms, as well as the increase in multidrug resistant organisms (MDRO), it is mandatory that hygienic procedures be observed in ENT institutions, in order to prevent transmission of bacteria and infections in patients. General guidelines for hygiene in otorhinolaryngology are presented based on the recommendations published by the German Commission on Hospital Hygiene and Infection Prevention (KRINKO). These encompass hand hygiene, surface disinfection, and reprocessing of medical devices. The correct reprocessing of the various components of ENT treatment units (including endoscopes, water bearing systems) is reported. Although law requires and KRINKO recommends that manufacturers of medical devices publish instructions for reprocessing their products, these reprocessing recommendations are often insufficient. Manufacturers should thus be called upon to improve their recommendations. In this paper, the requirements for handling of ENT treatment units are compared with the observations made by the Public Health Department in 7 ENT clinics and 32 ENT practices in Frankfurt/Main, Germany, in 2014.

Who Will Teach Our Children? A Strategy for Improving California's Schools. The Report of the California Commission on the Teaching Profession.

ERIC Educational Resources Information Center

California Commission on the Teaching Profession, Sacramento.

This report sets forth 27 recommendations by the California Commission on the Teaching Profession for improving California schools. After an outline summary of the recommendations and an introductory discussion of education as California's "growth industry," the recommendations are presented according to three general topic areas. The…

Improving the Financial Aid Delivery Process and the Federal Family Education Loan Program: Program Recommendations.

ERIC Educational Resources Information Center

Coalition for Student Loan Reform, Washington, DC.

This publication presents a set of eight recommended reforms and improvements for delivering financial aid to postsecondary students especially the Federal Family Education Loan Program (FFELP). The recommendations are: (1) make applying for student aid simpler for students; (2) assure the continued availability of a dependable, reliable source of…

Improving Conduct and Feasibility of Clinical Trials to Evaluate Antibacterial Drugs to Treat Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia: Recommendations of the Clinical Trials Transformation Initiative Antibacterial Drug Development Project Team.

PubMed

Knirsch, Charles; Alemayehu, Demissie; Botgros, Radu; Comic-Savic, Sabrina; Friedland, David; Holland, Thomas L; Merchant, Kunal; Noel, Gary J; Pelfrene, Eric; Reith, Christina; Santiago, Jonas; Tiernan, Rosemary; Tenearts, Pamela; Goldsack, Jennifer C; Fowler, Vance G

2016-08-15

The etiology of hospital-acquired or ventilator-associated bacterial pneumonia (HABP/VABP) is often multidrug-resistant infections. The evaluation of new antibacterial drugs for efficacy in this population is important, as many antibacterial drugs have demonstrated limitations when studied in this population. HABP/VABP trials are expensive and challenging to conduct due to protocol complexity and low patient enrollment, among other factors. The Clinical Trials Transformation Initiative (CTTI) seeks to advance antibacterial drug development by streamlining HABP/VABP clinical trials to improve efficiency and feasibility while maintaining ethical rigor, patient safety, information value, and scientific validity. In 2013, CTTI engaged a multidisciplinary group of experts to discuss challenges impeding the conduct of HABP/VABP trials. Separate workstreams identified challenges associated with HABP/VABP protocol complexity. The Project Team developed potential solutions to streamline HABP/VABP trials using a Quality by Design approach. CTTI recommendations focus on 4 key areas to improve HABP/VABP trials: informed consent processes/practices, protocol design, choice of an institutional review board (IRB), and trial outcomes. Informed consent processes should include legally authorized representatives. Protocol design decisions should focus on eligibility criteria, prestudy antibacterial therapy considerations, use of new diagnostics, and sample size. CTTI recommends that sponsors use a central IRB and discuss trial endpoints with regulators, including defining a clinical failure and evaluating the impact of concomitant antibacterial drugs. Streamlining HABP/VABP trials by addressing key protocol elements can improve trial startup and patient recruitment/retention, reduce trial complexity and costs, and ensure patient safety while advancing antibacterial drug development. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.

PubMed

Moran, Neil F; Naidoo, Mergan; Moodley, Jagidesa

2015-11-01

Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors Associated with Effective Nutrition Interventions for Pregnant Indigenous Women: A Systematic Review.

PubMed

Ashman, Amy M; Brown, Leanne J; Collins, Clare E; Rollo, Megan E; Rae, Kym M

2017-08-01

Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously. The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries, and to identify positive factors contributing to successful programs. Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively. Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia, Canada, and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2), peer counselor (n=3), or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3). Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes, as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Syrian Refugee Women’s Health in Lebanon, Turkey, and Jordan and Recommendations for Improved Practice

PubMed Central

Samari, Goleen

2017-01-01

Since 2011, an estimated nine million Syrian refugees have fled to neighboring countries, and over four million have fled to neighboring countries of Lebanon, Turkey, and Jordan. Seventy five percent of Syrian refugees are women and children. In times of conflict, women’s health disproportionately suffers. Based on an assessment of academic literature and international policy and development reports, this study explores the vulnerabilities of Syrian women and girls in Lebanon, Turkey, and Jordan, and how these countries approach Syrian refugee women’s health care. In all settings, sexual and gender-based violence, reduced use of modern contraceptives, menstrual irregularity, unplanned pregnancies, preterm birth, and infant morbidity are ongoing issues. Recommendations for improved practice include taking a multilevel approach to eliminate social and service delivery barriers that prevent access to care, conducting thorough needs assessments, and creating policy and programmatic solutions that establish long term care for Syrian refugee women. PMID:29051840

Guidelines for surgeons on establishing projects in low-income countries.

PubMed

Grimes, Caris E; Maraka, Jane; Kingsnorth, Andrew N; Darko, Rudolph; Samkange, Christopher A; Lane, Robert H S

2013-06-01

There is increasing interest by surgeons in high-income countries to support colleagues in low-income countries to improve the provision of surgical care, particularly in rural areas. Such interest may be demonstrated by single individuals, short-term surgical missions, or establishment of partnerships. Such altruistic efforts may cause problems unless properly planned and carried out. We reviewed the available literature and consulted widely to establish consensus guidelines for any surgeon considering participating in an initiative to improve surgical care in low-income countries. A series of recommendations is presented. These include ensuring that projects are appropriate, that there is an emphasis on training local healthcare providers in all aspects of perioperative care, that outcomes are monitored, and that initiatives work with local and regional training programs. With adherence to these recommendations, we hope that future partnerships and missions can maximize their effectiveness and minimize the risks of potential harm done.

Canadian Association of Gastroenterology policy on the application for, and implementation of, clinical practice guidelines

PubMed Central

Singh, Harminder; Leontiadis, Grigorios I; Hookey, Lawrence; Enns, Robert; Bistritz, Lana; Rioux, Louis-Charles; Hope, Louise; Sinclair, Paul

2014-01-01

An important mandate of the Canadian Association of Gastroenterology (CAG), as documented in the Association’s governance policies, is to optimize the care of patients with digestive disorders. Clinical practice guidelines are one means of achieving this goal. The benefits of timely, high-quality and evidenced-based recommendations include: Enhancing the professional development of clinical members through education and dissemination of synthesized clinical research;Improving patient care provided by members by providing focus on quality and evidence;Creating legislative environments that favour effective clinical practice;Enhancing the clinical care provided to patients with digestive disease by nongastroenterologists; andIdentifying areas that require further information or research to improve clinical care.The present document provides the foundation required to ensure that clinical practice guidelines produced by the CAG are necessary, appropriate, credible and applicable. These recommendations should be adhered to as closely as possible to obtain CAG endorsement. PMID:25314352

Canadian Association of Gastroenterology policy on the application for, and implementation of, clinical practice guidelines.

PubMed

Singh, Harminder; Leontiadis, Grigorios I; Hookey, Lawrence; Enns, Robert; Bistritz, Lana; Rioux, Louis-Charles; Hope, Louise; Sinclair, Paul

2014-10-01

An important mandate of the Canadian Association of Gastroenterology (CAG), as documented in the Association's governance policies, is to optimize the care of patients with digestive disorders. Clinical practice guidelines are one means of achieving this goal. The benefits of timely, high-quality and evidenced-based recommendations include: Enhancing the professional development of clinical members through education and dissemination of synthesized clinical research; Improving patient care provided by members by providing focus on quality and evidence; Creating legislative environments that favour effective clinical practice; Enhancing the clinical care provided to patients with digestive disease by nongastroenterologists; and Identifying areas that require further information or research to improve clinical care. The present document provides the foundation required to ensure that clinical practice guidelines produced by the CAG are necessary, appropriate, credible and applicable. These recommendations should be adhered to as closely as possible to obtain CAG endorsement.

Extracting the Information Backbone in Online System

PubMed Central

Zhang, Qian-Ming; Zeng, An; Shang, Ming-Sheng

2013-01-01

Information overload is a serious problem in modern society and many solutions such as recommender system have been proposed to filter out irrelevant information. In the literature, researchers have been mainly dedicated to improving the recommendation performance (accuracy and diversity) of the algorithms while they have overlooked the influence of topology of the online user-object bipartite networks. In this paper, we find that some information provided by the bipartite networks is not only redundant but also misleading. With such “less can be more” feature, we design some algorithms to improve the recommendation performance by eliminating some links from the original networks. Moreover, we propose a hybrid method combining the time-aware and topology-aware link removal algorithms to extract the backbone which contains the essential information for the recommender systems. From the practical point of view, our method can improve the performance and reduce the computational time of the recommendation system, thus improving both of their effectiveness and efficiency. PMID:23690946

Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage.

PubMed

Carson, Jeffrey L; Guyatt, Gordon; Heddle, Nancy M; Grossman, Brenda J; Cohn, Claudia S; Fung, Mark K; Gernsheimer, Terry; Holcomb, John B; Kaplan, Lewis J; Katz, Louis M; Peterson, Nikki; Ramsey, Glenn; Rao, Sunil V; Roback, John D; Shander, Aryeh; Tobian, Aaron A R

2016-11-15

More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions. The results were summarized using the Grading of Recommendations Assessment, Development and Evaluation method. For RBC transfusion thresholds, 31 RCTs included 12 587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dL). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes, including 30-day mortality, myocardial infarction, cerebrovascular accident, rebleeding, pneumonia, or thromboembolism. For RBC storage duration, 13 RCTs included 5515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes. It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level is 10 g/dL (strong recommendation, moderate quality evidence). A restrictive RBC transfusion threshold of 8 g/dL is recommended for patients undergoing orthopedic surgery, cardiac surgery, and those with preexisting cardiovascular disease (strong recommendation, moderate quality evidence). The restrictive transfusion threshold of 7 g/dL is likely comparable with 8 g/dL, but RCT evidence is not available for all patient categories. These recommendations do not apply to patients with acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk of bleeding), and chronic transfusion-dependent anemia (not recommended due to insufficient evidence). Recommendation 2: patients, including neonates, should receive RBC units selected at any point within their licensed dating period (standard issue) rather than limiting patients to transfusion of only fresh (storage length: <10 days) RBC units (strong recommendation, moderate quality evidence). Research in RBC transfusion medicine has significantly advanced the science in recent years and provides high-quality evidence to inform guidelines. A restrictive transfusion threshold is safe in most clinical settings and the current blood banking practices of using standard-issue blood should be continued.

[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.

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

PubMed Central

von Karsa, L.; Patnick, J.; Segnan, N.; Atkin, W.; Halloran, S.; Lansdorp-Vogelaar, I.; Malila, N.; Minozzi, S.; Moss, S.; Quirke, P.; Steele, R. J.; Vieth, M.; Aabakken, L.; Altenhofen, L.; Ancelle-Park, R.; Antoljak, N.; Anttila, A.; Armaroli, P.; Arrossi, S.; Austoker, J.; Banzi, R.; Bellisario, C.; Blom, J.; Brenner, H.; Bretthauer, M.; Camargo Cancela, M.; Costamagna, G.; Cuzick, J.; Dai, M.; Daniel, J.; Dekker, E.; Delicata, N.; Ducarroz, S.; Erfkamp, H.; Espinàs, J. A.; Faivre, J.; Faulds Wood, L.; Flugelman, A.; Frkovic-Grazio, S.; Geller, B.; Giordano, L.; Grazzini, G.; Green, J.; Hamashima, C.; Herrmann, C.; Hewitson, P.; Hoff, G.; Holten, I.; Jover, R.; Kaminski, M. F.; Kuipers, E. J.; Kurtinaitis, J.; Lambert, R.; Launoy, G.; Lee, W.; Leicester, R.; Leja, M.; Lieberman, D.; Lignini, T.; Lucas, E.; Lynge, E.; Mádai, S.; Marinho, J.; Maučec Zakotnik, J.; Minoli, G.; Monk, C.; Morais, A.; Muwonge, R.; Nadel, M.; Neamtiu, L.; Peris Tuser, M.; Pignone, M.; Pox, C.; Primic-Zakelj, M.; Psaila, J.; Rabeneck, L.; Ransohoff, D.; Rasmussen, M.; Regula, J.; Ren, J.; Rennert, G.; Rey, J.; Riddell, R. H.; Risio, M.; Rodrigues, V.; Saito, H.; Sauvaget, C.; Scharpantgen, A.; Schmiegel, W.; Senore, C.; Siddiqi, M.; Sighoko, D.; Smith, R.; Smith, S.; Suchanek, S.; Suonio, E.; Tong, W.; Törnberg, S.; Van Cutsem, E.; Vignatelli, L.; Villain, P.; Voti, L.; Watanabe, H.; Watson, J.; Winawer, S.; Young, G.; Zaksas, V.; Zappa, M.; Valori, R.

2015-01-01

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines. PMID:23212726

Incidental genetic findings in randomized clinical trials: recommendations from the Genomics and Randomized Trials Network (GARNET)

PubMed Central

2013-01-01

Recommendations and guidance on how to handle the return of genetic results to patients have offered limited insight into how to approach incidental genetic findings in the context of clinical trials. This paper provides the Genomics and Randomized Trials Network (GARNET) recommendations on incidental genetic findings in the context of clinical trials, and discusses the ethical and practical issues considered in formulating our recommendations. There are arguments in support of as well as against returning incidental genetic findings in clinical trials. For instance, reporting incidental findings in clinical trials may improve the investigator-participant relationship and the satisfaction of participation, but it may also blur the line between clinical care and research. The issues of whether and how to return incidental genetic findings, including the costs of doing so, should be considered when developing clinical trial protocols. Once decided, plans related to sharing individual results from the aim(s) of the trial, as well as incidental findings, should be discussed explicitly in the consent form. Institutional Review Boards (IRBs) and other study-specific governing bodies should be part of the decision as to if, when, and how to return incidental findings, including when plans in this regard are being reconsidered. PMID:23363732

Transcultural Diabetes Nutrition Algorithm: A Malaysian Application

PubMed Central

Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A.; Mechanick, Jeffrey I.

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations. PMID:24385984

Transcultural diabetes nutrition algorithm: a malaysian application.

PubMed

Hussein, Zanariah; Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Hussain, Husni; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A; Mechanick, Jeffrey I

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations.

Australian association for exercise and sports science position statement on exercise and hypertension.

PubMed

Sharman, James E; Stowasser, Michael

2009-03-01

Hypertension (high blood pressure; BP) is a leading contributor to premature death and disability from cardiovascular disease. Lifestyle modification that includes regular physical activity is often recommended to patients with hypertension as one of the first line treatments for lowering BP, as well as improving overall risk for cardiovascular events. It is recognised that allied health care professionals play an important role in helping patients to achieve BP control by influencing and reinforcing appropriate lifestyle behavior. The minimum amount of exercise that is recommended in patients with hypertension comprises a mix of moderate to vigorous aerobic (endurance) activity (up to 5 days/week) in addition to resistance (strength) training (on 2 or more non-consecutive days/week). However, due to the dose-response relationship between physical activity and health, exercise levels performed beyond the minimum recommendations are expected to confer additional health benefits. Vigorous exercise training is generally safe and well tolerated by most people, including those with hypertension, although some special considerations are required and these are discussed in this review.

Energy, atmospheric chemistry, and global climate

NASA Technical Reports Server (NTRS)

Levine, Joel S.

1991-01-01

Global atmospheric changes due to ozone destruction and the greenhouse effect are discussed. The work of the Intergovernmental Panel on Climate Change is reviewed, including its judgements regarding global warming and its recommendations for improving predictive capability. The chemistry of ozone destruction and the global atmospheric budget of nitrous oxide are reviewed, and the global sources of nitrous oxide are described.

The Institutional Development Agreement. A New Operational Framework for A.I.D. and the Universities.

ERIC Educational Resources Information Center

National Association of State Universities and Land Grant Colleges, Washington, DC.

This is the report of a joint committee of the National Association of State Universities and Land Grant Colleges (NASULGC) and the Agency for International Development (AID). The committee was asked to consider and recommend measures to improve operating arrangements between AID and the universities, including possible arrangements for…

Medical response to a natural disaster: the Barrie tornado.

PubMed Central

Morris, B A; Armstrong, T M

1986-01-01

On May 31, 1985, a tornado devastated an area of Barrie, Ont. Following a prepared disaster plan, the staff of the local hospital managed 155 casualties, including 16 cases of multiple trauma, over 5 hours. The authors summarize the hospital's experience and give recommendations to help the staff of other hospitals improve their disaster plans. PMID:3948094

Summary of moderate depth lunar drill development program from its conception to 1 July 1972

NASA Technical Reports Server (NTRS)

1972-01-01

The results are summarized of a program aimed at the development of a lunar drill capable of taking lunar surface cores to depths of at least 100 feet. The technologies employed in the program are described along with the accomplishments and problems encountered. Recommendations are included for future concept improvements and developments.

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,…

Recommendations for Exploring the Disfluency Hypothesis for Establishing Whether Perceptually Degrading Materials Impacts Performance

ERIC Educational Resources Information Center

Dunlosky, John; Mueller, Michael L.

2016-01-01

The target articles explore a common hypothesis pertaining to whether perceptually degrading materials will improve reasoning, memory, and metamemory. Outcomes are mixed, yet some evidence was garnered in support of a version of the disfluency hypothesis that includes moderators, and along with evidence from prior research, researchers will likely…

Research on spectroscopic imaging. Volume 1: Technical discussion. [birefringent filters

NASA Technical Reports Server (NTRS)

Title, A.; Rosenberg, W.

1979-01-01

The principals of operation and the capabilities of birefringent filters systems are examined. Topics covered include: Lyot, Solc, and partial polarizer filters; transmission profile management; tuning birefringent filters; field of view; bandpass control; engineering considerations; and recommendations. Improvements for field of view effects, and the development of birefringent filters for spaceflight are discussed in appendices.

Semi-Annual Report to Congress: October 1, 1982-March 31, 1983; No. 6. (Submitted pursuant to Public Law 95-452).

ERIC Educational Resources Information Center

Office of Inspector General (ED), Washington, DC.

The United States Department of Education (ED), Office of Inspector General (OIG), describes in its semiannual report its provisions for audit, investigation, fraud detection and prevention, as well as other activities. The first section reviews management improvement and preventive activities including recommended changes to legislation and…

The role of yogurt in improving the quality of the American diet and meeting dietary guidelines

USDA-ARS?s Scientific Manuscript database

The Dietary Guidelines for Americans (DGA) recommend 3 daily servings of lowfat or nonfat dairy products, however, two-thirds of Americans do not meet that goal. Including lowfat or nonfat yogurt as part of an overall healthful diet can be a positive step towards meeting the DGA. Yogurt contains cal...

Malthus under a Microscope: Using the Soil Nematode "Coenorhabditis elegans" to Test Darwin's Premises about Populations

ERIC Educational Resources Information Center

Mueller, Melinda M.

2007-01-01

Biological evolution is one of the over-arching concepts recommended for student learning by the "National Science Education Standards." As with all such complex concepts, student understanding of evolution is improved when instruction includes hands-on, inquiry-based activities. However, even authors writing in strong support of teaching…

A Child's Right to Human Dignity: Reforming Anti-Bullying Laws in the United States

ERIC Educational Resources Information Center

Dayton, John; Dupre, Anne Proffitt

2009-01-01

This article presents the findings of research into the bullying laws in the United States. Against the backdrop of international law, it addresses children's rights to protection from bullying in US schools. It includes recommendations for improving anti-bullying legislation based on state anti-bullying legislation in the United States, and…

State University of New York, College at Old Westbury. Report 96-F-46.

ERIC Educational Resources Information Center

Barber, Jerry

In March 1996, the New York State Comptroller's Office completed a review of the financial management practices of the State University of New York College at Old Westbury between April 1993 and February 1995. The Office's final report included 17 recommendations for improving the internal control structure over cash receipts and disbursements,…

A computer program incorporating fatigue and fracture criteria in the preliminary design of transport aircraft: An evaluation

NASA Technical Reports Server (NTRS)

Berger, P. E.; Thornton, E. A.

1976-01-01

The APAS program a multistation structural synthesis procedure developed to evaluate material, geometry, and configuration with various design criteria usually considered for the primary structure of transport aircraft is described and evaluated. Recommendations to improve accuracy and extend the capabilities of the APAS program are given. Flow diagrams are included.

Report on the Payroll System. MORE: Management Operations Review & Evaluation.

ERIC Educational Resources Information Center

Doody, Robert J.; And Others

Designed to improve the long-term operational efficiency of the Montgomery County, Maryland, Public Schools (MCPS) payroll system, this study begins with an executive summary, including a set of recommendations and a chapter-by-chapter synopsis. Following an introduction to the study and a general description of the payroll system in chapters 1…

The Successful Mobilization of a Campus Community for Student Retention. Report of the University Retention Steering Committee.

ERIC Educational Resources Information Center

Eastern Michigan Univ., Ypsilanti.

Components of a student retention program at Eastern Michigan University are examined; for each effort to improve retention, project objectives and design, results, and recommendations are presented. Retention initiatives, decided upon as a result of a campus-wide mobilization of effort, include: a student-focused orientation system, a fast track…

Virtual Bugs: An Innovative Peer Coaching Intervention to Improve the Instructional Behaviors of Teacher Candidates

ERIC Educational Resources Information Center

Benson, Tammy; Cotabish, Alicia

2014-01-01

Throughout the evolution of education, various methods of teacher training have emerged to provide general professional development to educators. After trial and error, forms of coaching, including peer coaching, emerged as one of several operational training tools and has been a recommended method of teacher development in recent years (Cotabish…

30 CFR 250.1920 - What are the auditing requirements for my SEMS program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... or your designated and qualified personnel according to the requirements of this subpart and API RP... subpart and API RP 75 to identify areas in which safety and environmental performance needs to be improved. (b) Your audit plan and procedures must meet or exceed all of the recommendations included in API RP...

Role of Radio and TV Programmes in Distance and Open Learning System: A Case of Bangladesh Open University.

ERIC Educational Resources Information Center

Karim, Salma; Kama, Mustafa Azad; Islam, Md. Mayenul

2001-01-01

Examines the role and effectiveness of radio and television programs in distance and open learning systems based on a survey of students at Bangladesh Open University. Offers recommendations for improvements, including extending the time span, ensuring the quality of presentations, teacher involvement, and audio and video cassette…

A review of methods for predicting air pollution dispersion

NASA Technical Reports Server (NTRS)

Mathis, J. J., Jr.; Grose, W. L.

1973-01-01

Air pollution modeling, and problem areas in air pollution dispersion modeling were surveyed. Emission source inventory, meteorological data, and turbulent diffusion are discussed in terms of developing a dispersion model. Existing mathematical models of urban air pollution, and highway and airport models are discussed along with their limitations. Recommendations for improving modeling capabilities are included.

The Aerospace Database data element dictionary with issues and recommendations from the meetings of July 24-25, August 13-14, and September 24-25, 1991

NASA Technical Reports Server (NTRS)

1991-01-01

The present volume contains descriptions of the individual fields (data elements) which comprise the bibliographic records of the Aerospace Database. Indexes by field name and field mnemonic are provided. In addition, the issues and recommendations defined by the NASA STI Database Upgrade Working Group are included as annotations to the individual field descriptions and are listed at the end of the volume. The activities of the Working Group were initiated by the NASA STI Program Coordinating Council as part of an effort to improve overall database quality.

Obesity in the Workplace: Impact, Outcomes, and Recommendations.

PubMed

Yarborough, Charles M; Brethauer, Stacy; Burton, Wayne N; Fabius, Raymond J; Hymel, Pamela; Kothari, Shanu; Kushner, Robert F; Morton, John Magaña; Mueller, Kathryn; Pronk, Nicolaas P; Roslin, Mitchell S; Sarwer, David B; Svazas, Brian; Harris, Jeffrey S; Ash, Garrett I; Stark, Jamie T; Dreger, Marianne; Ording, Julie

2018-01-01

To conduct a comprehensive literature review to develop recommendations for managing obesity among workers to improve health outcomes and to explore the impact of obesity on health costs to determine whether a case can be made for surgical interventions and insurance coverage. We searched PubMed from 2011 to 2016, and CINAHL, Scopus, and Cochrane Registry of Clinical Trials for interventions addressing obesity in the workplace. A total of 1419 articles were screened, resulting in 275 articles being included. Several areas were identified that require more research and investigation. Our findings support the use of both lifestyle modification and bariatric surgery to assist appropriate patients in losing weight.

Policy Perspective: Ensuring Comprehensive Care and Support for Gender Nonconforming Children and Adolescents

PubMed Central

Dowshen, Nadia; Meadows, Rachel; Byrnes, Maureen; Hawkins, Linda; Eder, Jennifer; Noonan, Kathleen

2016-01-01

Abstract Despite recent notable advances in societal equality for lesbian, gay, bisexual, and transgender (LGBT) individuals, youth who identify as trans* or gender nonconforming, in particular, continue to experience significant challenges accessing the services they need to grow into healthy adults. This policy perspective first offers background information describing this population, their unique healthcare needs, and obstacles when seeking care, including case study examples. The authors then provide recommendations for medical education, health systems, and insurance payers, as well as recommendations for school systems and broader public policy changes to improve the health and well-being of gender nonconforming youth. PMID:28861528

Guidelines for the Management of Postoperative Pain after Total Knee Arthroplasty

PubMed Central

2012-01-01

This clinical practice guideline was approved by Korean Knee Society on February 28, 2012. It is based on a systematic review of published studies on the management of postoperative pain after total knee arthroplasty and was developed to include the overall pain management modalities. The purpose of the guideline is to help improve treatment based on current best evidence. Eleven recommendations have been developed based on a systematic review of research evidence and the consensus opinions of a multidisciplinary working group of experts. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available. PMID:23269957

Promoting Postpartum Mental Health in Fathers: Recommendations for Nurse Practitioners

PubMed Central

Kumar, Sheena V.; Oliffe, John L.; Kelly, Mary T.

2017-01-01

The transition to fatherhood can challenge the mental health of first-time fathers and heighten their risk for postpartum depression (PPD). Paternal PPD not only affects the individual, but relationships with partners and children as well. This scoping review explores paternal PPD, highlighting the factors for and impacts of paternal PPD, the experiences of first-time fathers during the postnatal period, including their knowledge gaps and learning preferences. Drawing on the scoping review findings, recommendations are made for postnatal programs to improve the inclusion of new fathers amid describing how nurse practitioners can promote men’s mental health in the postpartum period. PMID:29183251

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.

A Recommendation on SLR Ranging to Future Global Navigation Satellite Systems

NASA Astrophysics Data System (ADS)

Labrecque, J. L.; Miller, J. J.; Pearlman, M.

2008-12-01

The multi-agency US Geodetic Requirements Working Group has recommended that Satellite Laser Retro- reflectors be installed on GPS III satellites as a principal component of the Positioning, Navigation, and Timing mandate of the Global Positioning System. The Working Group, which includes NASA, NGA, NOAA, NRL, USGS, and the USNO, echoes the Global Geodetic Observing System recommendation that SLR retro- reflectors be installed on all GNSS satellites. It is further recommended that the retro-reflectors conform to and hopefully exceed the minimum standard of the International Laser Ranging Service for retro-reflector cross sections of 100 million square meters for the HEO GNSS satellites to insure sufficiently accurate ranging by the global network of satellite laser ranging systems. The objective of this recommendation is to contribute to the improvement in the International Terrestrial Reference Frame, and its derivative the WGS84 reference frame, through continuing improvements in the characterization of the GPS orbits and clocks. Another objective is to provide an independent means of assessing the interoperability and accuracy of the GNSS systems and regional augmentation systems. The ranging to GNSS-mounted retro-reflectors will constitute a significant new means of space-based collocation to constrain the tie between the GPS and SLR networks that constitute over 50% of the data from which the ITRF is derived. The recommendation for the installation of SLR retro-reflectors aboard future GPS satellites is one of a number of efforts aimed at improving the accuracy and stability of ITRF. These steps are being coordinated with and supportive of the efforts of the GGOS and its services such at the VLBI2010 initiative, developing a next generation geodetic network, near real-time GPS positioning and EOP determination, and numerous efforts in the improvement of geodetic algorithms for GPS, SLR, VLBI, DORIS, and the determination of the ITRF. If past is prologue, the requirements of accuracy placed upon GNSS systems will continue to evolve at a factor of ten per decade for the lifetime of the GPS III, extending to 2025 and beyond. Global societal priorities such as sea level change measurement already require a factor of ten or more improvement in the accuracy and stability of the ITRF. Increasing accuracy requirements by civilian users for precision positioning and time keeping will certainly continue to grow at an exponential rate. The PNT accuracy of our GNSS systems will keep pace with these societal needs only if we equip the GNSS systems with the capability to identify and further reduce systematic errors.

CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.

PubMed

Dowell, Deborah; Haegerich, Tamara M; Chou, Roger

2016-03-18

This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (http://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations.

Clinical trials recruitment planning: A proposed framework from the Clinical Trials Transformation Initiative.

PubMed

Huang, Grant D; Bull, Jonca; Johnston McKee, Kelly; Mahon, Elizabeth; Harper, Beth; Roberts, Jamie N

2018-03-01

Patient recruitment is widely recognized as a key determinant of success for clinical trials. Yet a substantial number of trials fail to reach recruitment goals-a situation that has important scientific, financial, ethical, and policy implications. Further, there are important effects on stakeholders who directly contribute to the trial including investigators, sponsors, and study participants. Despite efforts over multiple decades to identify and address barriers, recruitment challenges persist. To advance a more comprehensive approach to trial recruitment, the Clinical Trials Transformation Initiative (CTTI) convened a project team to examine the challenges and to issue actionable, evidence-based recommendations for improving recruitment planning that extend beyond common study-specific strategies. We describe our multi-stakeholder effort to develop a framework that delineates three areas essential to strategic recruitment planning efforts: (1) trial design and protocol development, (2) trial feasibility and site selection, and (3) communication. Our recommendations propose an upstream approach to recruitment planning that has the potential to produce greater impact and reduce downstream barriers. Additionally, we offer tools to help facilitate adoption of the recommendations. We hope that our framework and recommendations will serve as a guide for initial efforts in clinical trial recruitment planning irrespective of disease or intervention focus, provide a common basis for discussions in this area and generate targets for further analysis and continual improvement. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Occupational exposures and health outcomes among Latina hotel cleaners.

PubMed

Hsieh, Yu-Chin Jerrie; Apostolopoulos, Yorghos; Hatzudis, Kiki; Sönmez, Sevil

2014-01-01

The poor working conditions of Latina hotel cleaners render them particularly vulnerable to elevated occupational hazards that lead to adverse health outcomes. This article presents a comprehensive review of occupational risks (including physical, chemical, biological, and psychosocial risk factors) and health outcomes (including musculoskeletal disorders, respiratory diseases, dermatological diseases and allergies, and psychological disorders) for Latina hotel cleaners, within their unique sociocultural contexts. Preventive interventions for improving Latina hotel cleaners' work and health conditions are recommended.

The need for nutrition support teams in pediatric units: a commentary by the ESPGHAN committee on nutrition.

PubMed

Agostoni, Carlo; Axelson, Irene; Colomb, Virginie; Goulet, Olivier; Koletzko, Berthold; Michaelsen, Kim F; Puntis, John W L; Rigo, Jacques; Shamir, Raanan; Szajewska, Hania; Turck, Dominique

2005-07-01

The reported prevalence of malnutrition in pediatric hospitals ranges from 15% to 30% of patients, with an impact on growth, morbidity and mortality. Major deficits in nutrition care have been highlighted in European hospitals, and the implementation of nutrition support teams (NSTs) has been suggested as a means to improve malnutrition diagnosis and nutrition care for hospitalized patients. This comment by the ESPGHAN Committee on Nutrition reviews disease related-mechanisms causing malnutrition and consequences of malnutrition and suggests a framework for implementation of NSTs in pediatric units. The recommendations by the Committee on Nutrition include: 1) Implementation of NSTs in hospitals is recommended to improve nutritional management of sick children; 2) The main tasks of the NST should include screening for nutritional risk, identification of patients who require nutritional support, provision of adequate nutritional management, education and training of hospital staff and audit of practice; 3) The NST should be multidisciplinary, with expertise in all aspects of clinical nutrition care; 4) The funds needed to support NSTs should be raised from the health care system; and 5) Further research is needed to evaluate the effects of NSTs in prevention and management of pediatric nutritional disorders, including cost effectiveness in different settings.

A simple clinical coding strategy to improve recording of child maltreatment concerns: an audit study.

PubMed

McGovern, Andrew Peter; Woodman, Jenny; Allister, Janice; van Vlymen, Jeremy; Liyanage, Harshana; Jones, Simon; Rafi, Imran; de Lusignan, Simon; Gilbert, Ruth

2015-01-14

Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording. To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records. Clinical audit of rates of maltreatment-related coding before January 2010-December 2011 and after January-December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code 'Child is cause for concern'. A total of 25,106 children aged 0-18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording. Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern. We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1-1.6), child protection procedures (RR 1.4; 95% CI 1.1-1.6) and cause for concern (RR 2.5; 95% CI 1.8-3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation. This simple coding strategy improved clinician's recording of maltreatment-related concerns in a small sample of practices with some 'buy-in'. Further research should investigate how recording can best support the doctor-patient relationship. HOW THIS FITS IN: Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial under-recording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns. These improvements could improve case finding of children at risk and information sharing.

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.

Visual Cortex Inspired CNN Model for Feature Construction in Text Analysis

PubMed Central

Fu, Hongping; Niu, Zhendong; Zhang, Chunxia; Ma, Jing; Chen, Jie

2016-01-01

Recently, biologically inspired models are gradually proposed to solve the problem in text analysis. Convolutional neural networks (CNN) are hierarchical artificial neural networks, which include a various of multilayer perceptrons. According to biological research, CNN can be improved by bringing in the attention modulation and memory processing of primate visual cortex. In this paper, we employ the above properties of primate visual cortex to improve CNN and propose a biological-mechanism-driven-feature-construction based answer recommendation method (BMFC-ARM), which is used to recommend the best answer for the corresponding given questions in community question answering. BMFC-ARM is an improved CNN with four channels respectively representing questions, answers, asker information and answerer information, and mainly contains two stages: biological mechanism driven feature construction (BMFC) and answer ranking. BMFC imitates the attention modulation property by introducing the asker information and answerer information of given questions and the similarity between them, and imitates the memory processing property through bringing in the user reputation information for answerers. Then the feature vector for answer ranking is constructed by fusing the asker-answerer similarities, answerer's reputation and the corresponding vectors of question, answer, asker, and answerer. Finally, the Softmax is used at the stage of answer ranking to get best answers by the feature vector. The experimental results of answer recommendation on the Stackexchange dataset show that BMFC-ARM exhibits better performance. PMID:27471460

Visual Cortex Inspired CNN Model for Feature Construction in Text Analysis.

PubMed

Fu, Hongping; Niu, Zhendong; Zhang, Chunxia; Ma, Jing; Chen, Jie

2016-01-01

Recently, biologically inspired models are gradually proposed to solve the problem in text analysis. Convolutional neural networks (CNN) are hierarchical artificial neural networks, which include a various of multilayer perceptrons. According to biological research, CNN can be improved by bringing in the attention modulation and memory processing of primate visual cortex. In this paper, we employ the above properties of primate visual cortex to improve CNN and propose a biological-mechanism-driven-feature-construction based answer recommendation method (BMFC-ARM), which is used to recommend the best answer for the corresponding given questions in community question answering. BMFC-ARM is an improved CNN with four channels respectively representing questions, answers, asker information and answerer information, and mainly contains two stages: biological mechanism driven feature construction (BMFC) and answer ranking. BMFC imitates the attention modulation property by introducing the asker information and answerer information of given questions and the similarity between them, and imitates the memory processing property through bringing in the user reputation information for answerers. Then the feature vector for answer ranking is constructed by fusing the asker-answerer similarities, answerer's reputation and the corresponding vectors of question, answer, asker, and answerer. Finally, the Softmax is used at the stage of answer ranking to get best answers by the feature vector. The experimental results of answer recommendation on the Stackexchange dataset show that BMFC-ARM exhibits better performance.