Health Promotion Board-Ministry of Health clinical practice guidelines: functional screening for older adults in the community.

PubMed

Thilagaratnam, S; Ding, Y Y; Au Eong, K G; Chiam, P C; Chow, Y L; Khoo, G; Lim, H B; Lim, H Y L; Lim, W S; Lim, W Y; Peh, K C; Phua, K T; Sitoh, Y Y; Tan, B Y; Wong, S F; Wong, W P; Yee, R

2010-06-01

The Health Promotion Board (HPB) and the Ministry of Health (MOH) publish clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the HPB-MOH clinical practice guidelines on Functional Screening for Older Adults in the Community, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website (http://www.hpb.gov.sg/uploadedFiles/HPB_Online/Publications/CPGFunctionalscreening.pdf). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients

ERIC Educational Resources Information Center

American Psychologist, 2012

2012-01-01

The "Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients" provide psychologists with (a) a frame of reference for the treatment of lesbian, gay, and bisexual clients and (b) basic information and further references in the areas of assessment, intervention, identity, relationships, diversity, education, training, and…

14 CFR 151.72 - Incorporation by reference of technical guidelines in Advisory Circulars.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Incorporation by reference of technical guidelines in Advisory Circulars. 151.72 Section 151.72 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Project Programming Standards § 151...

14 CFR 151.72 - Incorporation by reference of technical guidelines in Advisory Circulars.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Incorporation by reference of technical guidelines in Advisory Circulars. 151.72 Section 151.72 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Project Programming Standards § 151...

14 CFR 151.72 - Incorporation by reference of technical guidelines in Advisory Circulars.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Incorporation by reference of technical guidelines in Advisory Circulars. 151.72 Section 151.72 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Project Programming Standards § 151...

14 CFR 151.72 - Incorporation by reference of technical guidelines in Advisory Circulars.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Incorporation by reference of technical guidelines in Advisory Circulars. 151.72 Section 151.72 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Project Programming Standards § 151...

ENVIRONMENTAL MANGANESE: GUIDELINE EXPOSURE LEVELS, EVIDENCE OF HEALTH EFFECTS AND RESEARCH NEEDS.

EPA Science Inventory

Introduction. The ubiquitous element, manganese (Mn), is an essential nutrient, but toxic at excessive exposure levels. The US EPA, therefore, set guideline levels for Mn exposure through inhalation (reference concentration-RfC=0.05 g/m3) and ingestion (reference dose-RfD=0.14 m...

14 CFR 151.72 - Incorporation by reference of technical guidelines in Advisory Circulars.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Incorporation by reference of technical guidelines in Advisory Circulars. 151.72 Section 151.72 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Project Programming Standards § 151...

Knee joint replacement

MedlinePlus

... Knee joint replacement - series References American Academy of Orthopedic Surgeons (AAOS) website. Treatment of osteoarthritis of the knee: evidence-based guideline 2nd edition (summary) . www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf . Updated May 18, 2013. Accessed ...

34 CFR 685.209 - Income-contingent repayment plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... between the borrower's AGI and 150 percent of the poverty guideline for the borrower's family size; or (B... spouse's AGI, and 150 percent of the poverty guideline for the borrower's family size; and (vi) Poverty guideline refers to the income categorized by State and family size in the poverty guidelines published...

34 CFR 685.209 - Income-contingent repayment plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... between the borrower's AGI and 150 percent of the poverty guideline for the borrower's family size; or (B... spouse's AGI, and 150 percent of the poverty guideline for the borrower's family size; and (vi) Poverty guideline refers to the income categorized by State and family size in the poverty guidelines published...

Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline Number 3.

ERIC Educational Resources Information Center

Agency for Health Care Policy and Research (DHHS/PHS), Rockville, MD.

This package includes a clinical practice guideline, quick reference guide for clinicians, and patient's guide to predicting and preventing pressure ulcers in adults. The clinical practice guideline includes the following: overview of the incidence and prevalence of pressure ulcers; clinical practice guideline (introduction, risk assessment tools…

48 CFR 915.404-4-70-2 - Weighted guidelines system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Weighted guidelines system... guidelines system. (a) To properly reflect differences among contracts and the circumstances relating thereto... section. This is a structured system, referred to as weighted guidelines. Each profit factor or subfactor...

34 CFR 685.221 - Income-based repayment plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... and 150 percent of the poverty guideline for the borrower's family size; or (ii) For a married... percent of the poverty guideline for the borrower's family size. (5) Poverty guideline refers to the income categorized by State and family size in the poverty guidelines published annually by the United...

34 CFR 685.221 - Income-based repayment plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... and 150 percent of the poverty guideline for the borrower's family size; or (ii) For a married... percent of the poverty guideline for the borrower's family size. (5) Poverty guideline refers to the income categorized by State and family size in the poverty guidelines published annually by the United...

Identifying the effective evidence sources to use in developing Clinical Guidelines for Acute Stroke Management: lived experiences of the search specialist and project manager.

PubMed

Parkhill, Anne; Hill, Kelvin

2009-03-01

The Australian National Stroke Foundation appointed a search specialist to find the best available evidence for the second edition of its Clinical Guidelines for Acute Stroke Management. To identify the relative effectiveness of differing evidence sources for the guideline update. We searched and reviewed references from five valid evidence sources for clinical and economic questions: (i) electronic databases; (ii) reference lists of relevant systematic reviews, guidelines, and/or primary studies; (iii) table of contents of a number of key journals for the last 6 months; (iv) internet/grey literature; and (v) experts. Reference sources were recorded, quantified, and analysed. In the clinical portion of the guidelines document, there was a greater use of previous knowledge and sources other than electronic databases for evidence, while there was a greater use of electronic databases for the economic section. The results confirmed that searchers need to be aware of the context and range of sources for evidence searches. For best available evidence, searchers cannot rely solely on electronic databases and need to encompass many different media and sources.

Diabetes prevention information in Japanese magazines with the largest print runs. Content analysis using clinical guidelines as a standard.

PubMed

Noda, Emi; Mifune, Taka; Nakayama, Takeo

2013-01-01

To characterize information on diabetes prevention appearing in Japanese general health magazines and to examine the agreement of the content with that in clinical practice guidelines for the treatment of diabetes in Japan. We used the Japanese magazines' databases provided by the Media Research Center and selected magazines with large print runs published in 2006. Two medical professionals independently conducted content analysis based on items in the diabetes prevention guidelines. The number of pages for each item and agreement with the information in the guidelines were determined. We found 63 issues of magazines amounting to 8,982 pages; 484 pages included diabetes prevention related content. For 23 items included in the diabetes prevention guidelines, overall agreement of information printed in the magazines with that in the guidelines was 64.5% (471 out of 730). The number of times these items were referred to in the magazines varied widely, from 247 times for food items to 0 times for items on screening for pregnancy-induced diabetes, dyslipidemia, and hypertension. Among the 20 items that were referred to at least once, 18 items showed more than 90% agreement with the guidelines. However, there was poor agreement for information on vegetable oil (2/14, 14%) and for specific foods (5/247, 2%). For the fatty acids category, "fat" was not mentioned in the guidelines; however, the term frequently appeared in magazines. "Uncertainty" was never mentioned in magazines for specific food items. The diabetes prevention related content in the health magazines differed from that defined in clinical practice guidelines. Most information in the magazines agreed with the guidelines, however some items were referred to inappropriately. To disseminate correct information to the public on diabetes prevention, health professionals and the media must collaborate.

British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism

PubMed Central

Howard, Luke S; Barden, Steven; Condliffe, Robin; Connolly, Vincent; Davies, Chris; Donaldson, James; Everett, Bernard; Free, Catherine; Horner, Daniel; Hunter, Laura; Kaler, Jasvinder; Nelson-Piercy, Catherine; O’Dowd, Emma; Patel, Raj; Preston, Wendy; Sheares, Karen; Tait, Campbell

2018-01-01

The following is a summary of the recommendations and good practice points for the BTS Guideline for the initial outpatient management of pulmonary embolism. Please refer to the full guideline for full information about each section.

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...

Searching CINAHL did not add value to clinical questions posed in NICE guidelines.

PubMed

Beckles, Zosia; Glover, Sarah; Ashe, Joanna; Stockton, Sarah; Boynton, Janette; Lai, Rosalind; Alderson, Philip

2013-09-01

This study aims to quantify the unique useful yield from the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database to National Institute for Health and Clinical Excellence (NICE) clinical guidelines. A secondary objective is to investigate the relationship between this yield and different clinical question types. It is hypothesized that the unique useful yield from CINAHL is low, and this database can therefore be relegated to selective rather than routine searching. A retrospective sample of 15 NICE guidelines published between 2005 and 2009 was taken. Information on clinical review question type, number of references, and reference source was extracted. Only 0.33% (95% confidence interval: 0.01-0.64%) of references per guideline were unique to CINAHL. Nursing- or allied health (AH)-related questions were nearly three times as likely to have references unique to CINAHL as non-nursing- or AH-related questions (14.89% vs. 5.11%), and this relationship was found to be significant (P<0.05). No significant relationship was found between question type and unique CINAHL yield for drug-related questions. The very low proportion of references unique to CINAHL strongly suggests that this database can be safely relegated to selective rather than routine searching. Nursing- and AH-related questions would benefit from selective searching of CINAHL. Copyright © 2013 Elsevier Inc. All rights reserved.

Guidelines for Mass Screening of Congenital Hypothyroidism (2014 revision)

PubMed Central

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

2015-01-01

Purpose of developing the guidelines: Mass screening for congenital hypothyroidism started in 1979 in Japan, and the prognosis for intelligence has been improved by early diagnosis and treatment. The incidence was about 1/4000 of the birth population, but it has increased due to diagnosis of subclinical congenital hypothyroidism. The disease requires continuous treatment, and specialized medical facilities should make a differential diagnosis and treat subjects who are positive in mass screening to avoid unnecessary treatment. The Guidelines for Mass Screening of Congenital Hypothyroidism (1998 version) were developed by the Mass Screening Committee of the Japanese Society for Pediatric Endocrinology in 1998. Subsequently, new findings on prognosis and problems in the adult phase have emerged. Based on these new findings, the 1998 guidelines were revised in the current document (hereinafter referred to as the Guidelines). Target disease/conditions: Primary congenital hypothyroidism. Users of the Guidelines: Physician specialists in pediatric endocrinology, pediatric specialists, physicians referring patients to pediatric practitioners, general physicians, laboratory technicians in charge of mass screening, and patients. PMID:26594093

Reference Service Policy Statement.

ERIC Educational Resources Information Center

Young, William F.

This reference service policy manual provides general guidelines to encourage reference service of the highest possible quality and to insure uniform practice. The policy refers only to reference service in the University Libraries and is intended for use in conjunction with other policies and procedures issued by the Reference Services Division.…

WHO Expert Committee on Specifications for Pharmaceutical Preparations.

PubMed

2009-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new standards and guidelines were adopted and recommended for use: the current list of available International Chemical Reference Substances and International Infrared Reference Spectra; guidelines on stability testing of active pharmaceutical ingredients and finished pharmaceutical products; procedure for prequalification of pharmaceutical products; and the procedure for assessing the acceptability, in principle, of active pharmaceutical ingredients for use in pharmaceutical products.

What is new in the 2017 ESC clinical practice guidelines : Management of acute myocardial infarction in patients presenting with ST-segment elevation.

PubMed

Lang, Irene M

2018-05-23

Guidelines and recommendations are designed to guide physicians in making decisions in daily practice. Guidelines provide a condensed summary of all available evidence at the time of the writing process. Recommendations take into account the risk-benefit ratio of particular diagnostic or therapeutic means and the impact on outcome, but not monetary or political considerations. Guidelines are not substitutes but are complementary to textbooks and cover the European Society of Cardiology (ESC) core curriculum topics. The level of evidence and the strength of recommendations of particular treatment options were recently newly weighted and graded according to predefined scales. Guidelines endorsement and implementation strategies are based on abridged pocket guidelines versions, electronic version for digital applications, translations into the national languages or extracts with reference to main changes since the last version. The present article represents a condensed summary of new and practically relevant items contained in the 2017 European Society of Cardiology (ESC) guidelines for the management of acute myocardial infarction in patients with ST-segment elevation, with reference to key citations.

Objectivities of a Post-Normal Guideline Project: The Introduction of a Guideline for Sick-Listing Practices in Sweden

ERIC Educational Resources Information Center

Sager, Morten; Eriksson, Lena

2015-01-01

In this article we describe and diagnose ailments suffered by the so-called "medical insurance decision-making support tool" that was published in 2007 as part of a major reform of the Swedish social insurance. Through document studies and interviews the guideline is analysed and compared with a reference case, a guideline within…

Comments from the Developmental Neurotoxicology Committee of the Japanese Teratology Society on the OECD Guideline for the Testing of Chemicals, Proposal for a New Guideline 426, Developmental Neurotoxicity Study, Draft Document (October 2006 version), and on the Draft Document of the Retrospective Performance Assessment of the Draft Test Guideline 426 on Developmental Neurotoxicity.

PubMed

Ema, Makoto; Fukui, Yoshihiro; Aoyama, Hiroaki; Fujiwara, Michio; Fuji, Junichiro; Inouye, Minoru; Iwase, Takayuki; Kihara, Takahide; Oi, Akihide; Otani, Hiroki; Shinomiya, Mitsuhiro; Sugioka, Kozo; Yamano, Tsunekazu; Yamashita, Keisuke H; Tanimura, Takashi

2007-06-01

In October 2006, a new revision of the draft guideline (OECD Guideline for the Testing of Chemicals, Proposal for a New Guideline 426. Developmental Neurotoxicity Study) and Draft Document of the Retrospective Performance Assessment (RPA) of the Draft Test Guideline 426 on Developmental Neurotoxicity were distributed following incorporation of the results of the Expert Consultation Meeting in Tokyo on May 24-26, 2005. The draft guideline consists of 50 paragraphs and an appendix with 102 references; and the draft RPA consists of 37 paragraphs with 109 references. National coordinators were requested to arrange for national expert reviews of these draft documents in their member countries. Members of the Developmental Neurotoxicology (DNT) Committee of the Japanese Teratology Society (JTS) reviewed, discussed, and commented on the draft Test Guideline Proposal. The DNT Committee of the JTS also commented on the draft document of the RPA. These comments were sent to the OECD Secretariat. The DNT Committee of the JTS expects the comments to be useful for the finalization of these draft documents.

Awareness of radiographic guidelines for low back pain: a survey of Australian chiropractors.

PubMed

Jenkins, Hazel J

2016-01-01

Chiropractors have been shown to refer for lumbar radiography in clinical scenarios inconsistent with the current clinical guidelines for low back pain. It is unknown whether this is due to lack of adherence with known guidelines or a lack of awareness of relevant guidelines. Therefore, the aim of this study is to determine Australian chiropractors' awareness of, and reported adherence to, radiographic guidelines for low back pain. Demographic, chiropractic practice and radiographic usage characteristics will be investigated for association with poor guideline adherence. An online survey was distributed to Australian chiropractors from July to September, 2014. Survey questions assessed demographic, chiropractic practice and radiographic usage characteristics, awareness of radiographic guidelines for low back pain and the level of agreement with current guidelines. Results were analysed with descriptive statistics and logistic regression analysis. There were 480 surveys completed online. Only 49.6 % (95 % confidence interval (95 % CI): 44.9, 54.4) reported awareness of radiographic guidelines for low back pain. Chiropractors reported a likelihood of referring for radiographs for low back pain: in new patients (47.6 % (95 % CI: 42.9, 52.3)); to confirm biomechanical pathologies (69.0 % (95 % CI: 64.5, 73.1)); to perform biomechanical analysis (37.5 % (95 % CI: 33.1, 42.0)); or to screen for contraindications (39.4 % (95 % CI: 35.0, 44.0)). Chiropractors agreed that radiographs for low back pain could be useful for: acute low back pain (54.0 % (95 % CI: 49.2, 58.7)); screening for contraindications (55.8 % (95 % CI: 51.0, 60.5)); or to confirm diagnosis and direct treatment (61.3 % (95 % CI: 56.5, 65.9)). Poorer adherence to current guidelines was seen if the chiropractor referred to in-house radiographic facilities, practiced a technique other than diversified technique or was unaware or unsure of current radiographic guidelines for low back pain. Only 50 % of Australian chiropractors report awareness of current radiographic guidelines for low back pain. A poorer awareness of guidelines is associated with an increase in the reported likelihood of use, and the perceived usefulness of radiographs for low back pain, in clinical situations that fall outside of current guidelines. Therefore, education strategies may help to increase guideline knowledge and compliance.

75 FR 36725 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

..., entitled ``Numerical Guidelines Applicable to Volatile Market Opens'' with a new paragraph, entitled...) of Rule 2128 to eliminate the ability of the Exchange to deviate from the Numerical Guidelines... Numerical Guidelines or Reference Prices in various ``Unusual Circumstances.'' The Exchange proposes to...

Measurement guidelines for the sequestration of forest carbon

Treesearch

Timothy R.H. Pearson; Sandra L. Brown; Richard A. Birdsey

2007-01-01

Measurement guidelines for forest carbon sequestration were developed to support reporting by public and private entities to greenhouse gas registries. These guidelines are intended to be a reference for designing a forest carbon inventory and monitoring system by professionals with a knowledge of sampling, statistical estimation, and forest measurements. This report...

Telemetry Applications Handbook

DTIC Science & Technology

2006-05-01

Guidelines .......................................................... 3-2 3.4 References for Chapter 3...and Discriminators ............................................................. 4-45 4.8 Receiving/Recording System Parameter Selection Guidelines ...2-176 Figure 2-199. DSQ- 50 telemetry transmitter + BPF + LNA. ........................................... 2-177

75 FR 61802 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... replacing existing paragraph (a)(2)(C)(iv) of Rule 3312, entitled ``Numerical Guidelines Applicable to... Exchange to deviate from the Numerical Guidelines contained in paragraph (a)(2)(C)(i) when deciding which... Numerical Guidelines or Reference Prices in various ``Unusual Circumstances.'' The Exchange proposes to...

75 FR 36759 - Self-Regulatory Organizations; New York Stock Exchange LLC; Notice of Filing of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... proposes replacing existing paragraph (c)(4) of Rule 128, entitled ``Numerical Guidelines Applicable to... the Exchange to deviate from the Numerical Guidelines contained in paragraph (c)(1) (other than under...)(2), which provides flexibility to the Exchange to use different Numerical Guidelines or Reference...

75 FR 36732 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing of a Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

....'' Second, NASDAQ replacing existing paragraph (C)(4) of Rule 11890, entitled ``Numerical Guidelines... NASDAQ to deviate from the Numerical Guidelines contained in paragraph (C)(1) (other than under limited... provides flexibility to NASDAQ to use different Numerical Guidelines or Reference Prices in various...

75 FR 37494 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing of Proposed Rule Change, as...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-29

... proposes replacing existing paragraph (c)(4) of Rule 7.10, entitled ``Numerical Guidelines Applicable to... the Exchange to deviate from the Numerical Guidelines contained in paragraph (c)(1) (other than under...)(2), which provides flexibility to the Exchange to use different Numerical Guidelines or Reference...

75 FR 36749 - Self-Regulatory Organizations; NYSE Amex LLC; Notice of Filing of Proposed Rule Change Amending...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

..., entitled ``Numerical Guidelines Applicable to Volatile Market Opens'' with a new paragraph, entitled... (g) of Rule 128 to eliminate the ability of the Exchange to deviate from the Numerical Guidelines... flexibility to the Exchange to use different Numerical Guidelines or Reference Prices in various ``Unusual...

75 FR 36746 - Self-Regulatory Organizations; National Stock Exchange, Inc.; Notice of Filing of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... Exchange replacing existing paragraph (c)(4) of Rule 11.19, entitled ``Numerical Guidelines Applicable to... the Exchange to deviate from the Numerical Guidelines contained in paragraph (c)(1) (other than under... provides flexibility to the Exchange to use different Numerical Guidelines or Reference Prices in various...

2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association task force on practice guidelines

USDA-ARS?s Scientific Manuscript database

This guideline is based on the Full Panel Report which is provided as a data supplement to the guideline. The Full Panel Report contains background and additional material related to content, methodology, evidence synthesis, rationale and references and is supported by the NHLBI Systematic Evidence ...

Asthma and Respiratory Foundation NZ adult asthma guidelines: a quick reference guide.

PubMed

Beasley, Richard; Hancox, Robert J; Harwood, Matire; Perrin, Kyle; Poot, Betty; Pilcher, Janine; Reid, Jim; Talemaitoga, Api; Thayabaran, Darmiga

2016-11-18

The purpose of the Asthma and Respiratory Foundation NZ Adult Asthma Guidelines is to provide simple, practical and evidence-based recommendations for the diagnosis, assessment and management of asthma in adults (aged 16 and over) in a quick reference format. The intended users are health professionals responsible for delivering asthma care in the community and hospital Emergency Department settings, and those responsible for the training of such health professionals.

Differences in delineation guidelines for head and neck cancer result in inconsistent reported dose and corresponding NTCP.

PubMed

Brouwer, Charlotte L; Steenbakkers, Roel J H M; Gort, Elske; Kamphuis, Marije E; van der Laan, Hans Paul; Van't Veld, Aart A; Sijtsema, Nanna M; Langendijk, Johannes A

2014-04-01

To test the hypothesis that delineation of swallowing organs at risk (SWOARs) based on different guidelines results in differences in dose-volume parameters and subsequent normal tissue complication probability (NTCP) values for dysphagia-related endpoints. Nine different SWOARs were delineated according to five different delineation guidelines in 29 patients. Reference delineation was performed according to the guidelines and NTCP-models of Christianen et al. Concordance Index (CI), dosimetric consequences, as well as differences in the subsequent NTCPs were calculated. The median CI of the different delineation guidelines with the reference guidelines was 0.54 for the pharyngeal constrictor muscles, 0.56 for the laryngeal structures and 0.07 for the cricopharyngeal muscle and esophageal inlet muscle. The average difference in mean dose to the SWOARs between the guidelines with the largest difference (maxΔD) was 3.5±3.2Gy. A mean ΔNTCP of 2.3±2.7% was found. For two patients, ΔNTCP exceeded 10%. The majority of the patients showed little differences in NTCPs between the different delineation guidelines. However, large NTCP differences >10% were found in 7% of the patients. For correct use of NTCP models in individual patients, uniform delineation guidelines are of great importance. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Cancer cachexia: global awareness and guideline implementation on the web.

PubMed

Mauri, Davide; Tsiara, Anna; Valachis, Antonis; Kalopita, Konstantina; Tsali, Lampriani; Tolis, Panagiotis; Polyzos, Nikolaos P

2013-06-01

Cancer cachexia is a common associate of cancer and has a negative impact on patients' survival. Nonetheless, cancer cachexia assessment and management are frequently less than satisfactory in daily practice. To scrutinise global cancer cachexia awareness and relative web guideline implementation among oncology societies. Systematical identification of scientific and policymaker oncology societies and their guideline implementation on cancer cachexia. Assessment of the general level of awareness on cancer cachexia and evaluation of intercontinental and national variations on guideline implementation. 144,000 web pages were scrutinised, and 275 oncology societies identified covering a large array of oncology setting (educational/clinical/research/policymaker); 71 were international (African, American, Asian, European, Oceania and Intercontinental), 110 belonged to the top 10 countries with the highest development index and 94 pertained to 10 countries with a long lasting tradition in medical oncology (not included in the top 10 high developed countries). Overall, only 10/275 web sites provided guidelines; six of them (2.2%) provided guidelines for physicians and four (0.7%) for patients. Half of the guidelines (4/10) were outdated. All guidelines for physicians reported references, while only one of the recommendations for patients reported references to support its sentences. Cancer cachexia global awareness appears extremely low; guideline implementation on the web was inconsistent for any category analysed (nation vs continent vs international vs society type vs physician vs patient oriented) and for updating.

Treatment for Panic Disorder: Practical Guidelines.

ERIC Educational Resources Information Center

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

2002-01-01

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

A survey of psychiatrists' attitudes toward treatment guidelines.

PubMed

Healy, Daniel J; Goldman, Mona; Florence, Timothy; Milner, Karen K

2004-04-01

We developed a survey to look at psychiatrists' attitudes toward psychotropic prescribing guidelines, specifically the Texas Medication Algorithm Project (TMAP) algorithms. The 22-page survey was distributed to 24 psychiatrists working in 4 CMHC's; 13 completed the survey. 90% agreed that guidelines should be general and flexible. The majority also agreed that guidelines should define how to measure response to a specific agent; fewer agreed guidelines should specify dosage, side effect management, or augmentation strategies. Psychiatrists were familiar with TMAP; none referred to it in their practice. In spite of this, psychiatrists' medication preferences were similar to those suggested by guidelines.

National origin harassment in the work place: recent guideline developments from the EEOC.

PubMed

Hollon, C J; Bright, T L

1982-01-01

In December 1980 the EEOC published its revised "Guidelines on Discrimination Because of National Origin." The revised guidelines expand the definition of national origin harassment and declare it a violation of Title Vii. According to the EEOC, the guidelines reaffirm the position the Commission has taken in earlier decisions. In the following article, the authors examine the EEOC's position on national origin harassment. Using the guidelines as a frame of reference, they look at both EEOC decisions issued prior to the guidelines and court decisions that may offer employers guidance regarding impermissible conduct and liability in this area.

Manned space flight nuclear system safety. Volume 5: Nuclear System safety guidelines. Part 1: Space base nuclear safety

NASA Technical Reports Server (NTRS)

1972-01-01

The design and operations guidelines and requirements developed in the study of space base nuclear system safety are presented. Guidelines and requirements are presented for the space base subsystems, nuclear hardware (reactor, isotope sources, dynamic generator equipment), experiments, interfacing vehicles, ground support systems, range safety and facilities. Cross indices and references are provided which relate guidelines to each other, and to substantiating data in other volumes. The guidelines are intended for the implementation of nuclear safety related design and operational considerations in future space programs.

Manned space flight nuclear system safety. Voluem 5: Nuclear system safety guidelines. Part 2: Space shuttle/nuclear payloads safety

NASA Technical Reports Server (NTRS)

1972-01-01

The design and operations guidelines and requirements developed in the study of space shuttle nuclear system transportation are presented. Guidelines and requirements are presented for the shuttle, nuclear payloads (reactor, isotope-Brayton and small isotope sources), ground support systems and facilities. Cross indices and references are provided which relate guidelines to each other, and to substantiating data in other volumes. The guidelines are intended for the implementation of nuclear safety related design and operational considerations in future space programs.

Evaluation of exposure parameters in plain radiography: a comparative study with European guidelines.

PubMed

Lança, L; Silva, A; Alves, E; Serranheira, F; Correia, M

2008-01-01

Typical distribution of exposure parameters in plain radiography is unknown in Portugal. This study aims to identify exposure parameters that are being used in plain radiography in the Lisbon area and to compare the collected data with European references [Commission of European Communities (CEC) guidelines]. The results show that in four examinations (skull, chest, lumbar spine and pelvis), there is a strong tendency of using exposure times above the European recommendation. The X-ray tube potential values (in kV) are below the recommended values from CEC guidelines. This study shows that at a local level (Lisbon region), radiographic practice does not comply with CEC guidelines concerning exposure techniques. Further national/local studies are recommended with the objective to improve exposure optimisation and technical procedures in plain radiography. This study also suggests the need to establish national/local diagnostic reference levels and to proceed to effective measurements for exposure optimisation.

Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy.

PubMed

Venkatesh, Arjun K; Savage, Dan; Sandefur, Benjamin; Bernard, Kenneth R; Rothenberg, Craig; Schuur, Jeremiah D

2017-01-01

Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence. Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies. A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent. Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality standards.

Comparative assessment of bioanalytical method validation guidelines for pharmaceutical industry.

PubMed

Kadian, Naveen; Raju, Kanumuri Siva Rama; Rashid, Mamunur; Malik, Mohd Yaseen; Taneja, Isha; Wahajuddin, Muhammad

2016-07-15

The concepts, importance, and application of bioanalytical method validation have been discussed for a long time and validation of bioanalytical methods is widely accepted as pivotal before they are taken into routine use. United States Food and Drug Administration (USFDA) guidelines issued in 2001 have been referred for every guideline released ever since; may it be European Medical Agency (EMA) Europe, National Health Surveillance Agency (ANVISA) Brazil, Ministry of Health and Labour Welfare (MHLW) Japan or any other guideline in reference to bioanalytical method validation. After 12 years, USFDA released its new draft guideline for comments in 2013, which covers the latest parameters or topics encountered in bioanalytical method validation and approached towards the harmonization of bioanalytical method validation across the globe. Even though the regulatory agencies have general agreement, significant variations exist in acceptance criteria and methodology. The present review highlights the variations, similarities and comparison between bioanalytical method validation guidelines issued by major regulatory authorities worldwide. Additionally, other evaluation parameters such as matrix effect, incurred sample reanalysis including other stability aspects have been discussed to provide an ease of access for designing a bioanalytical method and its validation complying with the majority of drug authority guidelines. Copyright © 2016. Published by Elsevier B.V.

Guidelines for the public health management of typhoid and paratyphoid in England: practice guidelines from the National Typhoid and Paratyphoid Reference Group.

PubMed

Balasegaram, S; Potter, A L; Grynszpan, D; Barlow, S; Behrens, R H; Lighton, L; Booth, L; Inamdar, L; Neal, K; Nye, K; Lawrence, J; Jones, J; Gray, I; Tolley, D; Lane, C; Adak, B; Cummins, A; Addiman, S

2012-09-01

The Typhoid and Paratyphoid Reference Group (TPRG) was convened by the Health Protection Agency (HPA) and the Chartered Institute of Environmental Health (CIEH) to revise guidelines for public health management of enteric fever. This paper presents the new guidelines for England and their rationale. Methods include literature reviews including grey literature such as audit data and case studies; analysis of enhanced surveillance data from England, Wales and Northern Ireland; review of clearance and screening schedules in use in other non-endemic areas; and expert consensus. The evidence and principles underpinning the new guidance are summarised. Significant changes from previous guidance include: • Algorithms to guide risk assessment and management, based on risk group and travel history; • Outline of investigation of non-travel cases; • Simplified microbiological clearance schedules for cases and contacts; • Targeted co-traveller screening and a "warn and inform" approach for contacts; • Management of convalescent and chronic carriers. The guidelines were launched in February 2012. Feedback has been positive: the guidelines are reported to be clear, systematic, practical and risk-based. An evaluation of the guidelines is outlined and will add to the evidence base. There is potential for simplification and consistency between international guidelines. Copyright © 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

The Lean Reference Collection: Improving Functionality through Selection and Weeding.

ERIC Educational Resources Information Center

Nolan, Christopher W.

1991-01-01

Discusses references collections in academic libraries and offers guidelines for placing materials in a reference collection that focus on their suitability for true reference functions and the expected frequency of use. Problems with poorly managed collections are discussed, and the importance of selection policies and weeding are emphasized. (37…

Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines: a quick reference guide.

PubMed

Asher, Innes; McNamara, David; Davies, Cheryl; Demetriou, Teresa; Fleming, Theresa; Harwood, Matire; Hetaraka-Stevens, Lorraine; Ingham, Tristram; Kristiansen, John; Reid, Jim; Rickard, Debbie; Ryan, Debbie

2017-12-01

The purpose of the New Zealand Child and adolescent asthma guidelines: a quick reference guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment and management of asthma in children and adolescents in New Zealand, with the aim of improving outcomes and reducing inequities. The intended users are health professionals responsible for delivering asthma care in the community and hospital emergency department settings, and those responsible for the training of such health professionals.

Guidelines for Equal Treatment of the Sexes in McGraw-Hill Book Company Publications.

ERIC Educational Resources Information Center

McGraw-Hill Book Co., New York, NY.

Intended primarily for use in writing and editing teaching materials, reference works, and nonfiction works in general, these guidelines have been compiled to alert authors and McGraw-Hill Book Company staff members both to the problems of sex discrimination and to various solutions. In addition, the guidelines reveal ways in which males and…

[Formulation of guidelines for microscopic endodontics suitable for the situation of China].

PubMed

Ling, J Q

2016-08-01

In order to promote the use of dental operating microscope in endodontics, Society of Cariology and Endodontology of Chinese Stomatological Association formulated these guidelines, after extensive consultation with related authorities and careful reference to the available published materials and literatures. It is hoped that these guidelines will be useful for dental practitioners embarking on microscopic endodontics.

Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant.

PubMed

Andrews, Peter A

2014-12-15

The British Transplantation Society "Guideline for Transplantation Management of the Failing Kidney Transplant" was published in May 2014. This is the first national guideline in this field. In line with previous guidelines published by the British Transplantation Society, the guideline has used the GRADE system to rate the strength of evidence and recommendations.This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for the management of the failing kidney graft in the United Kingdom and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at: http://www.bts.org.uk/MBR/Clinical/Guidelines/Current/Member/Clinical/Current_Guidelines.aspx.

[Guidelines on urolithiasis: an outline and effective use of the revised version].

PubMed

Kohri, Kenjiro; Suzuki, Koji

2012-12-01

Progress has been made in the diagnosis and treatment of urolithiasis over the last 10 years, after the first version of the Guidelines on Urolithiasis was published in December 2002. Considering such a situation, the revised version is due for publication soon. At this symposium, 3 persons who were engaged in the revision of the guidelines presented its digest. The revised version is characterized by the adoption of a "Frequently asked questions style", aiming to facilitate its usage as a reference book or dictionary readers can refer to when a question is raised in practice. It may be possible to further promote the medical treatment of urolithiasis by effectively using this in combination with the relatively textbook-like first version.

Understanding health care provider barriers to hospital affiliated medical fitness center facility referral: a questionnaire survey and semi structured interviews.

PubMed

Smock, Carissa; Alemagno, Sonia

2017-08-03

The purpose of this study is to understand health care provider barriers to referring patients to Medical Fitness Center Facilities within an affiliated teaching hospital system using referral of diabetic services as an example. The aims of this study include: (1) to assess health care providers' awareness and use of facilities, (2) to determine barriers to referring patients to facilities, (3) identify current and needed resources and/or changes to increase referral to facilities. A 20-item electronic survey and requests for semi-structured interviews were administered to hospital system directors and managers (n = 51). Directors and managers instructed physicians and staff to complete the survey and interviews as applicable. Perceived barriers, knowledge, utilization, and referral of patients to Medical Fitness Center Facilities were collected and examined. Descriptive statistics were generated regarding practice characteristics, provider characteristics, and referral. Of the health care providers surveyed and interviewed (n = 25) 40% indicated verbally suggesting use of facilities, 24% provided a flyer about the facilities. No respondents indicated that they directly referred patients to the facilities. However, 16% referred patients to other locations for physical activity - including their own department's management and prevention services. 20% do not refer to Medical Fitness Center Facilities or any other lifestyle programs/locations. Lack of time (92%) and lack of standard guidelines and operating procedures (88%) are barriers to referral. All respondents indicated a strong ability to refer patients to Medical Fitness Center Facilities if given education about referral programs available as well as standard clinical guidelines and protocol for delivery. The results of this study indicate that, although few healthcare providers are currently referring patients to Medical Fitness Center Facilities, health care providers with an affiliated Medical Fitness Center Facility not only want clinical standard guidelines, protocol, and training to refer patients to Medical Fitness Center Facilities, but believe they have the ability to increase referral if given these tools. The Medical Fitness Association has a unique opportunity to bridge health care providers to Medical Fitness Center Facilities by developing clinical practice guidelines in cooperation with the American Diabetes Association.

45 CFR Appendix A to Part 1611 - Income Level for Individuals Eligible for Assistance

Code of Federal Regulations, 2014 CFR

2014-10-01

...: 5,075 6,350 5,838 * The figures in this table represent 125% of the poverty guidelines by household size as determined by DHHS. Reference Chart—200% of DHHS Federal Poverty Guidelines Size of household...

Reference Collection Development Policy. Penfield Library, State University of New York College at Oswego.

ERIC Educational Resources Information Center

Judd, Blanche; And Others

Intended for use by the head of reference and subject-area bibliographers at Penfield Library, this document provides guidelines for the selection and evaluation of titles for the 25,000 volume reference collection at this primarily undergraduate institution. The reference collection also supports the general information needs of both the college…

Careful Selection of Reference Genes Is Required for Reliable Performance of RT-qPCR in Human Normal and Cancer Cell Lines

PubMed Central

Jacob, Francis; Guertler, Rea; Naim, Stephanie; Nixdorf, Sheri; Fedier, André; Hacker, Neville F.; Heinzelmann-Schwarz, Viola

2013-01-01

Reverse Transcription - quantitative Polymerase Chain Reaction (RT-qPCR) is a standard technique in most laboratories. The selection of reference genes is essential for data normalization and the selection of suitable reference genes remains critical. Our aim was to 1) review the literature since implementation of the MIQE guidelines in order to identify the degree of acceptance; 2) compare various algorithms in their expression stability; 3) identify a set of suitable and most reliable reference genes for a variety of human cancer cell lines. A PubMed database review was performed and publications since 2009 were selected. Twelve putative reference genes were profiled in normal and various cancer cell lines (n = 25) using 2-step RT-qPCR. Investigated reference genes were ranked according to their expression stability by five algorithms (geNorm, Normfinder, BestKeeper, comparative ΔCt, and RefFinder). Our review revealed 37 publications, with two thirds patient samples and one third cell lines. qPCR efficiency was given in 68.4% of all publications, but only 28.9% of all studies provided RNA/cDNA amount and standard curves. GeNorm and Normfinder algorithms were used in 60.5% in combination. In our selection of 25 cancer cell lines, we identified HSPCB, RRN18S, and RPS13 as the most stable expressed reference genes. In the subset of ovarian cancer cell lines, the reference genes were PPIA, RPS13 and SDHA, clearly demonstrating the necessity to select genes depending on the research focus. Moreover, a cohort of at least three suitable reference genes needs to be established in advance to the experiments, according to the guidelines. For establishing a set of reference genes for gene normalization we recommend the use of ideally three reference genes selected by at least three stability algorithms. The unfortunate lack of compliance to the MIQE guidelines reflects that these need to be further established in the research community. PMID:23554992

Update of the Dutch manual for costing studies in health care

PubMed Central

Kanters, Tim A.; Bouwmans, Clazien A. M.; van der Linden, Naomi; Tan, Siok Swan; Hakkaart-van Roijen, Leona

2017-01-01

Objectives Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version. Methods An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute. Results The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1) costs within the health care sector; 2) patient and family costs; and 3) costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added. Conclusions The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines. PMID:29121647

Update of the Dutch manual for costing studies in health care.

PubMed

Kanters, Tim A; Bouwmans, Clazien A M; van der Linden, Naomi; Tan, Siok Swan; Hakkaart-van Roijen, Leona

2017-01-01

Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version. An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute. The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1) costs within the health care sector; 2) patient and family costs; and 3) costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added. The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines.

Smartphone Applications for the Clinical Oncologist in UK Practice.

PubMed

Rozati, Hamoun; Shah, Sonya Pratik; Shah, Neha

2015-06-01

A number of medical smartphone applications have been developed to assist clinical oncology specialists. Concerns have arisen that the information provided may not be under sufficient scrutiny. This study aims to analyse the current applications available for clinical oncologists in the UK. Applications aimed specifically at physician clinical oncologists were searched for on the major smartphone operating systems: Apple iOS; Google Android; Microsoft Windows OS; and Blackberry OS. All applications were installed and analysed. The applications were scrutinised to assess the following information: cost; whether the information included was referenced; when the information was last updated; and whether they made any reference to UK guidelines. A novel rating score based on these criteria was applied to each application. Fifty applications were identified: 24 for Apple's iOS; 23 for Google's Android; 2 for Blackberry OS; and 1 for Windows OS. The categories of applications available were: drug reference; journal reference; learning; clinical calculators; decision support; guidelines; and dictionaries. Journal reference and guideline applications scored highly on our rating system. Drug reference application costs were prohibitive. Learning tools were poorly referenced and not up-to-date. Smartphones provide easy access to information. There are numerous applications devoted to oncology physicians, many of which are free and contain referenced, up-to-date data. The cost and quality of drug reference and learning applications have significant scope for improvement. A regulatory body is needed to ensure the presence of peer-reviewed, validated applications to ensure their reliability.

Bacterial reference genes for gene expression studies by RT-qPCR: survey and analysis.

PubMed

Rocha, Danilo J P; Santos, Carolina S; Pacheco, Luis G C

2015-09-01

The appropriate choice of reference genes is essential for accurate normalization of gene expression data obtained by the method of reverse transcription quantitative real-time PCR (RT-qPCR). In 2009, a guideline called the Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) highlighted the importance of the selection and validation of more than one suitable reference gene for obtaining reliable RT-qPCR results. Herein, we searched the recent literature in order to identify the bacterial reference genes that have been most commonly validated in gene expression studies by RT-qPCR (in the first 5 years following publication of the MIQE guidelines). Through a combination of different search parameters with the text mining tool MedlineRanker, we identified 145 unique bacterial genes that were recently tested as candidate reference genes. Of these, 45 genes were experimentally validated and, in most of the cases, their expression stabilities were verified using the software tools geNorm and NormFinder. It is noteworthy that only 10 of these reference genes had been validated in two or more of the studies evaluated. An enrichment analysis using Gene Ontology classifications demonstrated that genes belonging to the functional categories of DNA Replication (GO: 0006260) and Transcription (GO: 0006351) rendered a proportionally higher number of validated reference genes. Three genes in the former functional class were also among the top five most stable genes identified through an analysis of gene expression data obtained from the Pathosystems Resource Integration Center. These results may provide a guideline for the initial selection of candidate reference genes for RT-qPCR studies in several different bacterial species.

Statistical Methods in Psychology Journals.

ERIC Educational Resources Information Center

Willkinson, Leland

1999-01-01

Proposes guidelines for revising the American Psychological Association (APA) publication manual or other APA materials to clarify the application of statistics in research reports. The guidelines are intended to induce authors and editors to recognize the thoughtless application of statistical methods. Contains 54 references. (SLD)

The Interview as a Technique for Assessing Oral Ability: Some Guidelines for Its Use.

ERIC Educational Resources Information Center

Nambiar, Mohana

1990-01-01

Some guidelines are offered that detail the complexities involved in interviewing for language testing purposes. They cover strategies for structuring interviews (informal conversational, interview guide, standardized open-ended), questions, interviewing skills, and physical setting. (five references) (LB)

24 CFR 35.1310 - References.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES Methods and Standards for Lead-Paint...) The HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (Guidelines...

24 CFR 35.1310 - References.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES Methods and Standards for Lead-Paint...) The HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (Guidelines...

24 CFR 35.1310 - References.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES Methods and Standards for Lead-Paint...) The HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (Guidelines...

24 CFR 35.1310 - References.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES Methods and Standards for Lead-Paint...) The HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (Guidelines...

24 CFR 35.1310 - References.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES Methods and Standards for Lead-Paint...) The HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (Guidelines...

Influence of qualitative research on women's health screening guidelines.

PubMed

Abadir, Anna Maria; Lang, Ariella; Klein, Talia; Abenhaim, Haim Arie

2014-01-01

Considerable time and resources are allocated to carry out qualitative research. The purpose of our study was to evaluate the availability of qualitative research on women's health screening and assess its influence on screening practice guidelines in the United States, Canada, and the United Kingdom. Medline, CINHAL, and WEB of Science databases were used to identify the availability of qualitative research conducted in the past 15 years on 3 different women's health screening topics: cervical cancer screening, breast cancer screening, and prenatal first-trimester screening. Key national practice guidelines on women's health screening were selected using the National Guideline Clearinghouse web site. Bibliometric analysis was used to determine the frequency of qualitative references cited in the guidelines. A total of 272 qualitative research papers on women's health screening was identified: 109 on cervical cancer screening, 104 on breast cancer screening, and 59 on prenatal first-trimester screening. The qualitative studies focused on health care provider perspectives as well as ethical, ethnographic, psychological, and social issues surrounding screening. Fifteen national clinical practice guidelines on women's health screening were identified. A total of 943 references was cited, only 2 of which comprised of qualitative research cited by only 1 clinical practice guideline. Although there is considerable qualitative research that has been carried out on women's health screening, its incorporation into clinical practice guidelines is minimal. Further exploration of the disconnect between the two is important for enhancing knowledge translation of qualitative research within clinical practice. Copyright © 2014 Mosby, Inc. All rights reserved.

Salient Features and Outline of the Joint Japanese Guidelines for Safe Handling of Cancer Chemotherapy Drugs

PubMed Central

Kanda, Kiyoko; Hirai, Kazue; Iino, Keiko; Nomura, Hisanaga; Yasui, Hisateru; Kano, Taro; Ichikawa, Chisato; Hiura, Sumiko; Morita, Tomoko; Mitsuma, Ayako; Komatsu, Hiroko

2017-01-01

The purpose of this paper is to introduce the outline and describe the salient features of the “Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs” (hereinafter, “Guideline”), which were published in July 2015. The purpose of this Guideline is to provide guidance to protect against occupational exposure to hazardous drugs (HDs) to all medical personnel involved in cancer chemotherapy, including physicians, pharmacists, and nurses and home health-care providers. The Guideline was developed according to the Medical Information Network Distribution Service guidance for developing clinical practice guidelines, with reference to five authoritative guidelines used worldwide. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ichushi-Web, and Cochrane Central Register of Controlled Trials were used for a systematic search of the literature. Eight clinical questions (CQs) were eventually established, and the strength of recommendation for each CQ is presented based on 867 references. The salient features of the Guideline are that it was jointly developed by three societies (Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology), contains descriptions including the definition of HDs and the concept of hierarchy of controls, and addresses exposure control measures during handling of chemotherapy drugs. Our future task is to collect additional evidence for the recommended exposure control measures and to assess whether publication of the Guideline has led to adherence of measures to prevent occupational exposure. PMID:28966958

Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?

PubMed

Powell, C Bethan; Littell, Ramey; Hoodfar, Elizabeth; Sinclair, Fiona; Pressman, Alice

2013-03-01

Kaiser Permanente Northern California is a large integrated health care delivery system in the United States that has guidelines for referring women with newly diagnosed BRCA1-and BRCA2-associated cancers for genetic counseling. This study assesses adherence to genetic counseling referral guidelines within this health system. Chart review was performed to identify patients with cancer who met the following pathology-based Kaiser Permanente Northern California guidelines for referral for genetic counseling: invasive breast cancer, younger than age 40; nonmucinous epithelial ovarian, fallopian tube, or peritoneal cancer, younger than age 60; women with synchronous or metachronous primary cancers of the breast and ovaries; and male breast cancer. We assessed compliance with referral guidelines. An electronic notice was sent to the managing physician of patients with newly diagnosed cancer to assess the feasibility of this intervention. A total of 340 patients were identified with breast cancer at younger than age 40 or with ovarian, peritoneal, or tubal cancer between January and June, 2008. Upon chart review, 105 of these patients met pathology-based criteria for referral to genetic counseling, of whom 47 (45%) were referred within the 2-year study period. Of the 67 subjects with breast cancer, 40 subjects (60%) were referred. In contrast, only 7 (21%) of 33 patients with ovarian cancer were referred (P < 0.001). A pilot study was performed to test the feasibility of notifying managing oncologists with an electronic letter alerting them of eligibility for genetic referral of patients with new diagnosis (n = 21). In the 3 to 6 months after this notification, 12 of these 21 patients were referred for counseling including 5 of 7 patients with a diagnosis of ovarian cancer. There is a missed opportunity for referring patients to genetic counseling, especially among patients with ovarian cancer. A pilot study suggests that alerting treating physicians is a feasible strategy to increase appropriate referral.

The `WikiGuidelines' smartphone application: Bridging the gaps in availability of evidence-based smartphone mental health applications.

PubMed

Zhang, Melvyn W B; Ho, Roger C M; Mcintyre, Roger S

2016-07-27

Over the past decade, there have been massive advances in technology. These advances in technology have significantly transformed various aspects of healthcare. The advent of E-health and its influence on healthcare practice also implies that there is a paradigm shift in the way healthcare professionals work. Conventionally, healthcare professionals would have to refer to books and journals for updates in treatment algorithms, but with the advent of technology, they could access this information via the web or via various smartphone applications on the go. In the field of Psychiatry, one of the commonest mental health disorder to date, with significant morbidity and mortality is that of Major depressive disorder. Routinely, clinicians and healthcare professionals are advised to refer to standard guidelines in guiding them with regards to their treatment options. Given the high prevalence of conditions like Major Depressive Disorder, it is thus of importance that whatever guidelines that clinicians and healthcare professionals refer to are constantly kept up to date, so that patients could benefit from latest evidence based therapy and treatment. A review of the current literature highlights that whilst there are a multitude of smartphone applications designed for mental health care, previous systematic review has highlighted a paucity of evidence based applications. More importantly, current literature with regards to provision of treatment information to healthcare professionals and patients are limited to web-based interventions. It is the aim of this technical note to highlight a methodology to which the authors have conceptualized in the implementation of an evidence based mental health guideline applications, known as the `Wiki Guidelines' smartphone application. The authors hope to illustrate the algorithms behind the development of the application, and how it could be easily updated by the guidelines working group.

[Reflections on a pedagogical praxis based on educational references and guidelines for nursing training].

PubMed

Timoteo, Rosalba Pessoa de Souza; Liberalino, Francisca Nazaré

2003-01-01

This text aims at supplying elements for reflection on Nursing education, considering the introduction of national curricular guidelines and the need for the creation of political-pedagogical projects in undergraduate programs. By taking as a reference some constituent factors of the pedagogical praxis, it searches to raise critical thinking on this field, on the bases and the plan for pedagogical action, as well as the relationship between theory and practice and the roles of the individuals involved in a teaching-learning process.

The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest.

PubMed

Cheskes, Sheldon; Schmicker, Robert H; Rea, Tom; Morrison, Laurie J; Grunau, Brian; Drennan, Ian R; Leroux, Brian; Vaillancourt, Christian; Schmidt, Terri A; Koller, Allison C; Kudenchuk, Peter; Aufderheide, Tom P; Herren, Heather; Flickinger, Katharyn H; Charleston, Mark; Straight, Ron; Christenson, Jim

2017-07-01

Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with American Heart Association (AHA) guidelines incorporating all the aforementioned metrics, is associated with improved survival from OHCA. We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database. As per the 2015 American Heart Association (AHA) guidelines, guideline compliant cardiopulmonary resuscitation (CPR) was defined as CCF >0.8, chest compression rate 100-120/minute, chest compression depth 50-60mm, and pre-shock pause <10s. Multivariable logistic regression models controlling for Utstein variables were used to assess the relationship between global guideline compliance and survival to hospital discharge and neurologically intact survival with MRS ≤3. Due to potential confounding between CPR quality metrics and cases that achieved early ROSC, we performed an a priori subgroup analysis restricted to patients who obtained ROSC after ≥10min of EMS resuscitation. After allowing for study exclusions, 19,568 defibrillator records were collected over a 4-year period ending in June 2015. For all reported models, the reference standard included all cases who did not meet all CPR quality benchmarks. For the primary model (CCF, rate, depth), there was no significant difference in survival for resuscitations that met all CPR quality benchmarks (guideline compliant) compared to the reference standard (OR 1.26; 95% CI: 0.80, 1.97). When the dataset was restricted to patients obtaining ROSC after ≥10min of EMS resuscitation (n=4,158), survival was significantly higher for those resuscitations that were guideline compliant (OR 2.17; 95% CI: 1.11, 4.27) compared to the reference standard. Similar findings were obtained for neurologically intact survival with MRS ≤3 (OR 3.03; 95% CI: 1.12, 8.20). In this observational study, compliance with AHA guidelines for CPR quality was not associated with improved outcomes from OHCA. Conversely, when restricting the cohort to those with late ROSC, compliance with guidelines was associated with improved clinical outcomes. Strategies to improve overall guideline compliance may have a significant impact on outcomes from OHCA. Copyright © 2017 Elsevier B.V. All rights reserved.

[The NHG guidelines 'Adult asthma' and 'COPD'].

PubMed

Geijer, Roeland M M; Tuut, Mariska K; in't Veen, Johannes C C M; Broekhuizen, Berna D L; Chavannes, Niels H; Smeele, Ivo J M

2015-01-01

The Dutch College of General Practitioners (NHG) guidelines 'Adult asthma' and 'COPD' have been revised. New spirometry reference values from the Global Lung Function Initiative are recommended. Airway obstruction is defined as a FEV1/FVC ratio below the 5th percentile for the reference population. Spirometry for diagnosis takes place without use of patients' inhaled medication and consists of measurements before and after standardized bronchodilation. In monitoring spirometry, patients continue using inhaled medication and standardized bronchodilation is not indicated. The goal of asthma management is optimal asthma control, tailored to individual goals. The most important non-drug intervention in asthma and COPD is to recommend stopping smoking. The goal of COPD management is to limit symptoms, improve exercise capacity and quality of life, and reduce the burden of disease. Inhaled corticosteroids are usually not indicated in COPD treatment. Patients with comorbid asthma and COPD are treated with non-drug interventions according to the COPD guideline and with medication according to the asthma guideline.

Recommendations for kidney disease guideline updating: a report by the KDIGO Methods Committee

PubMed Central

Uhlig, Katrin; Berns, Jeffrey S.; Carville, Serena; Chan, Wiley; Cheung, Michael; Guyatt, Gordon H.; Hart, Allyson; Lewis, Sandra Zelman; Tonelli, Marcello; Webster, Angela C.; Wilt, Timothy J.; Kasiske, Bertram L.

2017-01-01

Updating rather than de novo guideline development now accounts for the majority of guideline activities for many guideline development organizations, including Kidney Disease: Improving Global Outcomes (KDIGO), an international kidney disease guideline development entity that has produced guidelines on kidney diseases since 2008. Increasingly, guideline developers are moving away from updating at fixed intervals in favor of more flexible approaches that use periodic expert assessment of guideline currency (with or without an updated systematic review) to determine the need for updating. Determining the need for guideline updating in an efficient, transparent, and timely manner is challenging, and updating of systematic reviews and guidelines is labor intensive. Ideally, guidelines should be updated dynamically when new evidence indicates a need for a substantive change in the guideline based on a priori criteria. This dynamic updating (sometimes referred to as a living guideline model) can be facilitated with the use of integrated electronic platforms that allow updating of specific recommendations. This report summarizes consensus-based recommendations from a panel of guideline methodology professionals on how to keep KDIGO guidelines up to date. PMID:26994574

Naturalistic study of guideline implementation tool use via evaluation of website access and physician survey.

PubMed

Armstrong, Melissa J; Gronseth, Gary S; Dubinsky, Richard; Potrebic, Sonja; Penfold Murray, Rebecca; Getchius, Thomas S D; Rheaume, Carol; Gagliardi, Anna R

2017-01-13

Clinical guidelines support decision-making at the point-of-care but the onus is often on individual users such as physicians to implement them. Research shows that the inclusion of implementation tools in or with guidelines (GItools) is associated with guideline use. However, there is little research on which GItools best support implementation by individual physicians. The purpose of this study was to investigate naturalistic access and use of GItools produced by the American Academy of Neurology (AAN) to inform future tool development. Website accesses over six months were summarized for eight AAN guidelines and associated GItools published between July 2012 and August 2013. Academy members were surveyed about use of tools accompanying the sport concussion guideline. Data were analyzed using summary statistics and the Chi-square test. The clinician summary was accessed more frequently (29.0%, p < 0.001) compared with the slide presentation (26.8%), patient summary (23.2%) or case study (20.9%), although this varied by guideline topic. For the sport concussion guideline, which was accompanied by a greater variety of GItools, the mobile phone quick reference check application was most frequently accessed, followed by the clinician summary, patient summary, and slide presentation. For the sports concussion guideline survey, most respondents (response rate 21.8%, 168/797) were aware of the guideline (88.1%) and had read the guideline (78.6%). For GItool use, respondents indicated reading the reference card (51.2%), clinician summary (45.2%), patient summary (28.0%), mobile phone application (26.2%), and coach/athletic trainer summary (20.2%). Patterns of sports concussion GItool use were similar between respondents who said they had and had not yet implemented the guideline. Developers faced with resource limitations may wish to prioritize the development of printable or mobile application clinician summaries, which were accessed significantly more than other types of GItools. Further research is needed to understand how to optimize the design of such GItools.

Training Guidelines. Operatives-Precast Concrete.

ERIC Educational Resources Information Center

Ceramics, Glass, and Mineral Products Industry Training Board, Harrow (England).

This manual is intended to provide guidelines for firms in the precast concrete industry in planning their training programs particularly with reference to new entrants into the industry. Details for preparing training syllabuses for various job specifications are given--mould makers in timber, steel, and glass fiber; makers; finishers; site…

Clean air program : design guidelines for bus transit systems using compressed natural gas as an alternative fuel

DOT National Transportation Integrated Search

1996-06-01

This report documents design guidelines for the safe use of Compressed Natural Gas (CNG). The report is designed to provide guidance, information on safe industry practices, applicable national codes and standards, and reference data that transit age...

Reference Equations for Static Lung Volumes and TLCO from a Population Sample in Northern Greece.

PubMed

Michailopoulos, Pavlos; Kontakiotis, Theodoros; Spyratos, Dionisios; Argyropoulou-Pataka, Paraskevi; Sichletidis, Lazaros

2015-02-14

Background: The most commonly used reference equations for the measurement of static lung volumes/capacities and transfer factor of the lung for CO (TL CO ) are based on studies around 30-40 years old with significant limitations. Objectives: Our aim was to (1) develop reference equations for static lung volumes and TL CO using the current American Thoracic Society/European Respiratory Society guidelines, and (2) compare the equations derived with those most commonly used. Methods: Healthy Caucasian subjects (234 males and 233 females) aged 18-91 years were recruited. All of them were healthy never smokers with a normal chest X-ray. Static lung volumes and TL CO were measured with a single-breath technique according to the latest guidelines. Results: Curvilinear regression prediction equations derived from the present study were compared with those that are most commonly used. Our reference equations in accordance with the latest studies show lower values for all static lung volume parameters and TL CO as well as a different way of deviation of those parameters (i.e. declining with age total lung capacity, TL CO age decline in both sex and functional residual capacity age rise in males). Conclusions: We suggest that old reference values of static lung volumes and TL CO should be updated, and our perception of deviation of some spirometric parameters should be revised. Our new reference curvilinear equations derived according to the latest guidelines could contribute to the updating by respiratory societies of old existing reference values and result in a better estimation of the lung function of contemporary populations with similar Caucasian characteristics. © 2015 S. Karger AG, Basel.

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

PubMed Central

2012-01-01

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

IOM committee members respond to Endocrine Society vitamin D guideline

USDA-ARS?s Scientific Manuscript database

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

36 CFR 1238.20 - How must microform records be stored?

Code of Federal Regulations, 2011 CFR

2011-07-01

... specified in ISO 18911 and ANSI/PIMA IT9.2 (both incorporated by reference, see § 1238.5), except that the... may consult Life Expectance (LE) guidelines in ISO 18901 (incorporated by reference, see § 1238.5). ...

Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo

PubMed Central

Tabala, Martine; Batumbula, Marie Louise; Wenzi, Landry; Basaki, Emmanuel; Mungoyo, Eugenie; Mangala, Richard; Behets, Frieda

2016-01-01

Background. We assessed the impact of WHO's 2010 guidelines that removed the requirement of CD4 count before ART, on timely initiation of ART among HIV/TB patients in the Democratic Republic of Congo (DRC). Methods. Data collected to monitor implementation of provider initiated HIV testing and counseling (PITC) and linkage to HIV care from 65 and 13 TB clinics in Kinshasa and Kisangani, respectively, between November 2010 and June 2013. Results. Prior to the WHO's 2010 guidelines, in Kinshasa, 79.1% (401/507) of HIV/TB patients referred for HIV services were initiated on ART in clinics with onsite ART services compared to 50.0% (63/123) in clinics without. Following the implementation of the new guidelines, 89.8% (714/795) and 93.0% (345/371) of HIV/TB patients referred for HIV services were initiated on ART, respectively, in clinics with onsite and without onsite ART services. Similarly, in Kisangani, 69.7% (53/120) and 36.4% (16/44) in clinics with and without onsite ART service, respectively, were initiated on ART prior to the 2010 guidelines and 88.8% (135/152) and 72.6% (106/146), respectively, after the new guidelines. Conclusion. Though implementation of the 2010 guidelines increased the proportion of HIV/TB patients initiated on ART substantially, it remained below the 100% target, particularly in clinics without onsite ART services. PMID:27595020

Medicare program; standards for quality of water used in dialysis and revised guidelines on reuse of hemodialysis filters for end-stage renal disease (ESRD) patients--HCFA. Final rule.

PubMed

1995-09-18

This final rule revises the Medicare conditions for coverage of suppliers of end-stage renal disease services. The revisions remove general language in the regulations regarding water quality; incorporate by reference standards for monitoring the quality of water used in dialysis as published by the Association for the Advancement of Medical Instrumentation (AAMI) in its document, "Hemodialysis Systems" (second edition); and update existing regulations to incorporate by reference the second edition of AAMI's voluntary guidelines on "Reuse of Hemodialyzers."

40 CFR Appendix 8 to Subpart A of... - Reference C16-C18 Internal Olefin Drilling Fluid Formulation

Code of Federal Regulations, 2014 CFR

2014-07-01

... Drilling Fluid Formulation 8 Appendix 8 to Subpart A of Part 435 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS (CONTINUED) OIL AND GAS EXTRACTION POINT...—Reference C16-C18 Internal Olefin Drilling Fluid Formulation The reference C16-C18 internal olefin drilling...

40 CFR Appendix 8 to Subpart A of... - Reference C16-C18 Internal Olefin Drilling Fluid Formulation

Code of Federal Regulations, 2012 CFR

2012-07-01

... Drilling Fluid Formulation 8 Appendix 8 to Subpart A of Part 435 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS (CONTINUED) OIL AND GAS EXTRACTION POINT...—Reference C16-C18 Internal Olefin Drilling Fluid Formulation The reference C16-C18 internal olefin drilling...

40 CFR Appendix 8 to Subpart A of... - Reference C16-C18 Internal Olefin Drilling Fluid Formulation

Code of Federal Regulations, 2013 CFR

2013-07-01

... Drilling Fluid Formulation 8 Appendix 8 to Subpart A of Part 435 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS (CONTINUED) OIL AND GAS EXTRACTION POINT...—Reference C16-C18 Internal Olefin Drilling Fluid Formulation The reference C16-C18 internal olefin drilling...

Guidelines for Marine Biological Reference Collections. Unesco Reports in Marine Sciences, No. 22.

ERIC Educational Resources Information Center

Hureau, J. C.; Rice, A. L.

This manual provides practical advice on the appropriation, conservation, and documentation of a marine biological reference collection, in response to needs expressed by Mediterranean Arab countries. A reference collection is defined as a working museum containing a series of specimens with which biologists are able to compare their own material.…

Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre.

PubMed

Georges, Marjolaine; Golmard, Jean-Louis; Llontop, Claudia; Shoukri, Amr; Salachas, François; Similowski, Thomas; Morelot-Panzini, Capucine; Gonzalez-Bermejo, Jésus

2017-02-01

In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure. Non-invasive ventilation (NIV) maintains adequate ventilation in ALS patients. NIV alleviates symptoms and improves survival. In 2006, French guidelines established criteria for NIV initiation based on limited evidence. Their impact on clinical practice remains unknown. Our objective was to describe NIV initiation practices of the main French ALS tertiary referral centre with respect to guidelines. In this retrospective descriptive study, 624 patients followed in a single national reference centre began NIV between 2005 and 2013. We analysed criteria used to initiate NIV, including symptoms, PaCO 2 , forced vital capacity, maximal inspiratory pressures and time spent with SpO 2 <90% at night. At NIV initiation, 90% of patients were symptomatic. Median PaCO 2 was 48 mmHg. The main criterion to initiate NIV was 'symptoms' followed by 'hypercapnia' in 42% and 34% of cases, respectively. NIV was initiated on functional parameters in only 5% of cases. Guidelines were followed in 81% of cases. In conclusion, despite compliance with French guidelines, the majority of patients are treated at the stage of symptomatic daytime hypoventilation, which suggests that NIV is initiated late in the course of ALS. Whether this practice could be improved by changing guidelines or increasing respiratory-dedicated resources remains to be determined.

Radio tuning effects on visual and driving performance measures : simulator and test track studies.

DOT National Transportation Integrated Search

2013-05-01

Existing driver distraction guidelines for visual-manual device interface operation specify traditional : manual radio tuning as a reference task. This project evaluated the radio tuning reference task through two activities. : The first activity con...

International Continence Society guidelines on urodynamic equipment performance.

PubMed

Gammie, Andrew; Clarkson, Becky; Constantinou, Chris; Damaser, Margot; Drinnan, Michael; Geleijnse, Geert; Griffiths, Derek; Rosier, Peter; Schäfer, Werner; Van Mastrigt, Ron

2014-04-01

These guidelines provide benchmarks for the performance of urodynamic equipment, and have been developed by the International Continence Society to assist purchasing decisions, design requirements, and performance checks. The guidelines suggest ranges of specification for uroflowmetry, volume, pressure, and EMG measurement, along with recommendations for user interfaces and performance tests. Factors affecting measurement relating to the different technologies used are also described. Summary tables of essential and desirable features are included for ease of reference. It is emphasized that these guidelines can only contribute to good urodynamics if equipment is used properly, in accordance with good practice. © 2014 Wiley Periodicals, Inc.

WHO expert committee on specifications for pharmaceutical preparations.

PubMed

2013-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use: Release procedure for International Chemical Reference Substances; WHO guidelines on quality risk management; WHO guidelines on variations to a prequalified product; and the Collaborative procedure between the World Health Organization Prequalification of Medicines Programme and national medicines regulatory authorities in the assessment and accelerated national registration of WHO-prequalified pharmaceutical products.

[ADHD and addiction; application of the Belgian guideline with particular reference to comorbid affective disorders].

PubMed

Matthys, F; Joostens, P; Tremmery, S; Stes, S; Sabbe, B

2013-01-01

Two patients with a multi-substance use disorder and an apparent comorbid ADHD disorder were given psychiatric treatment for both illnesses. Each patient had a comorbid affective disorder. In both cases the approach was based on the Belgian guideline Good clinical practice in the recognition and treatment of young adults with addiction problems& squo. We use the case-reports to demonstrate the usefulness and relevance of the guideline in an outpatient setting compared to an inpatient setting and look particularly at the implications of other kinds of comorbidity encompassed by the guideline.

Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines.

PubMed

Thomson, Mike; Tringali, Andrea; Dumonceau, Jean-Marc; Tavares, Marta; Tabbers, Merit M; Furlano, Raoul; Spaander, Manon; Hassan, Cesare; Tzvinikos, Christos; Ijsselstijn, Hanneke; Viala, Jérôme; Dall'Oglio, Luigi; Benninga, Marc; Orel, Rok; Vandenplas, Yvan; Keil, Radan; Romano, Claudio; Brownstone, Eva; Hlava, Štěpán; Gerner, Patrick; Dolak, Werner; Landi, Rosario; Huber, Wolf D; Everett, Simon; Vecsei, Andreas; Aabakken, Lars; Amil-Dias, Jorge; Zambelli, Alessandro

2017-01-01

This guideline refers to infants, children, and adolescents ages 0 to 18 years. The areas covered include indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography; and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease has been dealt with in other guidelines and are therefore not mentioned in this guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.

Sustainable Design Guidelines for the Construction of New Facilities and the Renovation of Existing Structures.

ERIC Educational Resources Information Center

Dorsey, Judy; L'Esperance, Clare

This guide summarizes research conducted at Colorado's Poudre School District (PSD) to develop guidelines for the desired performance outcomes from employing sustainable educational facility design, and it suggests approaches for attaining them. The guide also provides case studies and references to further investigate opportunities on specific…

Guidelines to the Development of Human Resources in Libraries: Rationale, Policies, Programs and Recommendations

ERIC Educational Resources Information Center

Library Trends, 1971

1971-01-01

It is apparent that there are many roadblocks preventing the release of the human potential in our libraries. These guidelines take the position that a great deal can be done toward diagnosing and removing these roadblocks by establishing and developing meaningful policies and programs. (49 references) (Author/NH)

Teaching and Learning about the Earth. ERIC Digest.

ERIC Educational Resources Information Center

Lee, Hyonyong

This ERIC Digest investigates the earth and space science guidelines of the National Science Education Standards. These guidelines are frequently referred to as the earth system and include components such as plate tectonics, the water cycle, and the carbon cycle. This Digest describes the development of earth systems science and earth systems…

77 FR 21958 - Fisheries Off West Coast States; Coastal Pelagic Species Fisheries; Annual Specifications

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-12

...), harvest guideline (HG), annual catch target (ACT) and associated annual reference points for Pacific... metric tons (mt). The proposed ACT, which will be the directed fishing harvest target, is 30,386 mt. If... limit (ACL) and harvest guideline (HG) and/or annual catch target (ACT) recommendations and comments...

Creation of an Open Framework for Point-of-Care Computer-Assisted Reporting and Decision Support Tools for Radiologists.

PubMed

Alkasab, Tarik K; Bizzo, Bernardo C; Berland, Lincoln L; Nair, Sujith; Pandharipande, Pari V; Harvey, H Benjamin

2017-09-01

Decreasing unnecessary variation in radiology reporting and producing guideline-concordant reports is fundamental to radiology's success in value-based payment models and good for patient care. In this article, we present an open authoring system for point-of-care clinical decision support tools integrated into the radiologist reporting environment referred to as the computer-assisted reporting and decision support (CAR/DS) framework. The CAR/DS authoring system, described herein, includes: (1) a definition format for representing radiology clinical guidelines as structured, machine-readable Extensible Markup Language documents and (2) a user-friendly reference implementation to test the fidelity of the created definition files with the clinical guideline. The proposed definition format and reference implementation will enable content creators to develop CAR/DS tools that voice recognition software (VRS) vendors can use to extend the commercial tools currently in use. In making the definition format and reference implementation software freely available, we hope to empower individual radiologists, expert groups such as the ACR, and VRS vendors to develop a robust ecosystem of CAR/DS tools that can further improve the quality and efficiency of the patient care that our field provides. We hope that this initial effort can serve as the basis for a community-owned open standard for guideline definition that the imaging informatics and VRS vendor communities will embrace and strengthen. To this end, the ACR Assist™ initiative is intended to make the College's clinical content, including the Incidental Findings Committee White Papers, available for decision support tool creation based upon the herein described CAR/DS framework. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Liver elastography, comments on EFSUMB elastography guidelines 2013

PubMed Central

Cui, Xin-Wu; Friedrich-Rust, Mireen; Molo, Chiara De; Ignee, Andre; Schreiber-Dietrich, Dagmar; Dietrich, Christoph F

2013-01-01

Recently the European Federation of Societies for Ultrasound in Medicine and Biology Guidelines and Recommendations have been published assessing the clinical use of ultrasound elastography. The document is intended to form a reference and to guide clinical users in a practical way. They give practical advice for the use and interpretation. Liver disease forms the largest section, reflecting published experience to date including evidence from meta-analyses with shear wave and strain elastography. In this review comments and illustrations on the guidelines are given. PMID:24151351

ASVCP guidelines: quality assurance for point-of-care testing in veterinary medicine.

PubMed

Flatland, Bente; Freeman, Kathleen P; Vap, Linda M; Harr, Kendal E

2013-12-01

Point-of-care testing (POCT) refers to any laboratory testing performed outside the conventional reference laboratory and implies close proximity to patients. Instrumental POCT systems consist of small, handheld or benchtop analyzers. These have potential utility in many veterinary settings, including private clinics, academic veterinary medical centers, the community (eg, remote area veterinary medical teams), and for research applications in academia, government, and industry. Concern about the quality of veterinary in-clinic testing has been expressed in published veterinary literature; however, little guidance focusing on POCT is available. Recognizing this void, the ASVCP formed a subcommittee in 2009 charged with developing quality assurance (QA) guidelines for veterinary POCT. Guidelines were developed through literature review and a consensus process. Major recommendations include (1) taking a formalized approach to POCT within the facility, (2) use of written policies, standard operating procedures, forms, and logs, (3) operator training, including periodic assessment of skills, (4) assessment of instrument analytical performance and use of both statistical quality control and external quality assessment programs, (5) use of properly established or validated reference intervals, (6) and ensuring accurate patient results reporting. Where possible, given instrument analytical performance, use of a validated 13s control rule for interpretation of control data is recommended. These guidelines are aimed at veterinarians and veterinary technicians seeking to improve management of POCT in their clinical or research setting, and address QA of small chemistry and hematology instruments. These guidelines are not intended to be all-inclusive; rather, they provide a minimum standard for maintenance of POCT instruments in the veterinary setting. © 2013 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

Guidelines for psychological practice with older adults.

PubMed

2014-01-01

The "Guidelines for Psychological Practice With Older Adults" are intended to assist psychologists in evaluating their own readiness for working with older adults and in seeking and using appropriate education and training to increase their knowledge, skills, and experience relevant to this area of practice. The specific goals of these professional practice guidelines are to provide practitioners with (a) a frame of reference for engaging in clinical work with older adults and (b) basic information and further references in the areas of attitudes, general aspects of aging, clinical issues, assessment, intervention, consultation, professional issues, and continuing education and training relative to work with this group. The guidelines recognize and appreciate that there are numerous methods and pathways whereby psychologists may gain expertise and/or seek training in working with older adults. This document is designed to offer recommendations on those areas of awareness, knowledge, and clinical skills considered as applicable to this work, rather than prescribing specific training methods to be followed. The guidelines also recognize that some psychologists will specialize in the provision of services to older adults and may therefore seek more extensive training consistent with practicing within the formally recognized specialty of Professional Geropsychology (APA, 2010c). PsycINFO Database Record (c) 2014 APA, all rights reserved.

Guideline for Software Documentation Management.

ERIC Educational Resources Information Center

National Bureau of Standards (DOC), Washington, DC.

Designed as a basic reference for federal personnel concerned with the development, maintenance, enhancement, control, and management of computer-based systems, this manual provides a general overview of the software development process and software documentation issues so that managers can assess their own documentation requirements. Reference is…

Guidelines for Individual and Group Psychodynamic Psychotherapy for the Treatment of Persons Diagnosed with Psychosis and/or Schizophrenia.

PubMed

Ivezić, Slađana Štrkalj; Petrović, Branka Restek; Urlić, Ivan; Grah, Majda; Mayer, Nina; Stijačić, Dubravka; Jendričko, Tihana; Martić-Biočina, Sanja

2017-09-01

The hereby presented guidelines for the use of psychodynamic psychotherapy are based on references and research in the field of individual and group therapy and they refer to psychotherapy for patients suffering from the first psychotic episode, schizophrenia, schizoaffective psychosis, bipolar disorder and paranoid psychosis. The aim was to provide an overview of present literature and to give recommendations based on current knowledge. Clinical experience and research of the outcomes of psychodynamic psychotherapy encourage positioning of such treatments among recommendations for treating various mental disorders, as well as in the field of psychotherapy of patients with psychotic disorders (PD).

[The German program for disease management guidelines--implementation with pathways and quality management].

PubMed

Ollenschläger, Günter; Lelgemann, Monika; Kopp, Ina

2007-07-15

In Germany, physicians enrolled in disease management programs are legally obliged to follow evidence-based clinical practice guidelines. That is why a Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 aiming at implementation of best-practice evidence-based recommendations for nationwide as well as regional disease management programs. Against this background the article reviews programs, methods and tools for implementing DM-CPGs via clinical pathways as well as regional guidelines for outpatient care. Special reference is given to the institutionalized program of adapting DM-CPGs for regional use by primary-care physicians in the State of Hesse.

The McGill Interactive Pediatric OncoGenetic Guidelines: An approach to identifying pediatric oncology patients most likely to benefit from a genetic evaluation.

PubMed

Goudie, Catherine; Coltin, Hallie; Witkowski, Leora; Mourad, Stephanie; Malkin, David; Foulkes, William D

2017-08-01

Identifying cancer predisposition syndromes in children with tumors is crucial, yet few clinical guidelines exist to identify children at high risk of having germline mutations. The McGill Interactive Pediatric OncoGenetic Guidelines project aims to create a validated pediatric guideline in the form of a smartphone/tablet application using algorithms to process clinical data and help determine whether to refer a child for genetic assessment. This paper discusses the initial stages of the project, focusing on its overall structure, the methodology underpinning the algorithms, and the upcoming algorithm validation process. © 2017 Wiley Periodicals, Inc.

75 FR 36752 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing of a Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... Securities.'' Second, the Exchange is replacing existing paragraph (C)(4) of Rule 11890, entitled ``Numerical... the ability of the Exchange to deviate from the Numerical Guidelines contained in paragraph (C)(1... flexibility to the Exchange to use different Numerical Guidelines or Reference Prices in various ``Unusual...

A Study of the Implementation of Sex Education in Hong Kong Secondary Schools

ERIC Educational Resources Information Center

Che, Fok Shui

2005-01-01

Sex education is not treated as an important subject in the school curriculum of Hong Kong. The Hong Kong Education Department issued in 1986 and 1997, respectively, two guidelines on sex education for schools' reference. The 1997 Guidelines cover a broader conceptual framework relating to different aspects of human sexuality and also include…

A Primer for New Principals: Guidelines for Success

ERIC Educational Resources Information Center

Kellough, Richard D.

2008-01-01

Many new principals seek a professional guide that is simple, current, to-the-point, and enjoyable to read. This book can be used by beginning principals as a personal reference for the demands of the stressful and important job. The guidelines presented in this book are grade-level neutral-intended for the principal of K-12 public, charter, or…

New York City trans fat ban: improving the default option when purchasing foods prepared outside the home

USDA-ARS?s Scientific Manuscript database

The adverse effects of trans fatty acid (trans fat) on cardiovascular health have been known for at least 2 decades. During that time, both the Dietary Guidelines for Americans and the Institute of Medicine’s Dietary Reference Intake guidelines have recommended restricting trans fat intake to the ex...

The Community Health Worker. Working Guide. Guidelines for Training. Guidelines for Adaptation.

ERIC Educational Resources Information Center

World Health Organization, Geneva (Switzerland).

This book is a revised and enlarged edition of "The Primary Health Worker," a standard teaching text and reference manual developed for community health workers and their trainers and supervisors. The new edition has been updated with practical knowledge gained during the extensive field use of the previous work. The book also incorporates new…

76 FR 22342 - National Standard 10 Guidelines

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-21

... safety of human life at sea.'' NMFS published final guidelines for NS10 in 1998 (63 FR 24212; May 1, 1998... of human life at sea, including whether and to what extent such measures may affect the safety of...; and an explanation that the phrase ``safety of human life at sea'' refers to both the safety of a...

EMQN best practice guidelines for the molecular genetic diagnosis of hereditary hemochromatosis (HH).

PubMed

Porto, Graça; Brissot, Pierre; Swinkels, Dorine W; Zoller, Heinz; Kamarainen, Outi; Patton, Simon; Alonso, Isabel; Morris, Michael; Keeney, Steve

2016-04-01

Molecular genetic testing for hereditary hemochromatosis (HH) is recognized as a reference test to confirm the diagnosis of suspected HH or to predict its risk. The vast majority (typically >90%) of patients with clinically characterized HH are homozygous for the p.C282Y variant in the HFE gene, referred to as HFE-related HH. Since 1996, HFE genotyping was implemented in diagnostic algorithms for suspected HH, allowing its early diagnosis and prevention. However, the penetrance of disease in p.C282Y homozygotes is incomplete. Hence, homozygosity for p.C282Y is not sufficient to diagnose HH. Neither is p.C282Y homozygosity required for diagnosis as other rare forms of HH exist, generally referred to as non-HFE-related HH. These pose significant challenges when defining criteria for referral, testing protocols, interpretation of test results and reporting practices. We present best practice guidelines for the molecular genetic diagnosis of HH where recommendations are classified, as far as possible, according to the level and strength of evidence. For clarification, the guidelines' recommendations are preceded by a detailed description of the methodology and results obtained with a series of actions taken in order to achieve a wide expert consensus, namely: (i) a survey on the current practices followed by laboratories offering molecular diagnosis of HH; (ii) a systematic literature search focused on some identified controversial topics; (iii) an expert Best Practice Workshop convened to achieve consensus on the practical recommendations included in the guidelines.

EMQN best practice guidelines for the molecular genetic diagnosis of hereditary hemochromatosis (HH)

PubMed Central

Porto, Graça; Brissot, Pierre; Swinkels, Dorine W; Zoller, Heinz; Kamarainen, Outi; Patton, Simon; Alonso, Isabel; Morris, Michael; Keeney, Steve

2016-01-01

Molecular genetic testing for hereditary hemochromatosis (HH) is recognized as a reference test to confirm the diagnosis of suspected HH or to predict its risk. The vast majority (typically >90%) of patients with clinically characterized HH are homozygous for the p.C282Y variant in the HFE gene, referred to as HFE-related HH. Since 1996, HFE genotyping was implemented in diagnostic algorithms for suspected HH, allowing its early diagnosis and prevention. However, the penetrance of disease in p.C282Y homozygotes is incomplete. Hence, homozygosity for p.C282Y is not sufficient to diagnose HH. Neither is p.C282Y homozygosity required for diagnosis as other rare forms of HH exist, generally referred to as non-HFE-related HH. These pose significant challenges when defining criteria for referral, testing protocols, interpretation of test results and reporting practices. We present best practice guidelines for the molecular genetic diagnosis of HH where recommendations are classified, as far as possible, according to the level and strength of evidence. For clarification, the guidelines' recommendations are preceded by a detailed description of the methodology and results obtained with a series of actions taken in order to achieve a wide expert consensus, namely: (i) a survey on the current practices followed by laboratories offering molecular diagnosis of HH; (ii) a systematic literature search focused on some identified controversial topics; (iii) an expert Best Practice Workshop convened to achieve consensus on the practical recommendations included in the guidelines. PMID:26153218

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

PubMed Central

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

2015-01-01

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

Developing Korean Academy of Medical Sciences Guideline for Rating the Impairment in Mental and Behavioral Disorders; A Comparative Study of KNPA's New Guidelines and AMA's 6th Guides

PubMed Central

Ryu, Seong Gon; Hong, Narei; Hwang, Sun-Chul; Jung, Han-Young; Jeong, Dushin; Rah, Ueon Woo; Suh, Dong-Soo

2009-01-01

Quantifying and rating the impairments due to mental and behavior disorders are difficult for their own characteristics. Korean Academy of Medical Sciences (KAMS) is developing guidelines of rating impairment in mental and behavioral disorders based on Korean Neuropsychiatric Association (KNPA)'s new guidelines. We compared the new KNPA's guidelines and the American Medical Association (AMA)'s 6th Guides in assessing impairment due to mental and behavioral disorders to develop new guidelines of KAMS. Two guidelines are different in diagnosing system, applicable disorders, qualification of assessors, application of scales, contents of assessment and rate of impairment of the whole person. Both AMA's and the proposed guidelines have individual merits and characteristics. There is a limitation in using the 6th AMA's Guides in Korean situation. However to improve objectivity in Korean assessment of psychiatric impairment, the new AMA's Guides can serve as a good reference. PMID:19503692

Closing the Reference Interview: Implications for Policy and Practice.

ERIC Educational Resources Information Center

Nolan, Christopher W.

1992-01-01

Discusses reasons why patrons or librarians terminate the reference interview, including the content of the interview, interpersonal dynamics, and institutional or policy factors. Goals and objectives of the person terminating the interview are considered, and guidelines for policy development and performance improvement are offered. (30…

Historical considerations in evaluating timber structures

Treesearch

R. L. Tuomi; R. C. Moody

1979-01-01

Evaluation, maintenance, and upgrading of timber structures is an area where little printed reference material exists. This paper covers the state-of-the-art on design, material properties, and construction procedures on older buildings. Some guidelines are presented on rehabilitating and upgrading timber structures, along with significant references.

Adherence of Pharmaceutical Advertisements in Medical Journals to FDA Guidelines and Content for Safe Prescribing

PubMed Central

Korenstein, Deborah; Keyhani, Salomeh; Mendelson, Ali; Ross, Joseph S.

2011-01-01

Background Physician-directed pharmaceutical advertising is regulated in the United States by the Food and Drug Administration (FDA); adherence to current FDA guidelines is unknown. Our objective was to determine adherence rates of physician-directed print advertisements in biomedical journals to FDA guidelines and describe content important for safe prescribing. Methods and Findings Cross-sectional analysis of November 2008 pharmaceutical advertisements within top U.S.-based biomedical journals publishing original research. We excluded advertisements for devices, over the counter medications, and disease awareness. We utilized FDA guideline items identifying unique forms of advertisement bias to categorize advertisements as adherent to FDA guidelines, possibly non-adherent to at least 1 item, or non-adherent to at least 1 item. We also evaluated advertisement content important for safe prescribing, including benefit quantification, risk information and verifiable references. All advertisements were evaluated by 2 or more investigators, with differences resolved by discussion. Twelve journals met inclusion criteria. Nine contained pharmaceutical advertisements, including 192 advertisements for 82 unique products; median 2 per product (range 1–14). Six “teaser” advertisements presented only drug names, leaving 83 full unique advertisements. Fifteen advertisements (18.1%) adhered to all FDA guidelines, 41 (49.4%) were non-adherent with at least one form of FDA-described bias, and 27 (32.5%) were possibly non-adherent due to incomplete information. Content important for safe prescribing was often incomplete; 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification. Study limitations included its focus on advertisements from a single month, the subjectivity of FDA guidelines themselves, and the necessary subjectivity of determinations of adherence. Conclusions Few physician-directed print pharmaceutical advertisements adhere to all FDA guidelines; over half fail to quantify serious risks. The FDA could better protect public health by creating new more objective advertisement guidelines requiring transparent presentation of basic safety and efficacy information. PMID:21858076

Adherence of pharmaceutical advertisements in medical journals to FDA guidelines and content for safe prescribing.

PubMed

Korenstein, Deborah; Keyhani, Salomeh; Mendelson, Ali; Ross, Joseph S

2011-01-01

Physician-directed pharmaceutical advertising is regulated in the United States by the Food and Drug Administration (FDA); adherence to current FDA guidelines is unknown. Our objective was to determine adherence rates of physician-directed print advertisements in biomedical journals to FDA guidelines and describe content important for safe prescribing. Cross-sectional analysis of November 2008 pharmaceutical advertisements within top U.S.-based biomedical journals publishing original research. We excluded advertisements for devices, over the counter medications, and disease awareness. We utilized FDA guideline items identifying unique forms of advertisement bias to categorize advertisements as adherent to FDA guidelines, possibly non-adherent to at least 1 item, or non-adherent to at least 1 item. We also evaluated advertisement content important for safe prescribing, including benefit quantification, risk information and verifiable references. All advertisements were evaluated by 2 or more investigators, with differences resolved by discussion. Twelve journals met inclusion criteria. Nine contained pharmaceutical advertisements, including 192 advertisements for 82 unique products; median 2 per product (range 1-14). Six "teaser" advertisements presented only drug names, leaving 83 full unique advertisements. Fifteen advertisements (18.1%) adhered to all FDA guidelines, 41 (49.4%) were non-adherent with at least one form of FDA-described bias, and 27 (32.5%) were possibly non-adherent due to incomplete information. Content important for safe prescribing was often incomplete; 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification. Study limitations included its focus on advertisements from a single month, the subjectivity of FDA guidelines themselves, and the necessary subjectivity of determinations of adherence. Few physician-directed print pharmaceutical advertisements adhere to all FDA guidelines; over half fail to quantify serious risks. The FDA could better protect public health by creating new more objective advertisement guidelines requiring transparent presentation of basic safety and efficacy information.

Critical appraisal of apparently evidence-based written advertising in Pakistan.

PubMed

Rohra, Dileep Kumar; Bashir, Muhammad Umair; Khwaja, Ummey Aymen; Nazir, Muhammad Ressam

2008-06-01

The objective of the study was to critically assess references cited in support of claims in drug advertisements. Drug advertising brochures were collected from privately practicing General Practitioners from different parts of Karachi. Three blinded reviewers then categorized each reference in the brochure according to the sources viz: journals (both Medline indexed and non-indexed), medical reference books, web addresses, personal communications or testimonials, abstracts presented at symposia/conferences, WHO and National Health Guidelines, 'data on file' and 'others' (which included a diverse set of references). Each reviewer then assessed and analyzed the references further into 2 broad categories: traceable and non-traceable. Traceable references were appraised and, depending upon the claim with which the reference was attached, were classified into justifiable, inaccurate/false, exaggerated and ambiguous. We collected a total of 175 different brochures. Thirty-nine (22.3%) brochures did not cite any references and were not subjected to further analysis. The remaining 136 (77.7%) contained a total of 559 references. 305 (54.6%) of these references were from Medline-indexed journals; 67 (12.0%) were from non-indexed journals; 55 (9.8%) references quoted medical reference books; 27 (4.8%) references cited web addresses; 12 (2.1%) references were personal communications/testimonials; 11 (2.0%) references referred to abstracts presented at symposia/conferences; 12 (2.1%) references were from WHO and National Health Guidelines; 8 (1.4%) references were listed as 'data on file', while the remainder that could not be defined were classified as 'others' (13.1%). Out of a total of 559 references, 249 (44.5%) could not be traced. After critically analyzing the 310 traceable references, 197 (63.5%) were adjudged justifiable, 30 (9.7%) inaccurate/false, 79 (25.5%) exaggerated and 15 (4.8%) ambiguous. Results of this study show for the first time that the claims substantiated with references in the pharmaceutical advertisements in Pakistan are highly unreliable.

ADVERSE HEALTH EFFECTS FROM ENVIRONMENTAL MANGANESE EXPOSURE.

EPA Science Inventory

The ubiquitous element, manganese (Mn), is an essential nutrient, but toxic at excessive exposure levels. Therefore, the US EPA set guideline levels for Mn exposure through inhalation (reference concentration-RfC=0.05 ?g/m3) and ingestion (reference dose-RfD=0.14 mg/kg/day (10 mg...

77 FR 63343 - Biweekly Notice: Applications and Amendments to Facility Operating Licenses and Combined Licenses...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-16

... PWR [Pressurized-Water Reactor] Steam Generator Tubes'' (Reference 32) and [Nuclear Energy Institute... maintains the required structural margins of the SG tubes for both normal and accident conditions. Nuclear Energy Institute 97-06, ``Steam Generator Program Guidelines'' (Reference 8), and NRC Regulatory Guide 1...

Reference Intervals of Common Clinical Chemistry Analytes for Adults in Hong Kong.

PubMed

Lo, Y C; Armbruster, David A

2012-04-01

Defining reference intervals is a major challenge because of the difficulty in recruiting volunteers to participate and testing samples from a significant number of healthy reference individuals. Historical literature citation intervals are often suboptimal because they're be based on obsolete methods and/or only a small number of poorly defined reference samples. Blood donors in Hong Kong gave permission for additional blood to be collected for reference interval testing. The samples were tested for twenty-five routine analytes on the Abbott ARCHITECT clinical chemistry system. Results were analyzed using the Rhoads EP evaluator software program, which is based on the CLSI/IFCC C28-A guideline, and defines the reference interval as the 95% central range. Method specific reference intervals were established for twenty-five common clinical chemistry analytes for a Chinese ethnic population. The intervals were defined for each gender separately and for genders combined. Gender specific or combined gender intervals were adapted as appropriate for each analyte. A large number of healthy, apparently normal blood donors from a local ethnic population were tested to provide current reference intervals for a new clinical chemistry system. Intervals were determined following an accepted international guideline. Laboratories using the same or similar methodologies may adapt these intervals if deemed validated and deemed suitable for their patient population. Laboratories using different methodologies may be able to successfully adapt the intervals for their facilities using the reference interval transference technique based on a method comparison study.

Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World

PubMed Central

Evenson, Kelly R.; Barakat, Ruben; Brown, Wendy J.; Dargent-Molina, Patricia; Haruna, Megumi; Mikkelsen, Ellen M.; Mottola, Michelle F.; Owe, Katrine M.; Rousham, Emily K.; Yeo, SeonAe

2013-01-01

Introduction Women attain numerous benefits from physical activity during pregnancy. However, due to physical changes that occur during pregnancy, special precautions are also needed. This review summarizes current guidelines for physical activity among pregnant women worldwide. Methods We searched PubMed (MedLINE) for country-specific governmental and clinical guidelines on physical activity during pregnancy through the year 2012. We cross-referenced with articles referring to guidelines, with only the most recent included. An abstraction form was used to extract key details and summarize. Results In total, 11 guidelines were identified from nine countries (Australia, Canada, Denmark, France, Japan, Norway, Spain, United Kingdom, United States). Most guidelines supported moderate intensity physical activity during pregnancy (10/11) and indicated specific frequency (9/11) and duration/time (9/11) recommendations. Most guidelines provided advice on initiating an exercise program during pregnancy (10/11). Six guidelines included absolute and relative contraindications to exercise. All guidelines generally ruled-out sports with risks of falls, trauma, or collisions. Six guidelines included indications for stopping exercise during pregnancy. Conclusion This review contrasted pregnancy-related physical activity guidelines from around the world, and can help to inform new guidelines as they are created or updated, and facilitate the development of a worldwide guideline. PMID:25346651

Application of the perinatal oral health guidelines in clinical practice.

PubMed

Hilton, Irene

2010-09-01

While dental treatment during pregnancy is safe, pregnant women go to the dentist less frequently than women who are not pregnant. Practical strategies to reduce barriers to care based on the guidelines are presented. Collaboration with perinatal providers is critical to refer pregnant women into dental care. Recommendations regarding timing of care, treatment sequence, and patient positioning will help providers deliver care. Practical implementation of the guidelines can increase access to dental care for pregnant women and improve the oral health of the pregnant woman and her child.

21 CFR 320.26 - Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study.

Code of Federal Regulations, 2013 CFR

2013-04-01

... delivery systems other than oral or intravenous dosage forms with an appropriate reference standard, the... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study. 320.26 Section 320.26 Food and Drugs FOOD AND DRUG ADMINISTRATION...

21 CFR 320.26 - Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study.

Code of Federal Regulations, 2012 CFR

2012-04-01

... delivery systems other than oral or intravenous dosage forms with an appropriate reference standard, the... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study. 320.26 Section 320.26 Food and Drugs FOOD AND DRUG ADMINISTRATION...

21 CFR 320.26 - Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study.

Code of Federal Regulations, 2014 CFR

2014-04-01

... delivery systems other than oral or intravenous dosage forms with an appropriate reference standard, the... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study. 320.26 Section 320.26 Food and Drugs FOOD AND DRUG ADMINISTRATION...

Sudden cardiac death: a critical appraisal of the implantable cardioverter defibrillator.

PubMed

Rajabali, A; Heist, E K

2014-04-01

Approximately 350,000 Americans still die of sudden cardiac death each year. This exceeds the number of patients who die annually from stroke, lung cancer, breast cancer and AIDS combined. This review aims to trace the history of implantable cardioverter defibrillators (ICD) with reference to landmark trials and their influence on the formulation of Medicare guidelines for ICD implantation criteria. This paper will also discuss the cost-effectiveness of ICDs and the quality of life after implantation. The reasons for the disparity between guidelines for implantation and actual clinical practice will be elucidated, with suggestions for improving overall clinical performance. The ICD has been shown to be cost-effective in reducing sudden cardiac death and all-cause mortality. However, the existing recommendations for ICD implantation have yet to translate completely into clinical practice. Barriers to implementation of existing guidelines include knowledge gaps in the referring physician practices, lack of validated screening tools to assess patient candidacy for the device and patient understanding of the need for the device. Future strategies to increase compliance with the existing guidelines and improve clinical performance are areas of potential research focus. © 2013 John Wiley & Sons Ltd.

Management of atrial fibrillation around the world: a comparison of current ACCF/AHA/HRS, CCS, and ESC guidelines.

PubMed

Wasmer, Kristina; Eckardt, Lars

2011-10-01

New guidelines for the management of atrial fibrillation (AF) have recently been published by the American College of Cardiology Foundation/American Heart Association, and Heart Rhythm Society (ACCF/AHA/HRS) task force on practice guidelines, the Canadian Cardiovascular Society (CCS), and the European Society of Cardiology (ESC). Although they all refer to the same scientific data and agree in the majority of AF management, interpretation, and weighing of study results are quite different in some aspects. While recommendations for stroke risk assessment and prophylaxis are rather conservative in the ESC guidelines, the CCS guideline recommendations are more conservative with regard to lenient rate control and the ACCF/AHA/HRS recommendations are rather strict with regard to rhythm management.

Multi-faceted implementation strategy to increase use of a clinical guideline for the diagnosis of deep venous thrombosis in primary care.

PubMed

Kingma, Anna E C; van Stel, Henk F; Oudega, Ruud; Moons, Karel G M; Geersing, Geert-Jan

2017-08-01

A clinical decision rule (CDR), combined with a negative D-dimer test, can safely rule out deep venous thrombosis (DVT) in primary care. This strategy is recommended by guidelines, yet uptake by GPs is low. To evaluate a multi-faceted implementation strategy aimed at increased use of the guideline recommended CDR plus D-dimer test in primary care patients with suspected DVT. This multi-faceted implementation strategy consisted of educational outreach visits, financial reimbursements and periodical newsletters. 217 Dutch GPs (implementation group) received this strategy and included patients. Effectiveness was measured through the following patient-level outcomes: (i) proportion of non-referred patients, (ii) proportion of missed DVT cases within this group and (iii) the proportion of patients in whom the guideline was applied incorrectly. Implementation outcomes ('acceptability', 'feasibility', 'fidelity' and 'sustainability') were assessed with an online questionnaire. Patient-level outcomes were compared with those of patients included by 450 GPs, uninformed about the study's purposes providing information about usual care. 336 (54%) of 619 analyzable implementation group patients were not referred, missing 6 [1.8% (95% confidence interval 0.7% to 3.9%)] DVT cases. Incorrect guideline use was observed in 199 patients (32%). Self-reported acceptability, feasibility and expected sustainability were high. Guideline use increased from 42% to an expected continuation of use of 91%. Only 32 usual care GPs included 62 patients, making formal comparison unreliable. This multi-faceted implementation strategy safely reduced patient referral to secondary care, despite frequently incorrect application of the guideline and resulted in high acceptability, feasibility and expected sustainability. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Linking guidelines to Electronic Health Record design for improved chronic disease management.

PubMed

Barretto, Sistine A; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and workflow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR.

Linking Guidelines to Electronic Health Record Design for Improved Chronic Disease Management

PubMed Central

Barretto, Sistine A.; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and work-flow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR. PMID:14728135

Infection

MedlinePlus

... 23(4):251-69. Association for Professionals in Infection Control and Epidemiology (APIC) guideline. Back to Top Administration ... : Hospital Scope | Glossary | References | Site Map | Credits Freedom of ...

A JAVA-based multimedia tool for clinical practice guidelines.

PubMed

Maojo, V; Herrero, C; Valenzuela, F; Crespo, J; Lazaro, P; Pazos, A

1997-01-01

We have developed a specific language for the representation of Clinical Practice Guidelines (CPGs) and Windows C++ and platform independent JAVA applications for multimedia presentation and edition of electronically stored CPGs. This approach facilitates translation of guidelines and protocols from paper to computer-based flowchart representations. Users can navigate through the algorithm with a friendly user interface and access related multimedia information within the context of each clinical problem. CPGs can be stored in a computer server and distributed over the World Wide Web, facilitating dissemination, local adaptation, and use as a reference element in medical care. We have chosen the Agency for Health Care and Policy Research's heart failure guideline to demonstrate the capabilities of our tool.

New NASA SEE LEO Spacecraft Charging Design Guidelines: How to Survive in LEO Rather than GEO

NASA Technical Reports Server (NTRS)

Ferguson, Dale C.; Hillard, G. Barry

2004-01-01

It has been almost two solar cycles since the GEO Guidelines of Purvis et al (1984) were published. In that time, interest in high voltage LEO systems has increased. The correct and conventional wisdom has been that LEO conditions are sufficiently different from GEO that the GEO Guidelines (and other GEO and POLAR documents produced since then) should not be used for LEO spacecraft. Because of significant recent GEO spacecraft failures that have been shown in ground testing to be likely to also occur on LEO spacecraft, the SEE program commissioned the production of the new LEO Spacecraft Charging Design Guidelines (hereafter referred to as the LEO Guidelines). Now available in CD-ROM form, the LEO Guidelines highlight mitigation techniques to prevent spacecraft arcing on LEO solar arrays and other systems. We compare and contrast the mitigation techniques for LEO and GEO in this paper. We also discuss the extensive bibliography included in the LEO Guidelines, so results can be found in their primary sources.

[Chronic pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

PubMed

Takács, Tamás; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Patai, Árpád; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Tiszlavicz, László; Szücs, Ákos

2015-02-15

Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading symptoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate® grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinical questions were accepted with total or strong agreement. The present guideline is the first evidence based guideline for chronic pancreatitis in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

[Autoimmune pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

PubMed

Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Szücs, Ákos; Czakó, László

2015-02-22

Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

An audit of primary surgical treatment for women with ovarian cancer referred to a cancer centre

PubMed Central

Sengupta, P S; Jayson, G C; Slade, R J; Eardley, A; Radford, J A

1999-01-01

Ovarian cancer is the commonest cause of gynaecological cancer death in the UK, and guidelines for initial surgery and staging of this disease are widely available. We report a retrospective audit of the surgical management of patients with newly diagnosed ovarian cancer referred to the Christie Cancer Centre in Manchester in 1996. The aim was to assess compliance with surgical guidelines. The authors found that the majority of patients (92%) presented via an outpatient clinic and for these individuals surgery was therefore elective. This mode of presentation should allow management by a small number of dedicated gynaecologists at each hospital, but up to seven consultants in each hospital performed surgery on a relatively small number of patients. Furthermore, less than half the patients underwent the recommended surgical procedure. Although some patients may have ‘inoperable’ disease, these data suggest that a greater compliance with national and international guidelines are required to provide an optimal level of care. © 1999 Cancer Research Campaign PMID:10408851

Using features of Arden Syntax with object-oriented medical data models for guideline modeling.

PubMed

Peleg, M; Ogunyemi, O; Tu, S; Boxwala, A A; Zeng, Q; Greenes, R A; Shortliffe, E H

2001-01-01

Computer-interpretable guidelines (CIGs) can deliver patient-specific decision support at the point of care. CIGs base their recommendations on eligibility and decision criteria that relate medical concepts to patient data. CIG models use expression languages for specifying these criteria, and define models for medical data to which the expressions can refer. In developing version 3 of the GuideLine Interchange Format (GLIF3), we used existing standards as the medical data model and expression language. We investigated the object-oriented HL7 Reference Information Model (RIM) as a default data model. We developed an expression language, called GEL, based on Arden Syntax's logic grammar. Together with other GLIF constructs, GEL reconciles incompatibilities between the data models of Arden Syntax and the HL7 RIM. These incompatibilities include Arden's lack of support for complex data types and time intervals, and the mismatch between Arden's single primary time and multiple time attributes of the HL7 RIM.

Welcoming with risk classification in teaching hospitals: assessment of structure, process and result.

PubMed

Vituri, Dagmar Willamowius; Inoue, Kelly Cristina; Bellucci Júnior, José Aparecido; de Oliveira, Carlos Aparecido; Rossi, Robson Marcelo; Matsuda, Laura Misue

2013-01-01

To assess, from the worker's viewpoint, the structure, the process and the results of the Emergency Hospital Services that have taken up the guideline of "Welcoming with Risk Classification" in two teaching hospitals of the state of Paraná. Quantitative and descriptive research, exploratory and prospective, using random sampling stratified by professional category, comprising a universe of 216 professional people. They found some points of agreement regarding the promotion of a welcoming and humane environment; privacy and security; welcome and shelter of the companion and also the sheltering and classification of all patients; however, there was disagreement about the comfort of the environment, reference system and counter-reference, prioritisation of seriously ill patients in post-classification service, communication between the members of the multi-professional team and reassessment of the guideline. The workers assess the development of the guideline as being precarious, due mainly to the lack of physical structure, due to the lack of physical structure and shortcomings in the service process.

WHO Expert Committee on Biological Standardization.

PubMed

2002-01-01

This report presents the recommendations of a WHO Expert Committee commissioned to coordinate activities leading to the adoption of international recommendations for the production and quality control of vaccines and other biologicals and the establishment of international biological reference materials. The report starts with a discussion of general issues brought to the attention of the Committee and provides information on issues relevant to international guidelines, recommendations and other matters related to the manufacture and quality control of biologicals. This is followed by information on the status and development of reference materials for bovine spongiform encephalopathy, various antigens, blood products, cytokines, growth factors and endocrinological substances. The second part of the report, of particular interest to manufacturers and national control authorities, contains sets of recommendations for the production and control of poliomyelitis vaccine (oral) and poliomyelitis vaccine (inactivated) and guidelines for the production and control of live attenuated Japanese encephalitis vaccine. Also included are lists of recommendations and guidelines for biological substances used in medicine, and other relevant documents.

Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review.

PubMed

Aranceta, Javier; Pérez-Rodrigo, Carmen

2012-06-01

Dietary fat and its effects on health and disease has attracted interest for research and Public Health. Since the 1980s many bodies and organizations have published recommendations regarding fat intake. In this paper different sets of recommendations are analyzed following a systematic review process to examine dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids. A literature search was conducted in relevant literature databases along a search for suitable grey literature reports. Documents were included if they reported information on either recommended intake levels or dietary reference values or nutritional objectives or dietary guidelines regarding fat and/or fatty acids and/or cholesterol intake or if reported background information on the process followed to produce the recommendations. There is no standard approach for deriving nutrient recommendations. Recommendations vary between countries regarding the levels of intake advised, the process followed to set the recommendations. Recommendations on fat intake share similar figures regarding total fat intake, saturated fats and trans fats. Many sets do not include a recommendation about cholesterol intake. Most recent documents provide advice regarding specific n-3 fatty acids. Despite efforts to develop evidence based nutrient recommendations and dietary guidelines that may contribute to enhance health, there are still many gaps in research. It would be desirable that all bodies concerned remain transparent about the development of dietary recommendations. In order to achieve this, the type of evidence selected to base the recommendations should be specified and ranked. Regular updates of such recommendations should be planned.

Muscle-strengthening and aerobic activities and mortality among 3+ year cancer survivors in the U.S.

PubMed

Tarasenko, Yelena N; Linder, Daniel F; Miller, Eric A

2018-05-01

This study examined the association between adherence to American College of Sports Medicine and American Cancer Society guidelines on aerobic and muscle-strengthening activities and mortality risks among 3+ year cancer survivors in the U.S. The observational study was based on 1999-2009 National Health Interview Survey Linked Mortality Files with follow-up through 2011. After applying exclusion criteria, there were 13,997 observations. The hazard ratios (HRs) for meeting recommendations on muscle-strengthening activities only, on aerobic activities only, and on both types of physical activity (i.e., adhering to complete guidelines) were calculated using a reference group of cancer survivors engaging in neither. Unadjusted and adjusted HRs of all-cause, cancer-specific, and cardiovascular disease-specific mortalities were estimated using Cox proportional hazards models. In all models, compared to the reference group, cancer survivors adhering to complete guidelines had significantly decreased all-cause, cancer-specific, and cardiovascular disease-specific mortalities (HRs ranged from 0.37 to 0.64, p's < 0.05). There were no statistically significant differences between hazard rates of cancer survivors engaging in recommended levels of muscle-strengthening activities only and the reference group (HRs ranged from 0.76 to 0.94, p's > 0.05). Wald test statistics suggested a significant dose-response relationship between levels of adherence to complete guidelines and cancer-specific mortality. While muscle-strengthening activities by themselves do not appear to reduce mortality risks, such activities may provide added cancer-specific survival benefits to 3+ year cancer survivors who are already aerobically active.

21 CFR 320.27 - Guidelines on the design of a multiple-dose in vivo bioavailability study.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE BIOAVAILABILITY AND BIOEQUIVALENCE... therapeutic moiety in the body. (2) The test product and the reference material should be administered to...) Measurement of an acute pharmacological effect. When comparison of the test product and the reference material...

21 CFR 320.27 - Guidelines on the design of a multiple-dose in vivo bioavailability study.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE BIOAVAILABILITY AND BIOEQUIVALENCE... therapeutic moiety in the body. (2) The test product and the reference material should be administered to...) Measurement of an acute pharmacological effect. When comparison of the test product and the reference material...

21 CFR 320.27 - Guidelines on the design of a multiple-dose in vivo bioavailability study.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE BIOAVAILABILITY AND BIOEQUIVALENCE... therapeutic moiety in the body. (2) The test product and the reference material should be administered to...) Measurement of an acute pharmacological effect. When comparison of the test product and the reference material...

Energy Emergency Management Information System (EEMIS): Functional requirements

NASA Astrophysics Data System (ADS)

1980-10-01

These guidelines state that in order to create the widest practicable competition, the system's requirements, with few exceptions, must be expressed in functional terms without reference to specific hardware or software products, and that wherever exceptions are made a statement of justification must be provided. In addition, these guidelines set forth a recommended maximum threshold limit of annual contract value for schedule contract procurements.

21 CFR 320.26 - Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study. 320.26 Section 320.26 Food and Drugs FOOD AND DRUG ADMINISTRATION... test product and the reference material should be administered to subjects in the fasting state, unless...

Summary of the British Transplantation Society UK Guidelines for Living Donor Liver Transplantation.

PubMed

Manas, Derek; Burnapp, Lisa; Andrews, Peter Antony

2016-06-01

The British Transplantation Society Guidelines for Living Donor Liver Transplantation was published in July 2015 and is the first national guideline in the field of living donor liver transplantation. The guideline aims to review the evidence relating to the evaluation process of both recipient and donor candidates; address the moral and ethical issues surrounding the procedure; outline the technical aspects of the procedure, including the middle hepatic vein controversy and the "small for size syndrome"; review donor and recipient outcomes and complications including donor mortality; and examine evidence relating to the advantages and disadvantages of living donor liver transplantation. In line with previous guidelines published by the BTS, the guideline has used the Grading of Recommendations Assessment, Development and Evaluation system to rate the strength of evidence and recommendations. This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for the delivery of living liver donation in the United Kingdom and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at http://www.bts.org.uk/BTS/Guidelines_Standards/Current/BTS/Guidelines_Standards/Current_Guidelines.aspx?hkey=e285ca32-5920-4613-ac08-fa9fd90915b5.

[Reference citation].

PubMed

Brkić, Silvija

2013-01-01

Scientific and professional papers represent the information basis for scientific research and professional work. References important for the paper should be cited within the text, and listed at the end of the paper. This paper deals with different styles of reference citation. Special emphasis was placed on the Vancouver Style for reference citation in biomedical journals established by the International Committee of Medical Journal Editors. It includes original samples for citing various types of articles, both printed and electronic, as well as recommendations related to reference citation in accordance with the methodology and ethics of scientific research and guidelines for preparing manuscripts for publication.

Consumer response to healthy eating, physical activity and weight-related recommendations: a systematic review.

PubMed

Boylan, S; Louie, J C Y; Gill, T P

2012-07-01

Strong evidence linking poor diet and lack of physical activity to risk of obesity and related chronic disease has supported the development and promotion of guidelines to improve population health. Still, obesity continues to escalate as a major health concern, and so the impact of weight-related guidelines on behaviour is unclear. The aim of this review was to examine consumer response to weight-related guidelines. A systematic literature search was performed using Medline, PsycInfo, ProQuest Central and additional searches using Google and reference lists. Of the 1,765 articles identified, 46 relevant titles were included. Most studies examined attitudes towards content, source, tailoring and comprehension of dietary guidelines. Many respondents reported that guidelines were confusing, and that simple, clear, specific, realistic, and in some cases, tailored guidelines are required. Recognition of guidelines did not signify understanding nor did perceived credibility of a source guarantee utilization of guidelines. There was a lack of studies assessing: the impact of guidelines on behaviour; responses to physical activity guidelines; responses among males and studies undertaken in developing countries. Further research is needed, in particular regarding responses to physical activity guidelines and guidelines in different populations. Communication professionals should assist health professionals in the development of accurate and effective weight-related guidelines. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

Clinical decision guidelines for NHS cosmetic surgery: analysis of current limitations and recommendations for future development.

PubMed

Cook, S A; Rosser, R; Meah, S; James, M I; Salmon, P

2003-07-01

Because of increasing demand for publicly funded elective cosmetic surgery, clinical decision guidelines have been developed to select those patients who should receive it. The aims of this study were to identify: the main characteristics of such guidelines; whether and how they influence clinical decision making; and ways in which they should be improved. UK health authorities were asked for their current guidelines for elective cosmetic surgery and, in a single plastic surgery unit, we examined the impact of its guidelines by observing consultations and interviewing surgeons and managers. Of 115 authorities approached, 32 reported using guidelines and provided sufficient information for analysis. Guidelines mostly concerned arbitrary sets of cosmetic procedures and lacked reference to an evidence base. They allowed surgery for specified anatomical, functional or symptomatic reasons, but these indications varied between guidelines. Most guidelines also permitted surgery 'exceptionally' for psychological reasons. The guidelines that were studied in detail did not appreciably influence surgeons' decisions, which reflected criteria that were not cited in the guidelines, including cost of the procedure and whether patients sought restoration or improvement of their appearance. Decision guidelines in this area have several limitations. Future guidelines should: include all cosmetic procedures; be informed by a broad range of evidence; and, arguably, include several nonclinical criteria that currently inform surgeons' decision-making.

Guidelines for preparing software user documentation

NASA Technical Reports Server (NTRS)

Miller, Diane F.

1987-01-01

Clear, easy-to-use software user's manuals make strong demands on special technical communication techniques. Principles and guidelines are given for analyzing the audience and dealing with wide-ranging backgrounds of potential users. Types of information to be included in a complete manual are suggested, with a technique for creating a user-oriented rather than process-oriented organization. Accuracy verification is emphasized. Simple tips are gievn for formatting for quick comprehension and reference, for deciding on packaging, for creating helpful illustrations and examples, and for setting up clear and consistent conventions. Simple guidelines are offered for writing clearly and concisely and for editing.

Practical Treatments for Constipation in Korea

PubMed Central

Park, Kyung-Sik; Park, Moo-In; Shin, Jeong-Eun; Jung, Kee-Wook; Kim, Seong-Eun; Lee, Tae-Hee; Koo, Hoon-Sup

2012-01-01

Constipation is a digestive symptom that is frequently seen in clinical practice. Its prevalence has been reported to be 2% to 20%, depending on geographical region. Despite the rapid development of medical science, systematic studies on constipation have been rarely conducted in Korea. Recently, guidelines on the diagnosis and treatment of functional gastrointestinal disorders, including constipation, were proposed by The Korean Society of Neurogastroenterology and Motility. These guidelines are expected to reflect the current situation regarding treatment of constipation in Korea. In this paper, practical constipation treatment methods that are in current use will be reviewed with reference to these recent guidelines. PMID:23019388

ASVCP quality assurance guidelines: external quality assessment and comparative testing for reference and in-clinic laboratories.

PubMed

Camus, Melinda S; Flatland, Bente; Freeman, Kathleen P; Cruz Cardona, Janice A

2015-12-01

The purpose of this document is to educate providers of veterinary laboratory diagnostic testing in any setting about comparative testing. These guidelines will define, explain, and illustrate the importance of a multi-faceted laboratory quality management program which includes comparative testing. The guidelines will provide suggestions for implementation of such testing, including which samples should be tested, frequency of testing, and recommendations for result interpretation. Examples and a list of vendors and manufacturers supplying control materials and services to veterinary laboratories are also included. © 2015 American Society for Veterinary Clinical Pathology.

Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial

PubMed Central

Gervaix, Alain; Haddad, Kevin; Lacroix, Laurence; Schrurs, Philippe; Sahin, Ayhan; Lovis, Christian; Manzano, Sergio

2017-01-01

Background The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world’s most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. Objective The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. Methods We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario—pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Results Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other critical resuscitation endpoints and drug dose delivery were not improved using AR glasses. However, errors and deviations were significantly reduced in terms of defibrillation doses when compared with the use of the PALS pocket reference cards. In a total of 40 defibrillation attempts, residents not wearing AR glasses used wrong doses in 65% (26/40) of cases, including 21 shock overdoses >100 J, for a cumulative defibrillation dose of 18.7 Joules per kg. These errors were reduced by 53% (21/40, P<.001) and cumulative defibrillation dose by 37% (5.14/14, P=.001) with AR glasses. Conclusions AR glasses did not decrease time to first defibrillation attempt and other critical resuscitation endpoints when compared with PALS pocket cards. However, they improved adherence and performance among residents in terms of administering the defibrillation doses set by AHA. PMID:28554878

Between universalism and relativism: a conceptual exploration of problems in formulating and applying international biomedical ethical guidelines.

PubMed

Tangwa, G B

2004-02-01

In this paper, the author attempts to explore some of the problems connected with the formulation and application of international biomedical ethical guidelines, with particular reference to Africa. Recent attempts at revising and updating some international medical ethical guidelines have been bedevilled by intractable controversies and wrangling regarding both the content and formulation. From the vantage position of relative familiarity with both African and Western contexts, and the privilege of having been involved in the revision and updating of one of the international ethical guidelines, the author reflects broadly on these issues and attempts prescribing an approach from both the theoretical and practical angles liable to mitigate, if not completely eliminate, some of the problems and difficulties.

[Histological diagnosis of bone tumors: Guidelines of the French committee of bone pathologists reference network on bone tumors (RESOS)].

PubMed

Galant, Christine; Bouvier, Corinne; Larousserie, Frédérique; Aubert, Sébastien; Audard, Virginie; Brouchet, Anne; Marie, Béatrice; Guinebretière, Jean-Marc; de Pinieux du Bouexic, Gonzague

2018-04-01

The management of patients having a bone lesion requires in many cases the realization of a histological sample in order to obtain a diagnosis. However, with the technological evolution, CT-guided biopsies are performed more frequently, often in outpatient clinics. Interpretation of these biopsies constitutes new challenges for the pathologists within the wide spectrum of bone entities. The purpose of the document is to propose guidelines based on the experience of the French committee of bone pathologists of the reference network on bone tumors (RESOS) regarding the indications and limitations of the diagnosis on restricted material. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

[Guidelines of reference recording in scientific papers of Chinese Journal of Applied Ecology].

PubMed

Xiao, Hong

2008-01-01

To improve the compilation quality of references, work in well with articles search and periodicals evaluation, and promote international academic exchange, the Chinese Journal of Applied Ecology shall adjust its principles of reference recording in scientific papers based on the GB/T7714 -2005. From 2008, the references in scientific papers to be submitted are requested to record by the Citation-Sequence. In this paper, some examples were presented, and the issues needed to be paid more attention to by the authors were put forward.

Evidence-based Draft Guideline for Prevention of Midwifery Malpractices based on Referred Cases to the Forensic Medicine Commission and the Medical Council from 2006-2011.

PubMed

Asadi, Leila; Beigi, Marjan; Valiani, Mahbube; Mardani, Fardin

2017-01-01

Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence-based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services. In this cross-sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006-2011. Data were collected by a checklist and were analyzed using SPSS-16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence-based draft guideline for prevention of midwifery errors. A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed. This evidence-based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants.

Evidence-based Draft Guideline for Prevention of Midwifery Malpractices based on Referred Cases to the Forensic Medicine Commission and the Medical Council from 2006–2011

PubMed Central

Asadi, Leila; Beigi, Marjan; Valiani, Mahbube; Mardani, Fardin

2017-01-01

Background: Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence-based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services. Materials and Methods: In this cross-sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006–2011. Data were collected by a checklist and were analyzed using SPSS-16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence-based draft guideline for prevention of midwifery errors. Results: A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed. Conclusions: This evidence-based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants. PMID:28904546

Recommendations for age-appropriate education of children and adolescents with diabetes and their parents in the European Union.

PubMed

Martin, Delphine; Lange, Karin; Sima, Alexandra; Kownatka, Dagmar; Skovlund, Søren; Danne, Thomas; Robert, Jean-Jacques

2012-09-01

Education is the keystone of diabetes care, and structured self-management education is the key to a successful outcome. Existing guidelines provide comprehensive guidance on the various aspects of education and offer general and organizational principles of education, detailed curricula at different ages and stages of diabetes, and recommendations on models, methods, and tools to attain educative objectives. The International Society for Pediatric and Adolescent Diabetes guidelines give the most elaborate and detailed descriptions and recommendations on the practice of education, which other national guidelines address on specific aspects of education and care. The aim of the work package on education developed by Better Control in Paediatric and Adolescent Diabetes in the European Union: Working to Create Centers of Reference (SWEET) project was not to generate new guidelines but to evaluate how the existing guidelines were implemented in some pediatric diabetes reference centers. The SWEET members have completed a questionnaire that elaborates on the many aspects of delivery of education. This survey highlights a profound diversity of practices across centers in Europe, in terms of organization as well as the practices and the content of initial and continuing education. A toolbox is being developed within SWEET to facilitate exchanges on all aspects of education and to establish a process of validation of materials, tools, written structured age-adjusted programs, and evaluation procedures for the education of children and adolescents with diabetes. © 2012 John Wiley & Sons A/S.

[Impact and state of the art of regional healthcare planning and management guidelines in a local health authority of the Lazio region (Italy)].

PubMed

Priori, Maria Rosaria; Barbato, Angelo

2007-01-01

The aim of this study was to evaluate the impact of health care planning and management guidelines, elaborated by the Lazio regional healthcare authority, on the organizational structure and operational processes of local health authorities and, more specifically, of the Roma C local health authority. The guidelines are made up of three volumes and mainly describe an operational model, rather than being a set of standard references aimed at standardizing the quality of information low systems in local healthcare authorities. The guidelines are essentially a didactic text, and were elaborated by a consulting firm, Engineering Management Consulting, on behalf of the Lazio regional authority. In the first section, the main concepts are defined, while in subsequent sections, detailed models regarding the specific subject matter are described. Although the guidelines represent a useful tool in the process of converting local health authorities of the Lazio region into "business" organizations, so far they have been of use only in the first phase of assessment of different organizational models for healthcare planning and management. There is still a long way ahead towards defining standard procedures and references for describing activities and costs. This is what should hopefully be achieved briefly and which will necessarily require the introduction of a data warehouse and business intelligence software that will allow monitoring of activities and making short term predictions through the use balanced scorecards and data mining.

User Satisfaction and Service Transactions for a Reference Department in an Illinois Community College Learning Resources Center.

ERIC Educational Resources Information Center

Cornish, Nancy M.

Users of the reference library at Blackhawk Community College (Illinois) were surveyed to determine user satisfaction and the total number of transactions. The survey's objective was to pinpoint problem areas, supply objective information, develop guidelines and standards, and support needed improvements or the continued maintenance of good…

40 CFR Appendix 8 to Subpart A of... - Reference C16-C18 Internal Olefin Drilling Fluid Formulation

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Reference C16-C18 Internal Olefin Drilling Fluid Formulation 8 Appendix 8 to Subpart A of Part 435 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS OIL AND GAS EXTRACTION POINT SOURCE CATEGORY...

40 CFR Appendix 8 to Subpart A of... - Reference C16-C18 Internal Olefin Drilling Fluid Formulation

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 30 2011-07-01 2011-07-01 false Reference C16-C18 Internal Olefin Drilling Fluid Formulation 8 Appendix 8 to Subpart A of Part 435 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS OIL AND GAS EXTRACTION POINT SOURCE CATEGORY...

Design of Guidelines on the Learning Psychology in the Use of Facebook as a Medium for Teaching & Learning in Secondary School

ERIC Educational Resources Information Center

Noh, Nurulrabihah Mat; Siraj, Saedah; Jamil, Mohd Ridhuan Mohd; Husin, Zaharah; Sapar, Ahmad Arifin

2015-01-01

Use of Facebook in education is an innovation that is very suitable for getting the benefits of ICT to improve the quality of learning in Malaysia. Although Facebook is much applied in the teaching and learning process, no guidelines exist in Malaysia as a reference for teachers to develop teaching and learning effectively with Facebook. This…

Barriers to pediatricians' adherence to American Academy of Pediatrics oral health referral guidelines: North Carolina general dentists' opinions.

PubMed

Long, C Marshall; Quinonez, Rocio B; Rozier, R Gary; Kranz, Ashley M; Lee, Jessica Y

2014-01-01

The purposes of this study were to: (1) assess knowledge, attitudes, and behaviors of North Carolina general dentists (GDs) regarding American Academy of Pediatrics (AAP) dental referral guidelines; and (2) determine factors that influence pediatricians' ability to comply with AAP guidelines. One thousand GDs were surveyed to determine barriers toward acceptance of physician referrals of infants and toddlers. The primary outcome using ordered logistic regression was GDs' acceptance of children described in five case scenarios, with different levels of risk and oral health status. GDs believed pediatricians should refer patients at risk for caries to a dentist. While 61 to 75 percent of GDs were willing to accept low caries risk referrals of infants and toddlers, only 35 percent would accept referrals when caries was present. Predictors of referral acceptance were correct knowledge about AAP guidelines (OR=2.0, 95%CI=1.2-3.3), confidence in providing preventive care to infants and toddlers (OR=2.6, 95%CI=1.3-4.9), and agreement that parents see importance in dental referrals (OR=2.1, 95% CI=1.2-3.6). This study identified factors influencing acceptance of pediatrician referrals for the age one dental visit among North Carolina GDs and highlighted challenges pediatricians face in referring young children for dental care.

Guideline for translation and national validation of the Quality of Life in Hand Eczema Questionnaire (QOLHEQ).

PubMed

Oosterhaven, Jart A F; Schuttelaar, Marie L A; Apfelbacher, Christian; Diepgen, Thomas L; Ofenloch, Robert F

2017-08-01

There is a need for well-developed and validated questionnaires to measure patient reported outcomes. The Quality of Life in Hand Eczema Questionnaire (QOLHEQ) is such a validated instrument measuring disease-specific health-related quality of life in hand eczema patients. A re-validation of measurement properties is required before an instrument is used in a new population. With the objective of arriving at a guideline for translation and national validation of the QOLHEQ, we have developed the design of a reference study on how to adequately assess measurement properties of the QOLHEQ based on interdisciplinary discussions and current standards. We present a step-by-step guideline to assess translation (including cross-cultural adaptation), scale structure, validity, reproducibility, responsiveness, and interpretability. We describe which outcomes should be reported for each measurement property, and give advice on how to calculate these. It is also specified which sample size is needed, how to deal with missing data, and which cutoff values should be applied for the measurement properties assessed during the validation process. In conclusion, this guideline, presenting a reference validation study for the QOLHEQ, creates the possibility to harmonize the national validation of the various language versions of the QOLHEQ. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DNA Commission of the International Society for Forensic Genetics: revised and extended guidelines for mitochondrial DNA typing.

PubMed

Parson, W; Gusmão, L; Hares, D R; Irwin, J A; Mayr, W R; Morling, N; Pokorak, E; Prinz, M; Salas, A; Schneider, P M; Parsons, T J

2014-11-01

The DNA Commission of the International Society of Forensic Genetics (ISFG) regularly publishes guidelines and recommendations concerning the application of DNA polymorphisms to the question of human identification. Previous recommendations published in 2000 addressed the analysis and interpretation of mitochondrial DNA (mtDNA) in forensic casework. While the foundations set forth in the earlier recommendations still apply, new approaches to the quality control, alignment and nomenclature of mitochondrial sequences, as well as the establishment of mtDNA reference population databases, have been developed. Here, we describe these developments and discuss their application to both mtDNA casework and mtDNA reference population databasing applications. While the generation of mtDNA for forensic casework has always been guided by specific standards, it is now well-established that data of the same quality are required for the mtDNA reference population data used to assess the statistical weight of the evidence. As a result, we introduce guidelines regarding sequence generation, as well as quality control measures based on the known worldwide mtDNA phylogeny, that can be applied to ensure the highest quality population data possible. For both casework and reference population databasing applications, the alignment and nomenclature of haplotypes is revised here and the phylogenetic alignment proffered as acceptable standard. In addition, the interpretation of heteroplasmy in the forensic context is updated, and the utility of alignment-free database searches for unbiased probability estimates is highlighted. Finally, we discuss statistical issues and define minimal standards for mtDNA database searches. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Analysis of on-line clinical laboratory manuals and practical recommendations.

PubMed

Beckwith, Bruce; Schwartz, Robert; Pantanowitz, Liron

2004-04-01

On-line clinical laboratory manuals are a valuable resource for medical professionals. To our knowledge, no recommendations currently exist for their content or design. To analyze publicly accessible on-line clinical laboratory manuals and to propose guidelines for their content. We conducted an Internet search for clinical laboratory manuals written in English with individual test listings. Four individual test listings in each manual were evaluated for 16 data elements, including sample requirements, test methodology, units of measure, reference range, and critical values. Web sites were also evaluated for supplementary information and search functions. We identified 48 on-line laboratory manuals, including 24 academic or community hospital laboratories and 24 commercial or reference laboratories. All manuals had search engines and/or test indices. No single manual contained all 16 data elements evaluated. An average of 8.9 (56%) elements were present (range, 4-14). Basic sample requirements (specimen and volume needed) were the elements most commonly present (98% of manuals). The frequency of the remaining data elements varied from 10% to 90%. On-line clinical laboratory manuals originate from both hospital and commercial laboratories. While most manuals were user-friendly and contained adequate specimen-collection information, other important elements, such as reference ranges, were frequently absent. To ensure that clinical laboratory manuals are of maximal utility, we propose the following 13 data elements be included in individual test listings: test name, synonyms, test description, test methodology, sample requirements, volume requirements, collection guidelines, transport guidelines, units of measure, reference range, critical values, test availability, and date of latest revision.

Underreporting of conflicts of interest in clinical practice guidelines: cross sectional study

PubMed Central

2013-01-01

Background Conflicts of interest affect recommendations in clinical guidelines and disclosure of such conflicts is important. However, not all conflicts of interest are disclosed. Using a public available disclosure list we determined the prevalence and underreporting of conflicts of interest among authors of clinical guidelines on drug treatments. Methods We included up to five guidelines published from July 2010 to March 2012 from each Danish clinical specialty society. Using the disclosure list of the Danish Health and Medicines Authority, we identified author conflicts of interest and compared them with the disclosures in the guidelines. For each guideline we extracted methodological characteristics of guideline development. Results Forty-five guidelines from 14 specialty societies were included. Of 254 authors, 135 (53%) had conflicts of interest, corresponding to 43 of the 45 guidelines (96%) having one or more authors with a conflict of interest. Only one of the 45 guidelines (2%) disclosed author conflicts of interest. The most common type of conflict of interest (83 of the 135) was being a consultant, an advisory board member or a company employee. Only 10 guidelines (22%) described the methods used for guideline development, 27 (60%) used references in the text and 11 (24%) graded the types of evidence. Conclusions Conflicts of interest were common, but disclosures were very rare. Most guidelines did not describe how they were developed and many did not describe the evidence behind specific recommendations. Publicly available disclosure lists may assist guideline issuing bodies in ensuring that all conflicts are disclosed. PMID:23642105

Assessing voids in SNOMED CT for pediatric concepts.

PubMed

Wade, Geraldine; Gotlieb, Edward M; Weigle, Carl; Warren, Robert

2008-11-06

Reference terminologies such as SNOMED CT may have voids in their representation of concepts important to the practice of pediatrics. In this project, relevant pediatric concepts were extracted from an American Academy of Pediatrics guideline and were mapped to SNOMED CT. Concepts were identified that should be included in the standard reference terminology. A process for formally evaluating voids in reference terminologies for concepts needed in pediatric clinical decision-making is planned as a next step.

Methods used in adaptation of health-related guidelines: A systematic survey.

PubMed

Abdul-Khalek, Rima A; Darzi, Andrea J; Godah, Mohammad W; Kilzar, Lama; Lakis, Chantal; Agarwal, Arnav; Abou-Jaoude, Elias; Meerpohl, Joerg J; Wiercioch, Wojtek; Santesso, Nancy; Brax, Hneine; Schünemann, Holger; Akl, Elie A

2017-12-01

Adaptation refers to the systematic approach for considering the endorsement or modification of recommendations produced in one setting for application in another as an alternative to de novo development. To describe and assess the methods used for adapting health-related guidelines published in peer-reviewed journals, and to assess the quality of the resulting adapted guidelines. We searched Medline and Embase up to June 2015. We assessed the method of adaptation, and the quality of included guidelines. Seventy-two papers were eligible. Most adapted guidelines and their source guidelines were published by professional societies (71% and 68% respectively), and in high-income countries (83% and 85% respectively). Of the 57 adapted guidelines that reported any detail about adaptation method, 34 (60%) did not use a published adaptation method. The number (and percentage) of adapted guidelines fulfilling each of the ADAPTE steps ranged between 2 (4%) and 57 (100%). The quality of adapted guidelines was highest for the "scope and purpose" domain and lowest for the "editorial independence" domain (respective mean percentages of the maximum possible scores were 93% and 43%). The mean score for "rigor of development" was 57%. Most adapted guidelines published in peer-reviewed journals do not report using a published adaptation method, and their adaptation quality was variable.

Integrating geographical information and augmented reality techniques for mobile escape guidelines on nuclear accident sites.

PubMed

Tsai, Ming-Kuan; Lee, Yung-Ching; Lu, Chung-Hsin; Chen, Mei-Hsin; Chou, Tien-Yin; Yau, Nie-Jia

2012-07-01

During nuclear accidents, when radioactive materials spread into the environment, the people in the affected areas should evacuate immediately. However, few information systems are available regarding escape guidelines for nuclear accidents. Therefore, this study constructs escape guidelines on mobile phones. This application is called Mobile Escape Guidelines (MEG) and adopts two techniques. One technique is the geographical information that offers multiple representations; the other is the augmented reality that provides semi-realistic information services. When this study tested the mobile escape guidelines, the results showed that this application was capable of identifying the correct locations of users, showing the escape routes, filtering geographical layers, and rapidly generating the relief reports. Users could evacuate from nuclear accident sites easily, even without relief personnel, since using slim devices to access the mobile escape guidelines is convenient. Overall, this study is a useful reference for a nuclear accident emergency response. Copyright © 2012 Elsevier Ltd. All rights reserved.

Personalized Guideline-Based Treatment Recommendations Using Natural Language Processing Techniques.

PubMed

Becker, Matthias; Böckmann, Britta

2017-01-01

Clinical guidelines and clinical pathways are accepted and proven instruments for quality assurance and process optimization. Today, electronic representation of clinical guidelines exists as unstructured text, but is not well-integrated with patient-specific information from electronic health records. Consequently, generic content of the clinical guidelines is accessible, but it is not possible to visualize the position of the patient on the clinical pathway, decision support cannot be provided by personalized guidelines for the next treatment step. The Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) provides common reference terminology as well as the semantic link for combining the pathways and the patient-specific information. This paper proposes a model-based approach to support the development of guideline-compliant pathways combined with patient-specific structured and unstructured information using SNOMED CT. To identify SNOMED CT concepts, a software was developed to extract SNOMED CT codes out of structured and unstructured German data to map these with clinical pathways annotated in accordance with the systematized nomenclature.

[Standards and guidelines of radiation protection and safety in dental X-ray examinations].

PubMed

Guo, X L; Li, G; Cheng, Y; Yu, Q; Wang, H; Zhang, Z Y

2017-12-09

With the rapid development of imaging technology, the application of dental imaging in diagnosis, treatment planning, intraoperative surgical navigation, monitoring of treatment or lesion development and assessment of treatment outcomes is playing an essential role in oral healthcare. The increased total number of dental X-ray examinations is accompanied by a relatively significant increase in collective dose to patients as well as to dental healthcare workers, which is harmful to human bodies to a certain degree. Some radiation protection standards and guidelines in dental radiology have been published in European countries, US, Canada and Australia, etc. Adherence to these standards and guidelines helps to achieve images with diagnostic quality and avoid unnecessary and repeated exposures. However, no radiation protection standard or guideline with regard to dental X-ray examinations has been put in force so far in mainland China. Therefore, a literature review on available radiation protection standards and guidelines was conducted to provide reference to the development of radiation protection standards or guidelines in mainland China.

[Guidelines for employment policies in Europe and national action plans: opportunities for people with disabilities].

PubMed

Niehaus, M

2000-06-01

The scourge of unemployment has been roundly identified throughout Europe as the most pressing social and economic problem on the current political agenda. At Luxembourg in November 1997, the European Jobs Summit brought Europe's leaders together in an historic occasion that mapped out employment guidelines for Europe. The Luxembourg Jobs Summit agreed a set of guidelines for the Member States employment policy under four pillars, employability, entrepreneurship, adaptability, and equal opportunities. One guideline referred to promoting integration of people with disabilities into working life. The Member States subsequently agreed to incorporate the Guidelines into national employment action plans. The question of this paper is, to what extent do employment guidelines and National Action Plans improve the opportunities of disabled persons? This paper seeks to establish a set of fundamental issues concerning employment and disability. Included in this analysis are recommendations in order to achieve a better presence of disabled people in National Action Plans in future.

The Development of Human Factor Guidelines for Unmanned Aircraft System Control Stations

NASA Technical Reports Server (NTRS)

Hobbs, Alan

2014-01-01

Despite being referred to as unmanned some of the major challenges confronting unmanned aircraft systems (UAS) relate to human factors. NASA is conducting research to address the human factors relevant to UAS access to non-segregated airspace. This work covers the issues of pilot performance, interaction with ATC, and control station design. A major outcome of this research will be recommendations for human factors design guidelines for UAS control stations to support routine beyond-line-of-sight operations in the US national airspace system (NAS). To be effective, guidelines must be relevant to a wide range of systems, must not be overly prescriptive, and must not impose premature standardization on evolving technologies. In developing guidelines, we recognize that existing regulatory and guidance material may already provide adequate coverage of certain issues. In other cases suitable guidelines may be found in existing military or industry human factors standards. In cases where appropriate existing standards cannot be identified, original guidelines will be proposed.

Occupational safety and health aspects of corporate social responsibility (CSR) in Japanese companies listed on the Tokyo Stock Exchange (TSE) first section.

PubMed

Kawashita, Futoshi; Taniyama, Yukari; Hwi, Song You; Fujisaki, Takeshi; Kameda, Takashi; Mori, Koji

2005-11-01

Recently, corporate social responsibility (CSR) is becoming widely recognized as an issue for Japanese companies. Corporate responsibility for employees is considered important by various stakeholders, and occupational safety and health is regarded as one of these responsibilities. The present authors examined this issue from the viewpoint of corporate management by analysis of statements found in CSR-related reports. For companies listed on the First Section of the Tokyo Stock Exchange (TSE), we searched for CSR-related reports, and titles and contents, based on two established guidelines: the GRI Sustainability Reporting Guidelines 2002 as the international reference and the Environmental Reporting Guidelines of the Ministry of the Environment, Government of Japan, as the domestic reference. Corporations that published CSR reports were 26.3% (416/1,581) of the total, and large differences were recognized by type of industry. Comparing the numbers of pages for various contents, more concern was shown about the environment than about social activity, indicating the environment to be the main issue of CSR in Japan. In the items included in the guidelines, many matters about occupational accidents were mentioned, but it was found that statements regarding HIV/AIDS, which is not of such strong social concern in Japan, and statements regarding the costs of safety that are difficult to calculate were few. However, statements regarding mental health, which is of high interest socially, were many, even though this issue is not included in the two guidelines used. In revising the guidelines, these matters should be reviewed. In the future, continuance of analysis of CSR-related reports with regard to changes and comparisons with overseas reports will help improve occupational safety and health.

Facilitating adherence to the tobacco use treatment guideline with computer-mediated decision support systems: physician and clinic office manager perspectives.

PubMed

Marcy, Theodore W; Skelly, Joan; Shiffman, Richard N; Flynn, Brian S

2005-08-01

A majority of physicians do not adhere to all the elements of the evidence-based USPHS guideline on tobacco use and dependence treatment. Among physicians and clinic office managers in Vermont we assessed perceived barriers to guideline adherence. We then assessed attitudes towards a computer-mediated clinical decision support system (CDSS) to gauge whether this type of intervention could support performance of the guideline. A random sample of 600 Vermont primary care and subspecialty physicians were surveyed with a mailed survey instrument. A separate survey instrument was mailed to the census of 93 clinic office managers. The response rates of physicians and clinic office managers were 67% and 76%, respectively. Though most physicians were aware of the guideline and had positive attitudes towards it, there was a lack of familiarity with Vermont's smoking cessation resources as 35% would refer smokers to non-existent counseling resources and only 48% would refer patients to a toll-free quit line. Time constraints and the perception that smokers are unreceptive to counseling were the two most common barriers cited by both physicians and office managers. The vast majority of physicians (92%) have access to a computer in their outpatient clinics, and 68% have used computers during the course of a patient's visit. Four of the eight information management services that a CDSS could provide were highly valued by both physicians and clinic office managers. Interventions to improve adherence to the guideline should address the inaccurate perception that smokers are unreceptive to counseling, and physicians' lack of familiarity with resources. A CDSS may improve knowledge of these resources if the design addresses cost, space, and time limitations.

Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer.

PubMed

Wu, Abraham J; Bosch, Walter R; Chang, Daniel T; Hong, Theodore S; Jabbour, Salma K; Kleinberg, Lawrence R; Mamon, Harvey J; Thomas, Charles R; Goodman, Karyn A

2015-07-15

Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future. Copyright © 2015 Elsevier Inc. All rights reserved.

Expert consensus contouring guidelines for IMRT in esophageal and gastroesophageal junction cancer

PubMed Central

Wu, Abraham J.; Bosch, Walter R.; Chang, Daniel T.; Hong, Theodore S.; Jabbour, Salma K.; Kleinberg, Lawrence R.; Mamon, Harvey J.; Thomas, Charles R.; Goodman, Karyn A.

2015-01-01

Purpose/Objective(s) Current guidelines for esophageal cancer contouring are derived from traditional two-dimensional fields based on bony landmarks, and do not provide sufficient anatomical detail to ensure consistent contouring for more conformal radiotherapy techniques such as intensity-modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials Eight expert academically-based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform CT simulation datasets and an accompanying diagnostic PET-CT were distributed to each expert, and he/she was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results Kappa statistics indicated substantial agreement between panelists for each of the three test cases. A consensus CTV atlas was generated for the three test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets utilizing these guidelines may require modification in the future. PMID:26104943

Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

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

Wu, Abraham J., E-mail: wua@mskcc.org; Bosch, Walter R.; Chang, Daniel T.

Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophagealmore » cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future.« less

Guidelines for testing and release procedures

NASA Technical Reports Server (NTRS)

Molari, R.; Conway, M.

1984-01-01

Guidelines and procedures are recommended for the testing and release of the types of computer software efforts commonly performed at NASA/Ames Research Center. All recommendations are based on the premise that testing and release activities must be specifically selected for the environment, size, and purpose of each individual software project. Guidelines are presented for building a Test Plan and using formal Test Plan and Test Care Inspections on it. Frequent references are made to NASA/Ames Guidelines for Software Inspections. Guidelines are presented for selecting an Overall Test Approach and for each of the four main phases of testing: (1) Unit Testing of Components, (2) Integration Testing of Components, (3) System Integration Testing, and (4) Acceptance Testing. Tools used for testing are listed, including those available from operating systems used at Ames, specialized tools which can be developed, unit test drivers, stub module generators, and the use of format test reporting schemes.

Pharmacokinetic equivalence of a levothyroxine sodium soft capsule manufactured using the new food and drug administration potency guidelines in healthy volunteers under fasting conditions.

PubMed

Colucci, Philippe; D'Angelo, Pina; Mautone, Giuseppe; Scarsi, Claudia; Ducharme, Murray P

2011-06-01

To assess the pharmacokinetic equivalence of a new soft capsule formulation of levothyroxine versus a marketed reference product and to assess the soft capsule formulated with stricter potency guidelines versus the capsule before the implementation of the new potency rule. Two single-dose randomized two-way crossover pharmacokinetic equivalence studies and one dosage form proportionality single-dose study comparing low, medium, and high strengths of the new formulation. All three studies were performed in a clinical setting. Participants were healthy male and female adult subjects with normal levothyroxine levels. A total of 90 subjects participated in the three studies. Pharmacokinetic parameters were calculated on baseline- adjusted concentrations. The first pharmacokinetic equivalence study compared the levothyroxine sodium soft capsule formulation (Tirosint) with the reference Synthroid tablets and the two products were considered bioequivalent. The dosage form proportionality study compared the 50-, 100-, and 150-μg test capsules strengths dosed at the same level (600 μg) and all three strengths were considered equivalent when given at the same dosage. The last study compared the test capsule used in the first two studies with a new capsule formulation following the new potency guideline (±5%) set forward by the Food and Drug Administration and the two capsules were considered bioequivalent. Doses were well tolerated by subjects in all three studies with no serious adverse events reported. The levothyroxine soft capsule formulated with the stricter new potency guideline set forward by the Food and Drug Administration met equivalence criteria in terms of rate and extent of exposure under fasting conditions to the reference tablet formulation. Clinical doses of the capsule formulation can be given using any combination of the commercialized strengths.

Innovative Telemonitoring Enhanced Care Programme for Chronic Heart Failure (ITEC-CHF) to improve guideline compliance and collaborative care: protocol of a multicentre randomised controlled trial

PubMed Central

Jayasena, Rajiv; Maiorana, Andrew; Dowling, Alison; Chen, Sheau Huey; Karunanithi, Mohan; Layland, Jamie; Edwards, Iain

2017-01-01

Introduction Chronic heart failure (CHF) is a life-threatening chronic disease characterised by periodic exacerbations and recurrent hospitalisations. In the management of CHF, patient compliance with evidence-based clinical guidelines is essential, but remains difficult practically. The objective of this study is to examine whether an Innovative Telemonitoring Enhanced Care Programme for CHF (ITEC-CHF) improves patients’ compliance, and associated health and economic outcomes. Methods and analysis An open multicentre randomised controlled trial has been designed. Patients will be recruited and randomised to receive either ITEC-CHF (n=150) or usual care CHF (n=150) for at least 6 months. ITEC-CHF combines usual care and an additional telemonitoring service including remote weight monitoring, structured telephone support and nurse-led collaborative care. The primary outcomes are the compliance rates with the best-practice guidelines for daily weight monitoring. The secondary outcomes include the compliance with other guideline recommendations (health maintenance, medication, diet and exercise), health (health-related quality of life, risk factors, functional capacity and psychological states) and economic outcomes related to the use of healthcare resources such as hospital readmissions and general practitioner/emergency department visits. Ethics and dissemination The clinical trial has been approved by Peninsula Health Human Research Ethics Committee (HREC Reference: HREC/14/PH/27), Royal Perth Hospital Human Research Ethics Committee (Reference: 15-081) and the Curtin University Human Research Ethics Committee (Reference: HR 181/2014). We will disseminate the final results to the public via conferences and journal publications. A final study report will also be provided to the ethics committees. Trial registration number Registered with Australian New Zealand Clinical Trial Registry (ACTRN12614000916640). PMID:28993389

Childhood extravasation injuries: improved outcome following the introduction of hospital-wide guidelines.

PubMed

Ghanem, Ali M; Mansour, Abdulrab; Exton, Rebecca; Powell, Jonathan; Mashhadi, Syed; Bulstrode, Neil; Smith, Gillian

2015-04-01

Extravasation is an iatrogenic injury that may produce soft tissue necrosis requiring surgical reconstruction (Rose et al., 2008) and (Goon et al., 2006). Previous review of extravasation injuries within our hospital showed that early referral to plastic surgeons and washout of high-risk cases lead to favourable outcome in 86% of patients (Gault, 1993). Hospital-wide guidelines were introduced in 2005. This paper closes the audit loop by evaluating extravasation injuries outcome following the introduction of these guidelines. All patients referred to the plastic surgery department for extravasation injuries between October 2008 and October 2009 were reviewed. A favourable outcome was defined as resolution without tissue loss requiring surgical reconstruction. Patients were excluded if they sustained the extravasation in other institution. A total of 82 extravasation injuries in 78 patients were reviewed during the audit period. Mean age was 3.2 years (Median 0.2 years, Minimum 0 day, and maximum 16.7 years). The injuries were more frequent on the left half of the body (52%) and involving the upper limbs (59%). Mean time to referral was 8 h, with 60% of patients referred within 6 h of the injury, 30% in 6-12 h, and 10% referred after more than 12 h 26% of the injuries required washout treatment - the rest was treated conservatively. Tissue necrosis occurred in 3 cases (4%) but required no surgical intervention due to the small area affected. Our audit showed an improved outcome of extravasation injury following introduction of hospital-wide guidelines of early referral to specialist team and washout of high-risk cases. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Diabetic retinopathy screening in New Zealand requires improvement: results from a multi-centre audit.

PubMed

Hutchins, Edward; Coppell, Kirsten J; Morris, Ainsley; Sanderson, Gordon

2012-06-01

To determine whether diabetic retinal screening services and retinopathy referral centres in New Zealand meet the national guidelines for referral and assessment of screen detected moderate retinal and mild macular diabetic eye disease. Diabetic retinal screening pathways and the data collected at four main centre retinal screening services were described and compared with recommendations in the national diabetes retinal screening guidelines. A retrospective audit of photoscreen detected moderate retinopathy (grade R3), and mild maculopathy (grades M2B and M3) during May to August 2008 was undertaken. Data collected by retinopathy referral centres were used to examine the follow-up of screen detected cases and to make comparisons with the national recommendations. All four screening services used the guidelines for grading, but the recommended dataset was incomplete. Not all recorded data were readily accessible. The retinal photos of 157 (2.4%) patients were graded as R3, M2B, M3 or a combination. The proportion of those screened with these grades varied across the four centres from 1.2% to 3.4%. Follow-up of the 157 screen positive patients did not always comply with guideline recommendations. Seventy five (48%) were referred for review by an ophthalmologist as recommended, 45 (60% of referred) were seen within the recommended six months. Nine patients (15% of the 60 with a documented assessment) were referred for or received laser treatment at 12-months follow-up. Quality diabetic retinal screening data systems and quality assurance programs are required to improve the monitoring and quality of retinal screening in New Zealand. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Management errors in adults with congenital heart disease: prevalence, sources, and consequences.

PubMed

Cordina, Rachael; Nasir Ahmad, Subha; Kotchetkova, Irina; Eveborn, Gry; Pressley, Lynne; Ayer, Julian; Chard, Richard; Tanous, David; Robinson, Peter; Kilian, Jens; Deanfield, John E; Celermajer, David S

2018-03-21

Improved survival has resulted in increasing numbers and complexity of adults with congenital heart disease (ACHD). International guidelines recommend specialized care but many patients are still not managed at dedicated ACHD centres. This study analysed referral sources and appropriateness of management for patients referred to our tertiary ACHD Centre over the past 3 years. We compared differences in care between patients referred from paediatric/ACHD-trained vs. general adult cardiologists, according to Adherence (A) or Non-Adherence (NA) with published guidelines. Non-Adherent cases were graded according to the severity of adverse outcome or risk of adverse outcome. Of 309 consecutively referred patients (28 ± 14 years, 51% male), 134 (43%) were from general cardiologists (19% highly complex CHD) and 115 (37%) were from paediatric cardiology or ACHD specialists (33% highly complex CHD). Sixty referrals (20%) were from other medical teams and of those, 31 had been lost to follow-up. Guideline deviations were more common in referrals from general compared to CHD-trained cardiologists (P < 0.001). Of general cardiology referrals, 49 (37%) were NA; 18 had catastrophic or major complications (n = 2, 16 respectively). In contrast, only 12 (10%) of the paediatric/ACHD referrals were NA, but none of these were catastrophic and only 3 were major. Simple, moderate, and highly complex CHD patients were at increased risk of adverse outcome when not under specialized CHD cardiology care (P = 0.04, 0.009, and 0.002, respectively). Non-adherence with guidelines was common in the ACHD population, and this frequently resulted in important adverse clinical consequences. These problems were more likely in patients who had not been receiving specialized CHD care. Configuring healthcare systems to optimize 'whole of life' care for this growing population is essential.

Proposal of an innovative benchmark for comparison of the performance of contactless digitizers

NASA Astrophysics Data System (ADS)

Iuliano, Luca; Minetola, Paolo; Salmi, Alessandro

2010-10-01

Thanks to the improving performances of 3D optical scanners, in terms of accuracy and repeatability, reverse engineering applications have extended from CAD model design or reconstruction to quality control. Today, contactless digitizing devices constitute a good alternative to coordinate measuring machines (CMMs) for the inspection of certain parts. The German guideline VDI/VDE 2634 is the only reference to evaluate whether 3D optical measuring systems comply with the declared or required performance specifications. Nevertheless it is difficult to compare the performance of different scanners referring to such a guideline. An adequate novel benchmark is proposed in this paper: focusing on the inspection of production tools (moulds), the innovative test piece was designed using common geometries and free-form surfaces. The reference part is intended to be employed for the evaluation of the performance of several contactless digitizing devices in computer-aided inspection, considering dimensional and geometrical tolerances as well as other quantitative and qualitative criteria.

Guideline for the utilization of commercial grade items in nuclear safety related applications: Final report. [Contains Glossary

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

Tulay, M.P.; Yurich, F.J.; Schremser, F.M. Jr.

1988-06-01

This guideline provides direction for the procurement and use of Commercial Grade Items (CGI)in safety-related applications. It is divided into five major sections. A glossary of terms and definitions, an acronym listing, and seven appendices have been included. The glossary defines terms used in this guideline. In certain instances, the definitions may be unique to this guideline. Identification of acronyms utilized in this guideline is also provided. Section 1 provides a background of the commercial grade item issues facing the nuclear industry. It provides a historical perspective of commercial grade item issues. Section 2 discusses the generic process for themore » acceptance of a commercial grade item for safety-related use. Section 3 defines the four distinct methods used to accept commercial grade items for safety-related applications. Section 4 lists specific references that are identified in this guideline. Section 5 is a bibliography of documents that were considered in developed this guideline, but were not directly referenced in the document.« less

Publication guidelines for quality improvement in health care: evolution of the SQUIRE project

PubMed Central

Davidoff, F; Batalden, P; Stevens, D; Ogrinc, G; Mooney, S

2008-01-01

In 2005, draft guidelines were published for reporting studies of quality improvement interventions as the initial step in a consensus process for development of a more definitive version. This article contains the full revised version of the guidelines, which the authors refer to as SQUIRE (Standards for QUality Improvement Reporting Excellence). This paper also describes the consensus process, which included informal feedback from authors, editors and peer reviewers who used the guidelines; formal written commentaries; input from a group of publication guideline developers; ongoing review of the literature on the epistemology of improvement and methods for evaluating complex social programmes; a two-day meeting of stakeholders for critical discussion and debate of the guidelines’ content and wording; and commentary on sequential versions of the guidelines from an expert consultant group. Finally, the authors consider the major differences between SQUIRE and the initial draft guidelines; limitations of and unresolved questions about SQUIRE; ancillary supporting documents and alternative versions that are under development; and plans for dissemination, testing and further development of SQUIRE. PMID:18836063

Medication and monitoring in palliative sedation therapy: a systematic review and quality assessment of published guidelines.

PubMed

Schildmann, Eva Katharina; Schildmann, Jan; Kiesewetter, Isabel

2015-04-01

Palliative sedation therapy (PST) is increasingly used in patients at the end of life. However, consensus about medications and monitoring is lacking. To assess published PST guidelines with regard to quality and recommendations on drugs and monitoring. We searched CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, and references of included articles until July 2014. Search terms included "palliative sedation" or "sedation" and "guideline" or "policy" or "framework." Guideline selection was based on English or German publications that included a PST guideline. Two investigators independently assessed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II) and extracted information on drug selection and monitoring. Nine guidelines were eligible. Eight guidelines received high quality scores for the domain "scope and purpose" (median 69%, range 28-83%), whereas in the other domains the guidelines' quality differed considerably. The majority of guidelines suggest midazolam as drug of first choice. Recommendations on dosage and alternatives vary. The guidelines' recommendations regarding monitoring of PST show wide variation in the number and details of outcome parameters and methods of assessment. The published guidelines on PST vary considerably regarding their quality and content on drugs and monitoring. Given the need for clear guidance regarding PST in patients at the end of life, this comparative analysis may serve as a starting point for further improvement. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care

PubMed Central

Bush, Shirley H.; Bruera, Eduardo; Lawlor, Peter G.; Kanji, Salmaan; Davis, Daniel H.J.; Agar, Meera; Wright, David; Hartwick, Michael; Currow, David C.; Gagnon, Bruno; Simon, Jessica; Pereira, José L.

2014-01-01

Context Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. Objectives This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. Methods We searched PubMed (1990–2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. Results There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from “expert opinion” for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Conclusion Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development. PMID:24766743

The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics.

PubMed

Mota de Almeida, F J; Knutsson, K; Flygare, L

2014-01-01

The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems. The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis. 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%). CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.

[European community guidelines and standards in indoor air quality: what proposals for Italy].

PubMed

Settimo, Gaetano; D'Alessandro, Daniela

2014-01-01

Indoor air quality is an issue on which to focus because of the increasing number of exposed population and in view of the strong public feeling on this issue. This paper reports the rules of EU and several European countries about indoor air quality, focusing on the initiatives performed in Italy to respond to WHO recommendations. Several EU countries have introduced in their legislation rules relating to indoor air quality. At the moment, in Italy, a reference rule has not been issued. For this reason, up to date main informations concerning some guidelines or reference values in indoor air, to be used for a first comparison, are those obtained by the scientific literature, or by the guidelines issued by other European countries or, for analogy, by other standard values such as limit or reference values regarding outdoor air. Even the EU, while reaffirming the priority of energy efficiency measures, recommends healthier indoor environments and the development of a specific European strategy on the issue of indoor air quality. The National Study Group on indoor pollution of the Italian National Health Institute (ISS), is working for the development of shared technical and scientific documents, in order to provide greater uniformity of actions at national level, waiting for a legal framework for indoor air quality, in the light of the indication already produced by the WHO.

Belgian guidelines for economic evaluations: second edition.

PubMed

Thiry, Nancy; Neyt, Mattias; Van De Sande, Stefaan; Cleemput, Irina

2014-12-01

The aim of this study was to present the updated methodological guidelines for economic evaluations of healthcare interventions (drugs, medical devices, and other interventions) in Belgium. The update of the guidelines was performed by three Belgian health economists following feedback from users of the former guidelines and personal experience. The updated guidelines were discussed with a multidisciplinary team consisting of other health economists, assessors of reimbursement request files, representatives of Belgian databases and representatives of the drugs and medical devices industry. The final document was validated by three external validators that were not involved in the previous discussions. The guidelines give methodological guidance for the following components of an economic evaluation: literature review, perspective of the evaluation, definition of the target population, choice of the comparator, analytic technique and study design, calculation of costs, valuation of outcomes, definition of the time horizon, modeling, handling uncertainty and discounting. We present a reference case that can be considered as the minimal requirement for Belgian economic evaluations of health interventions. These guidelines will improve the methodological quality, transparency and uniformity of the economic evaluations performed in Belgium. The guidelines will also provide support to the researchers and assessors performing or evaluating economic evaluations.

Existing reporting guidelines for clinical trials are not completely relevant for implantable medical devices: a systematic review.

PubMed

Motte, Anne-France; Diallo, Stéphanie; van den Brink, Hélène; Châteauvieux, Constance; Serrano, Carole; Naud, Carole; Steelandt, Julie; Alsac, Jean-Marc; Aubry, Pierre; Cour, Florence; Pellerin, Olivier; Pineau, Judith; Prognon, Patrice; Borget, Isabelle; Bonan, Brigitte; Martelli, Nicolas

2017-11-01

The aim of this study was to determine relevant items for reporting clinical trials on implantable medical devices (IMDs) and to identify reporting guidelines which include these items. A panel of experts identified the most relevant items for evaluating IMDs from an initial list based on reference papers. We then conducted a systematic review of articles indexed in MEDLINE. We retrieved reporting guidelines from the EQUATOR network's library for health research reporting. Finally, we screened these reporting guidelines to find those using our set of reporting items. Seven relevant reporting items were selected that related to four topics: randomization, learning curve, surgical setting, and device information. A total of 348 reporting guidelines were identified, among which 26 met our inclusion criteria. However, none of the 26 reporting guidelines presented all seven items together. The most frequently reported item was timing of randomization (65%). On the contrary, device information and learning curve effects were poorly specified. To our knowledge, this study is the first to identify specific items related to IMDs in reporting guidelines for clinical trials. We have shown that no existing reporting guideline is totally suitable for these devices. Copyright © 2017 Elsevier Inc. All rights reserved.

Reporting of clinical trials: a review of research funders' guidelines

PubMed Central

Dwan, Kerry; Gamble, Carrol; Williamson, Paula R; Altman, Douglas G

2008-01-01

Background Randomised controlled trials (RCTs) represent the gold standard methodological design to evaluate the effectiveness of an intervention in humans but they are subject to bias, including study publication bias and outcome reporting bias. National and international organisations and charities give recommendations for good research practice in relation to RCTs but to date no review of these guidelines has been undertaken with respect to reporting bias. Methods National and international organisations and UK based charities listed on the Association for Medical Research Charities website were contacted in 2007; they were considered eligible for this review if they funded RCTs. Guidelines were obtained and assessed in relation to what was written about trial registration, protocol adherence and trial publication. It was also noted whether any monitoring against these guidelines was undertaken. This information was necessary to discover how much guidance researchers are given on the publication of results, in order to prevent study publication bias and outcome reporting bias. Results Seventeen organisations and 56 charities were eligible of 140 surveyed for this review, although there was no response from 12. Trial registration, protocol adherence, trial publication and monitoring against the guidelines were often explicitly discussed or implicitly referred too. However, only eleven of these organisations or charities mentioned the publication of negative as well as positive outcomes and just three of the organisations specifically stated that the statistical analysis plan should be strictly adhered to and all changes should be reported. Conclusion Our review indicates that there is a need to provide more detailed guidance for those conducting and reporting clinical trials to help prevent the selective reporting of results. Statements found in the guidelines generally refer to publication bias rather than outcome reporting bias. Current guidelines need to be updated and include the statement that all primary and secondary outcomes prespecified in the protocol should be fully reported and should not be selected for inclusion in the final report based on their results. PMID:19032743

"I do not have time. Is there a handout I can use?": combining physicians' needs and behavior change theory to put physical activity evidence into practice.

PubMed

Clark, R E; McArthur, C; Papaioannou, A; Cheung, A M; Laprade, J; Lee, L; Jain, R; Giangregorio, L M

2017-06-01

Guidelines for physical activity exist and following them would improve health. Physicians can advise patients on physical activity. We found barriers related to physicians' knowledge, a lack of tools and of physician incentives, and competing demands for limited time with a patient. We discuss interventions that could reduce these barriers. Uptake of physical activity (PA) guidelines would improve health and reduce mortality in older adults. However, physicians face barriers in guideline implementation, particularly when faced with needing to tailor recommendations in the presence of chronic disease. We performed a behavioral analysis of physician barriers to PA guideline implementation and to identify interventions. The Too Fit To Fracture physical activity recommendations were used as an example of disease-specific PA guidelines. Focus groups and semi-structured interviews were conducted with physicians and nurse practitioners in Ontario, stratified by type of physician, geographic area, and urban/rural, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the behavior change wheel framework, themes were categorized into capability, opportunity and motivation, and interventions were identified. Fifty-nine family physicians, specialists, and nurse practitioners participated. Barriers were as follows: Capability-lack of exercise knowledge or where to refer; Opportunity-pragmatic tools, fit within existing workflow, available programs that meet patients' needs, physical activity literacy and cultural practices; Motivation-lack of incentives, not in their scope of practice or professional identity, competing priorities, outcome expectancies. Interventions selected: education, environmental restructuring, enablement, persuasion. Policy categories: communications/marketing, service provision, guidelines. Key barriers to PA guideline implementation among physicians include knowledge on where to refer or what to say, access to pragmatic programs or resources, and things that influence motivation, such as competing priorities or lack of incentives. Future work will report on the development and evaluation of knowledge translation interventions informed by the barriers.

[A new update of the SIMLII Guidelines on carcinogens].

PubMed

Pira, Enrico; Giachino, Gian Mario; Discalzi, Gianluigi

2011-01-01

The second update of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) guidelines on Cancerogens and Mutagens, first published in 2003 and reviewed in 2007, is presented. The general setting of the guidelines remaines unmodified. In this new release some important developments on regulatory system, risk assessment, and health surveillance are discussed. The relevant evolution of the regulatory rules is illustrated in detail, with particular reference to the recent implementation in European Union and in Italy of the Regulation (EC) 1272/2008 on Classification, Labelling and Packaging of substances and mixtures. The recent tendencies of the European Scientific Committee on Occupational Exposure Limits in risk assessment, are presented. Some remarks on the use of new biomarkers in health surveillance, with reference to lung and bladder cancer, are discussed. The more recent results on the effectiveness of the use of LDTC scan on screening in asymptomatic persons at high risk for lung cancer, are presented. The use of this imaging technique in health surveillance of special group of workers (i.e., subjects with relevant past asbestos exposure and smokers) could be adopted.

Implementing NICE Guidelines on Recall Intervals into General Practice.

PubMed

Akram, Sarah; D’Cruz, Len

2010-09-01

The NICE guidelines require practitioners to ensure that each patient has a specific recall interval based on an oral health needs assessment. There appears to be a hesitancy in the profession to move away from the ‘six-month recall’. In England and Wales, Primary Care Organizations (PCOs) monitor activity using quantitative data. One particular metric measures how many patients are seen by the practice within 3 months and also between 3 and 9 months from their last course of treatment. The purpose of this paper is to introduce a quick reference chart based on the NICE guidelines which, when used in combination with clinical judgement, can aid the clinician in selecting a tailored recall interval. This paper discusses the purpose and benefits for using the guidelines in relation to NHS contractual obligations.

Between universalism and relativism: a conceptual exploration of problems in formulating and applying international biomedical ethical guidelines

PubMed Central

Tangwa, G

2004-01-01

In this paper, the author attempts to explore some of the problems connected with the formulation and application of international biomedical ethical guidelines, with particular reference to Africa. Recent attempts at revising and updating some international medical ethical guidelines have been bedevilled by intractable controversies and wrangling regarding both the content and formulation. From the vantage position of relative familiarity with both African and Western contexts, and the privilege of having been involved in the revision and updating of one of the international ethical guidelines, the author reflects broadly on these issues and attempts prescribing an approach from both the theoretical and practical angles liable to mitigate, if not completely eliminate, some of the problems and difficulties. PMID:14872078

The Diabetes Surgery Summit II Guidelines: a Disease-Based Clinical Recommendation.

PubMed

Cohen, Ricardo V; Shikora, Scott; Petry, Tarissa; Caravatto, Pedro Paulo; Le Roux, Carel W

2016-08-01

There is mounting evidence, derived from mechanistic studies, RCTs, and other high-quality studies that there are weight loss independent antidiabetic effects of gastrointestinal surgery. Additionally, there appears to be no relation between the positive metabolic outcomes to baseline BMI. The outdated US National Health Institutes guidelines from 1991 were centered on BMI only criterion and often misleading. The Second Diabetes Surgery Summit held in collaboration with leading diabetes organizations and endorsed by a large group of international Professional Societies developed guidelines that defined eligibility based on the severity and degree of T2D medical control while referring to obesity as a qualifier and not the sole criterion. That is the first time that guidelines are provided to put metabolic surgery into the T2D treatment algorithms.

Technical Guidelines and References: Crops Training Component. From: Agricultural Development Workers Training Manual. Volume III: Crops.

ERIC Educational Resources Information Center

Peace Corps, Washington, DC. Information Collection and Exchange Div.

This reference manual for training Peace Corps agricultural development workers deals with crops. The document begins with common units of area, length, weight, volume, and conversions between them. A practice problem is worked and other conversion problems are given. The second section is intended to show agricultural field workers how to survey…

The Library as the Community Switchboard. Bay Area Reference Center Workshop, February 14 and 15, 1973.

ERIC Educational Resources Information Center

San Francisco Public Library, CA. Bay Area Reference Center.

In a two-day workshop at the San Francisco Public Library, the staff of the Bay Area Reference Center (BARC) led discussions on how the library can serve as a community information and referral center. Various speakers reviewed the problems and possibilities of such a service and presented guidelines for the establishment, volunteer staffing, and…

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Resolution A.393(X), adopted on 14 November 1977, Recommendation on International Performance and Test...), Guidelines on the Enhanced Programme of Inspections During Surveys of Bulk Carriers and Oil Tankers, Annex B... reference approved for § 157.445. (c) Oil Companies International Marine Forum (OCIMF) 27 Queen Anne's Gate...

Fitness Unfolding: How To Begin and Maintain a Quality, Healthy Lifestyle. Tips, Guidelines, Resources, and References.

ERIC Educational Resources Information Center

Meredith, Sydney

This book presents a holistic approach to fitness, opens channels of information, and identifies useful resources and references. After an introduction to the subject of health related fitness, the book presents 12 chapters answering the following questions: (1) Why Not Be Fit? (2) What Is Physical Fitness? (3) Why Participate in Fitness? (4) What…

21 CFR 1311.08 - Incorporation by reference.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., (301) 975-6478 or TTY (301) 975-8295, [email protected]nist.gov, and are available at http://csrc.nist.gov...); incorporation by reference approved for §§ 1311.120(b), 1311.205(b), and 1311.210(c). (6) Draft NIST Special Publication 800-63-1, Electronic Authentication Guideline, December 8, 2008 (NIST SP 800-63-1); Burr, W. et al...

21 CFR 1311.08 - Incorporation by reference.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., (301) 975-6478 or TTY (301) 975-8295, [email protected]nist.gov, and are available at http://csrc.nist.gov...); incorporation by reference approved for §§ 1311.120(b), 1311.205(b), and 1311.210(c). (6) Draft NIST Special Publication 800-63-1, Electronic Authentication Guideline, December 8, 2008 (NIST SP 800-63-1); Burr, W. et al...

21 CFR 1311.08 - Incorporation by reference.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., (301) 975-6478 or TTY (301) 975-8295, [email protected]nist.gov, and are available at http://csrc.nist.gov...); incorporation by reference approved for §§ 1311.120(b), 1311.205(b), and 1311.210(c). (6) Draft NIST Special Publication 800-63-1, Electronic Authentication Guideline, December 8, 2008 (NIST SP 800-63-1); Burr, W. et al...

What NPs need to know about anticoagulation therapy.

PubMed

Gay, Sarah E; Munaco, Sandra

2012-10-10

Venous thromboembolism (VTE) refers to pulmonary embolism and deep venous thrombosis. Anticoagulation is the cornerstone of management for patients with VTE. This review will discuss current anticoagulation guidelines.

Guidelines for the detection of Trichinella larvae at the slaughterhouse in a quality assurance system.

PubMed

Rossi, Patrizia; Pozio, Edoardo

2008-01-01

The European Community Regulation (EC) No. 2075/2005 lays down specific rules on official controls for the detection of Trichinella in fresh meat for human consumption, recommending the pooled-sample digestion method as the reference method. The aim of this document is to provide specific guidance to implement an appropriate Trichinella digestion method by a laboratory accredited according to the ISO/IEC 17025:2005 international standard, and performing microbiological testing following the EA-04/10:2002 international guideline. Technical requirements for the correct implementation of the method, such as the personnel competence, specific equipments and reagents, validation of the method, reference materials, sampling, quality assurance of results and quality control of performance are provided, pointing out the critical control points for the correct implementation of the digestion method.

Toward Clarity in Clinical Vitamin D Status Assessment: 25(OH)D Assay Standardization.

PubMed

Binkley, Neil; Carter, Graham D

2017-12-01

Widespread variation in 25-hydroxyvitamin D (25(OH)D) assays continues to compromise efforts to develop clinical and public health guidelines regarding vitamin D status. The Vitamin D Standardization Program helps alleviate this problem. Reference measurement procedures and standard reference materials have been developed to allow current, prospective, and retrospective standardization of 25(OH)D results. Despite advances in 25(OH)D measurement, substantial variability in clinical laboratory 25(OH)D measurement persists. Existing guidelines have not used standardized data and, as a result, it seems unlikely that consensus regarding definitions of vitamin D deficiency, inadequacy, sufficiency, and excess will soon be reached. Until evidence-based consensus is reached, a reasonable clinical approach is advocated. Copyright © 2017 Elsevier Inc. All rights reserved.

Examining Guidelines for School-Based Breakfast Programs in Canada: A Systematic Review of the Grey Literature.

PubMed

Godin, Katelyn M; Kirkpatrick, Sharon I; Hanning, Rhona M; Stapleton, Jackie; Leatherdale, Scott T

2017-06-01

School breakfast programs are widespread and serve varying objectives regarding youth health promotion. Evidence-based guidelines for breakfast programs may be important in maximizing their effectiveness related to student outcomes, yet it is unclear what is available in Canada. A systematic review was conducted to identify and compare Canadian guidelines related to breakfast programs. Data sources included grey literature databases, customized search engines, targeted websites, and content expert consultations. Eligible guidelines met the following criteria: government and nongovernment sources at the federal and provincial/territorial levels, current version, and intended for program coordinators. Recommendations for program delivery were extracted, categorized, and mapped onto the 4 environments outlined in the ANGELO framework, and they were classified as "common" or "inconsistent" across guidelines. Fifteen sets of guidelines were included. No guidelines were available from federal or territorial governments and 4 provincial governments. There were few references to peer-reviewed literature within the guidelines and despite many common recommendations for program delivery, conflicting recommendations were also identified. Potential barriers to program participation, including a lack of consideration of allergies and other dietary restrictions, were identified. Future research should identify how guidelines are implemented and evaluate what effect their implementation has on program delivery and student outcomes.

Using AGREE II to Evaluate the Quality of Traditional Medicine Clinical Practice Guidelines in China.

PubMed

Deng, Wei; Li, Le; Wang, Zixia; Chang, Xiaonan; Li, Rui; Fang, Ziye; Wei, Dang; Yao, Liang; Wang, Xiaoqin; Wang, Qi; An, Guanghui

2016-03-15

To evaluate/assess the quality of the Clinical Practice Guidelines (CPGs) of traditional medicine in China. We systematically searched the literature databases WanFang Data, VIP, CNKI and CBM for studies published between 1978 and 2012 to identify and select CPGs of traditional medicine. We used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate these guidelines. A total of 75 guidelines were included, of which 46 guidelines (62%) were on Traditional Chinese Medicine, 19 (25%) on Chinese Integrated Medicine, and 10 (13%) on Uyghur Medicine. Most traditional medicine CPGs published in domestic journals scored <20% (range: 0-63%). Eleven (14%) CPGs were developed following the methodology of evidence-based medicine. In each domain of AGREE II, traditional Medicine CPGs performed clearly better than international CPGs. The same trend was seen in guidelines of Modern Medicine. An increasing amount of CPGs are being published, but their quality is low. Referring to the key points of international guidelines development, supervision through AGREE II, cooperating with international groups and exploring the strategy of guideline development could improve the quality of CPGs on traditional medicine. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Clinical practice guidelines (II): searching and critical evaluation].

PubMed

Alonso, P; Bonfill, X

2007-01-01

Clinical practice guidelines have unique characteristics of the Internet era in which they are starting to be increasingly popular. The fact that they are often elaborated by governmental agencies and are not published in conventional journals means that they may not be accessible using the usual search methods employed for other types of scientific studies and documents (clinical trials, reviews, etc.). The Internet has become an essential tool for locating clinical practice guidelines, and meta-search engines, specific databases, directories, and elaborating institutions are of special importance. The relative lack of indexing of clinical practice guides means that Medline and Embase are not as useful in this context as in searching for original studies. With the aim of evaluating the validity, reproducibility, and reliability of clinical practice guidelines, a series of European institutions designed a tool to evaluate clinical practice guidelines at the end of the 1990s. This instrument, named AGREE, aims to offer a framework for the evaluation of the quality of clinical practice guidelines. It can also be useful in the design of new clinical practice guidelines as well as in the evaluation of the validity of guidelines to be updated or adapted. The AGREE instrument has become the reference for those that use guidelines, those that elaborate them, and for healthcare providers.

Adherence To Diabetes Mellitus Treatment Guidelines From Theory To Practice: The Missing Link.

PubMed

Hashmi, Noreen Rahat; Khan, Shahzad Ali

2016-01-01

Diabetes mellitus is a complex multisystem disease that requires high quality care. Clinical practice guidelines help physicians and patients make the best possible health care decisions and improve health care management of diabetic patients. These guidelines provide the norms for clinical management as well as monitoring of diabetes care. They are not simple algorithms but are based on structured evidence based diabetic management protocols developed from randomized controlled trials. Despite the widespread availability of this diabetic guideline, their use is suboptimal at best. There are several factors blamed for contributing to this missing link from available theoretical guideline recommendations to practical applications of these guidelines. We present a brief review based on available literature review for an ongoing interventional study being done by authors in two tertiary care hospital in Lahore Pakistan for improving adherence to diabetes guidelines. We will discuss guideline implementation cycle and also present a framework encompassing various factors involved in adherence to guidelines. Until recently the emphasis to improve the guideline adherence targeted the factors relating to individual health care professionals in reference to their knowledge, attitude practice of the guidelines. However, we will discuss that broader range of health care systems, organizational factors, and factors relating to patients which may also significantly impact the adherence to the guidelines. The framework emphasises that it is important to understand the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines. This will help plan appropriate strategies in the pre-implementation stage for effective and improved diabetes guidelines adherence and management.

Linking water quality guidelines to the natural characteristics of catchments in order to support distinct aquatic ecosystems: Water quality guidelines for suspended particulate matter

NASA Astrophysics Data System (ADS)

Bilotta, G. S.; Grove, M. K.; Harrison, C.; Joyce, C. B.; Peacock, C.

2012-12-01

The natural characteristics of a catchment provide a template that controls the background rates of geomorphological processes operating within that catchment, which in-turn determines the background physico-chemical and hydro-morphological characteristics of the catchment's surface waters. Large differences in the natural characteristics of catchments (e.g. geology, topography, climate), lead to unique physico-chemical and hydro-morphological conditions that support unique freshwater communities. However, this uniqueness is not always recognised in international water quality guidelines, which often attempt to apply blanket water-quality guidelines to 'protect' a wide range of ecosystems. In this paper we investigate the natural characteristics that control background concentrations of suspended particulate matter (SPM - including nano-scale particles to sand-sized sediments), which is a well-known cause of ecological degradation. At present, the management of SPM is hampered by a lack of understanding of the SPM conditions that water quality managers should aim to achieve in contrasting environments in order to support good ecological status. To address this, in this paper we examine the SPM preferences of contrasting biological communities that are in reference condition (minimal anthropogenic disturbance and high ecological status). We analyse historical SPM data collected on a monthly basis from a wide range of reference-condition temperate environments (638 stream/river sites comprising 42 different biological community-types). This analysis reveals that there are statistically significant differences (One-way ANOVA p < 0.001) between the background SPM concentrations observed in contrasting communities that are in reference condition. Mean background SPM concentrations for contrasting communities ranged from 1.7 to 26.2 mg L-1 (i.e. more than a 15-fold difference). We propose a model for predicting environment-specific water quality guidelines for SPM. In order to develop this model, the 638 reference-condition sites were first classified into one of five mean background SPM ranges (0.00-5.99, 6.00-11.99, 12.00-17.99, 18.00-23.99 and >24.00 mg L-1). Stepwise Multiple Discriminant Analysis (MDA) of these ranges showed that a site's SPM range can be predicted as a function of: mean annual air temperature, mean annual precipitation, mean altitude of upstream catchment, distance from source, slope to source, channel width and depth, the percentage of catchment area comprised of clay, chalk, and hard rock solid geology, and the percentage of the catchment area comprised of blown sand/landslide material as the surface (drift) material. Although the model is still being improved and developed, this research highlights the need to link water quality guidelines to the natural characteristics of catchments and the physico-chemical preferences of the biological communities that would naturally inhabit them.

Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

PubMed

Siebert, Johan N; Ehrler, Frederic; Gervaix, Alain; Haddad, Kevin; Lacroix, Laurence; Schrurs, Philippe; Sahin, Ayhan; Lovis, Christian; Manzano, Sergio

2017-05-29

The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario-pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other critical resuscitation endpoints and drug dose delivery were not improved using AR glasses. However, errors and deviations were significantly reduced in terms of defibrillation doses when compared with the use of the PALS pocket reference cards. In a total of 40 defibrillation attempts, residents not wearing AR glasses used wrong doses in 65% (26/40) of cases, including 21 shock overdoses >100 J, for a cumulative defibrillation dose of 18.7 Joules per kg. These errors were reduced by 53% (21/40, P<.001) and cumulative defibrillation dose by 37% (5.14/14, P=.001) with AR glasses. AR glasses did not decrease time to first defibrillation attempt and other critical resuscitation endpoints when compared with PALS pocket cards. However, they improved adherence and performance among residents in terms of administering the defibrillation doses set by AHA. ©Johan N Siebert, Frederic Ehrler, Alain Gervaix, Kevin Haddad, Laurence Lacroix, Philippe Schrurs, Ayhan Sahin, Christian Lovis, Sergio Manzano. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.05.2017.

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR’s Guideline Definition Language

PubMed Central

2014-01-01

Background Providing scalable clinical decision support (CDS) across institutions that use different electronic health record (EHR) systems has been a challenge for medical informatics researchers. The lack of commonly shared EHR models and terminology bindings has been recognised as a major barrier to sharing CDS content among different organisations. The openEHR Guideline Definition Language (GDL) expresses CDS content based on openEHR archetypes and can support any clinical terminologies or natural languages. Our aim was to explore in an experimental setting the practicability of GDL and its underlying archetype formalism. A further aim was to report on the artefacts produced by this new technological approach in this particular experiment. We modelled and automatically executed compliance checking rules from clinical practice guidelines for acute stroke care. Methods We extracted rules from the European clinical practice guidelines as well as from treatment contraindications for acute stroke care and represented them using GDL. Then we executed the rules retrospectively on 49 mock patient cases to check the cases’ compliance with the guidelines, and manually validated the execution results. We used openEHR archetypes, GDL rules, the openEHR reference information model, reference terminologies and the Data Archetype Definition Language. We utilised the open-sourced GDL Editor for authoring GDL rules, the international archetype repository for reusing archetypes, the open-sourced Ocean Archetype Editor for authoring or modifying archetypes and the CDS Workbench for executing GDL rules on patient data. Results We successfully represented clinical rules about 14 out of 19 contraindications for thrombolysis and other aspects of acute stroke care with 80 GDL rules. These rules are based on 14 reused international archetypes (one of which was modified), 2 newly created archetypes and 51 terminology bindings (to three terminologies). Our manual compliance checks for 49 mock patients were a complete match versus the automated compliance results. Conclusions Shareable guideline knowledge for use in automated retrospective checking of guideline compliance may be achievable using GDL. Whether the same GDL rules can be used for at-the-point-of-care CDS remains unknown. PMID:24886468

Research in disaster settings: a systematic qualitative review of ethical guidelines.

PubMed

Mezinska, Signe; Kakuk, Péter; Mijaljica, Goran; Waligóra, Marcin; O'Mathúna, Dónal P

2016-10-21

Conducting research during or in the aftermath of disasters poses many specific practical and ethical challenges. This is particularly the case with research involving human subjects. The extraordinary circumstances of research conducted in disaster settings require appropriate regulations to ensure the protection of human participants. The goal of this study is to systematically and qualitatively review the existing ethical guidelines for disaster research by using the constant comparative method (CCM). We performed a systematic qualitative review of disaster research ethics guidelines to collect and compare existing regulations. Guidelines were identified by a three-tiered search strategy: 1) searching databases (PubMed and Google Scholar), 2) an Internet search (Google), and 3) a search of the references in the included documents from the first two searches. We used the constant comparative method (CCM) for analysis of included guidelines. Fourteen full text guidelines were included for analysis. The included guidelines covered the period 2000-2014. Qualitative analysis of the included guidelines revealed two core themes: vulnerability and research ethics committee review. Within each of the two core themes, various categories and subcategories were identified. Some concepts and terms identified in analyzed guidelines are used in an inconsistent manner and applied in different contexts. Conceptual clarity is needed in this area as well as empirical evidence to support the statements and requirements included in analyzed guidelines.

Management of Subclinical Hypothyroidism in Pregnancy: A Comment from the Italian Society of Endocrinology and the Italian Thyroid Association to the 2017 American Thyroid Association Guidelines-"The Italian Way".

PubMed

Rotondi, Mario; Chiovato, Luca; Pacini, Furio; Bartalena, Luigi; Vitti, Paolo

2018-05-01

The 2017 American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum were published six years after the previous ones. They provide comprehensive clinical recommendations for the whole spectrum of thyroid diseases, as well as for optimal iodine intake during pregnancy, postpartum, and lactation. The present position statement mainly regards the recommended flow chart for therapeutic decision making in pregnant women being diagnosed with subclinical hypothyroidism. Here, we comment on the major biochemical and clinical situations and the corresponding therapeutic recommendations. In particular, we welcome the critical revision of the thyrotropin (TSH) reference range in pregnancy, and we agree that there is no need to treat thyroid peroxidase antibody-negative women with a serum TSH ranging from 2.5 μIU/mL to the upper limit of the reference range. This recommendation will hopefully reduce the huge proportion of healthy pregnant women in whom, according to the previous guidelines, levothyroxine therapy had to be initiated. On the other hand, we are concerned with the recommendation to only "consider treatment" in thyroid peroxidase antibody-negative pregnant women with a serum TSH ranging from the upper limit of the reference range to 10.0 μIU/mL. This is because thyroid antibodies may be falsely negative during gestation, and serum negative chronic autoimmune thyroiditis is a well-known clinical entity even outside pregnancy. Based on these and other arguments, we recommend treatment with levothyroxine in pregnant women with TSH levels ranging between the upper limit of the reference range and 10.0 μIU/mL independently from their thyroid antibody status.

Chapter A10. Lakes and reservoirs: Guidelines for study design and sampling

USGS Publications Warehouse

Green, William R.; Robertson, Dale M.; Wilde, Franceska D.

2015-09-29

Within this chapter are references to other chapters of the NFM that provide more detailed guidelines related to specific topics and more detailed protocols for the quality assurance and assessment of the lake and reservoir data. Protocols and procedures to address and document the quality of lake and reservoir investigations are adapted from, or referenced to, the protocols and standard operating procedures contained in related chapters of this National Field Manual.

Do neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding?

PubMed

Sundercombe, Samantha L; Raynes-Greenow, Camille H; Turner, Robin M; Jeffery, Heather E

2014-12-01

to establish how well postnatal ward neonatal hypoglycaemia guidelines facilitate breast feeding and adhere to UNICEF UK Baby Friendly Initiative (BFI) recommendations, and to compare compliance with different recommendations. an appraisal of guidelines obtained via email survey using a UNICEF UK BFI checklist tool. Information about Baby Friendly Health/Hospital Initiative (BFHI) accreditation status was obtained by email questionnaire. tertiary neonatal centres in Australia and New Zealand. 22 guidelines were returned from 23 centres eligible to participate. guidelines generally scored poorly. On a scale ranging from 31 to 124 of overall guideline quality, the median score was 71. On a scale of 9 to 36 for adherence to recommendations to facilitate breast feeding, the median guideline score was 20. Compliance with the recommendation to promote skin-to-skin contact and early breast feeding was poor across all centres, achieving a score of 59 out of 88. Nine of 22 guidelines mentioned skin-to-skin contact after birth and 14 advised feeding within one hour of birth. The recommendation about discussing artificial milk supplementation with parents received a score of 44 out of 88. Fourteen guidelines listed Large for Gestational Age (LGA) infants to be at risk of hypoglycaemia. Few guidelines included up-to-date references or flowcharts. guidelines need to recommend early skin-to-skin contact and discussion with parents before artificial milk supplementation. Guidelines suggest LGA neonates are being screened unnecessarily. guidelines need constant revision as evidence for best practice expands. The UNICEF UK BFI checklist provides a readily available quality improvement tool. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinical practice guidelines for delirium management: potential application in palliative care.

PubMed

Bush, Shirley H; Bruera, Eduardo; Lawlor, Peter G; Kanji, Salmaan; Davis, Daniel H J; Agar, Meera; Wright, David Kenneth; Hartwick, Michael; Currow, David C; Gagnon, Bruno; Simon, Jessica; Pereira, José L

2014-08-01

Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The detection of patients with 'fragility fractures' in fracture clinic - an audit of practice with reference to recent British Orthopaedic Association guidelines.

PubMed

Gidwani, S; Davidson, N; Trigkilidas, D; Blick, C; Harborne, R; Maurice, H D

2007-03-01

The British Orthopaedic Association published guidelines on the care of fragility fracture patients in 2003. A section of these guidelines relates to the secondary prevention of osteoporotic fractures. The objective of this audit was to compare practice in our fracture clinic to these guidelines, and take steps to improve our practice if required. We retrospectively audited the treatment of all 462 new patients seen in January and February 2004. Using case note analysis, 38 patients who had sustained probable fragility fractures were selected. Six months' post-injury, a telephone questionnaire was administered to confirm the nature of the injury and to find out whether the patient had been assessed, investigated or treated for osteoporosis. A second similar audit was conducted a year later after steps had been taken to improve awareness amongst the orthopaedic staff and prompt referral. During the first audit period, only 5 of 38 patients who should have been assessed and investigated for osteoporosis were either referred or offered referral. This improved to 23 out of 43 patients during the second audit period. Improvements in referral and assessment rates of patients at risk of further fragility fractures can be achieved relatively easily by taking steps to increase awareness amongst orthopaedic surgeons, although additional strategies and perhaps the use of automated referral systems may be required to achieve referral rates nearer 100%.

The Prime Time Diet: A Content Analysis of Eating Behavior and Food Messages in Television Program Content and Commercials.

ERIC Educational Resources Information Center

Story, Mary; Faulkner, Patricia

1990-01-01

Identifies and analyzes messages related to food and eating behavior as presented on prime time television programing and commercials. Finds that food references occur an average of 4.8 times per 30 minutes and that over half of all food references were for low nutrient beverages and sweets, which is inconsistent with healthy dietary guidelines.…

Reference intervals for 24 laboratory parameters determined in 24-hour urine collections.

PubMed

Curcio, Raffaele; Stettler, Helen; Suter, Paolo M; Aksözen, Jasmin Barman; Saleh, Lanja; Spanaus, Katharina; Bochud, Murielle; Minder, Elisabeth; von Eckardstein, Arnold

2016-01-01

Reference intervals for many laboratory parameters determined in 24-h urine collections are either not publicly available or based on small numbers, not sex specific or not from a representative sample. Osmolality and concentrations or enzymatic activities of sodium, potassium, chloride, glucose, creatinine, citrate, cortisol, pancreatic α-amylase, total protein, albumin, transferrin, immunoglobulin G, α1-microglobulin, α2-macroglobulin, as well as porphyrins and their precursors (δ-aminolevulinic acid and porphobilinogen) were determined in 241 24-h urine samples of a population-based cohort of asymptomatic adults (121 men and 120 women). For 16 of these 24 parameters creatinine-normalized ratios were calculated based on 24-h urine creatinine. The reference intervals for these parameters were calculated according to the CLSI C28-A3 statistical guidelines. By contrast to most published reference intervals, which do not stratify for sex, reference intervals of 12 of 24 laboratory parameters in 24-h urine collections and of eight of 16 parameters as creatinine-normalized ratios differed significantly between men and women. For six parameters calculated as 24-h urine excretion and four parameters calculated as creatinine-normalized ratios no reference intervals had been published before. For some parameters we found significant and relevant deviations from previously reported reference intervals, most notably for 24-h urine cortisol in women. Ten 24-h urine parameters showed weak or moderate sex-specific correlations with age. By applying up-to-date analytical methods and clinical chemistry analyzers to 24-h urine collections from a large population-based cohort we provide as yet the most comprehensive set of sex-specific reference intervals calculated according to CLSI guidelines for parameters determined in 24-h urine collections.

WHO Expert Committee on Specifications for Pharmaceutical Preparations.

PubMed

2014-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use, in addition to 20 monographs and general texts for inclusion in The International Pharmacopoeia and 11 new International Chemical Reference Substances. The International Pharmacopoeia--updating mechanism for the section on radiopharmaceuticals; WHO good manufacturing practices for pharmaceutical products: main principles; Model quality assurance system for procurement agencies; Assessment tool based on the model quality assurance system for procurement agencies: aide-memoire for inspection; Guidelines on submission of documentation for prequalification of finished pharmaceutical products approved by stringent regulatory authorities; and Guidelines on submission of documentation for a multisource (generic) finished pharmaceutical product: quality part.

Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary.

PubMed

Tringali, Andrea; Thomson, Mike; Dumonceau, Jean-Marc; Tavares, Marta; Tabbers, Merit M; Furlano, Raoul; Spaander, Manon; Hassan, Cesare; Tzvinikos, Christos; Ijsselstijn, Hanneke; Viala, Jérôme; Dall'Oglio, Luigi; Benninga, Marc; Orel, Rok; Vandenplas, Yvan; Keil, Radan; Romano, Claudio; Brownstone, Eva; Hlava, Štěpán; Gerner, Patrick; Dolak, Werner; Landi, Rosario; Huber, Wolf Dietrich; Everett, Simon; Vecsei, Andreas; Aabakken, Lars; Amil-Dias, Jorge; Zambelli, Alessandro

2017-01-01

This Executive summary of the Guideline on pediatric gastrointestinal endoscopy from the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) refers to infants, children, and adolescents aged 0 - 18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; endoscopic management of corrosive ingestion and stricture/stenosis; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) have been dealt with in other Guidelines and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance will be addressed in an imminent sister publication. © Georg Thieme Verlag KG Stuttgart · New York.

Target volume definition for post prostatectomy radiotherapy: Do the consensus guidelines correctly define the inferior border of the CTV?

PubMed

Manji, Mo; Crook, Juanita; Schmid, Matt; Rajapakshe, Rasika

2016-01-01

We compare urethrogram delineation of the caudal aspect of the anastomosis to the recommended guidelines of post prostatectomy radiotherapy. Level one evidence has established the indications for, and importance of, adjuvant radiotherapy following radical prostatectomy. Several guidelines have recently addressed delineation of the prostate bed target volume including identification of the vesico-urethral anastomosis, taken as the first CT slice caudal to visible urine in the bladder neck. The inferior border of clinical target volume is then variably defined 5-12 mm below this anastomosis or 15 mm cranial to the penile bulb. Thirty-three patients who received adjuvant radiotherapy following radical prostatectomy were reviewed. All underwent planning CT with urethrogram. The authors (MM, JC) independently identified the CT slice caudal to the last slice showing urine in the bladder neck (called the CT Reference Slice), and measured the distance between this and the tip of the urethrogram cone. Five patients also had a diagnostic MRI at the time of CT planning to better visualize the anatomy. Sixty-six readings were obtained. The mean distance between the Bladder CT Reference Slice and the most cranial urethrogram contrast slice was 16.1 mm (MM 16.4 mm, JC 15.8 mm), range: 6.8-34.2 mm. The mean distance between the urethrogram tip and the ischial tuberosities was 19.9 mm (range 12.5-29.8 mm). The mean distance between the CT Reference Slice and the ischial tuberosities was 36.9 mm (range 28.3-52.4 mm). Guidelines for prostate bed radiation post prostatectomy have been developed after publication of the trials proving benefit of such treatment, and are thus untested. The anastomosis is a frequent site of local relapse but is variably defined by the existing guidelines, none of which take into account anatomic patient variation and all of which are at variance with urethrogram data. We recommend the use of planning urethrogram to better delineate the vesico-urethral junction and minimize the potential for geographic misses.

Guidelines for the training, credentialing, use, and supervision of speech-language pathology assistants. Task Force on Support Personnel.

PubMed

1996-01-01

These guidelines are an official statement of the American Speech-Language-Hearing Association. They provide guidance on the training, credentialing, use, and supervision of one category of support personnel in speech-language pathology: speech-language pathology assistants. Guidelines are not official standards of the Association. They were developed by the Task Force on Support Personnel: Dennis J. Arnst, Kenneth D. Barker, Ann Olsen Bird, Sheila Bridges, Linda S. DeYoung, Katherine Formichella, Nena M. Germany, Gilbert C. Hanke, Ann M. Horton, DeAnne M. Owre, Sidney L. Ramsey, Cathy A. Runnels, Brenda Terrell, Gerry W. Werven, Denise West, Patricia A. Mercaitis (consultant), Lisa C. O'Connor (consultant), Frederick T. Spahr (coordinator), Diane Paul-Brown (associate coordinator), Ann L. Carey (Executive Board liaison). The 1994 guidelines supersede the 1981 guidelines entitled, "Guidelines for the Employment and Utilization of Supportive Personnel" (Asha, March 1981, 165-169). Refer to the 1995 position statement on the "Training, Credentialing, Use, and Supervision of Support Personnel in Speech-Language Pathology" (Asha, 37 [Suppl. 14], 21).

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

PubMed

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

2007-05-01

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

Evidence-Based Management Guidelines on Peyronie's Disease.

PubMed

Chung, Eric; Ralph, David; Kagioglu, Ates; Garaffa, Guilio; Shamsodini, Ahmed; Bivalacqua, Trinity; Glina, Sidney; Hakim, Lawrence; Sadeghi-Nejad, Hossein; Broderick, Gregory

2016-06-01

Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease. To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD. A systematic literature search was conducted to identify published literature relevant to PD. The search included all relevant articles published up to June 2015, including preclinical studies and published guidelines. References used in the text were assessed according to their level of evidence, and guideline recommendations were graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Owing to the paucity of larger series and randomized placebo-controlled trials with regard to surgical intervention, guideline statements are provided as clinical principle or expert opinion. This literature was discussed at a panel meeting, and selected articles with the highest evidence available were used to create consensus guideline statements for the Fourth International Consultation on Sexual Medicine guidelines on PD. In addition to existing Third International Consultation on Sexual Medicine guidelines on PD, seven new summary recommendations were created. A greater understanding of the scientific basis of PD is greatly needed to address our understanding of the pathophysiology, clinical epidemiology, psychosocial, and diagnostic assessment as well as treatment strategies. Copyright © 2016 International Society for Sexual Medicine. All rights reserved.

Toward Uniformity in Exchange Communication

ERIC Educational Resources Information Center

Shinn, Isabella

1972-01-01

Instant communication, characterized by brevity, should be the practice of exchange librarians trading titles on the international level. Guidelines for a multilingual, many-purpose form letter, which could achieve uniformity, are presented. (14 references) (Author/SJ)

Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines.

PubMed

Andrade, Vera Lúcia Fonseca; Fernandes, Filipa Alexandra Veludo

2016-01-01

to describe strategies used by health professionals on the implementation of the Centers for Disease Control and Prevention guidelines for the prevention of urinary infection related to catheterism. systematic review on literature based on data from CINAHL(r), Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE(r), Academic Search Complete, ACS - American Chemical Society, Health Reference Center Academic, Nursing Reference Center, ScienceDirect Journals and Wiley Online Library. A sample of 13 articles was selected. studies have highlighted the decrease of urinary tract infection related to catheterism through reminder systems to decrease of people submitted to urinary catheterism, audits about nursing professionals practice and bundles expansion. the present review systemizes the knowledge of used strategies by health professionals on introduction to international recommendations, describing a rate decrease of such infection in clinical practice.

Management of acute epididymitis: are European guidelines being followed?

PubMed

Drury, Nigel E; Dyer, Jonathan P; Breitenfeldt, Nicole; Adamson, Andrew S; Harrison, G S M

2004-10-01

Acute epididymitis is increasing in men aged 35 years or under due to sexually-transmitted Chlamydia trachomatis. This study examines whether Urological surgeons are following European guidelines for the management of acute epididymitis in these patients. A postal questionnaire survey was conducted of specialists in Urology in two regions of the UK. Of 79 completed replies, 41 (52%) take a detailed sexual history but only 34 (43%) refer patients to a Genitourinary medicine clinic. Quinolones are the most commonly prescribed first-line antibiotic by 56 (71%) respondents, principally ciprofloxacin. The current management of acute epididymitis in young men must be improved. Ciprofloxacin is not the optimal antimicrobial for the treatment of urogenital chlamydial infection. We recommend that all such patients be referred to local Genitourinary medicine services for contact-tracing and treatment of their sexual partners.

The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics

PubMed Central

Knutsson, K; Flygare, L

2014-01-01

Objectives: The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems. Methods: The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis. Results: 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%). Conclusions: CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines. PMID:24766060

Minimum Information for Reporting Next Generation Sequence Genotyping (MIRING): Guidelines for Reporting HLA and KIR Genotyping via Next Generation Sequencing

PubMed Central

Mack, Steven J.; Milius, Robert P.; Gifford, Benjamin D.; Sauter, Jürgen; Hofmann, Jan; Osoegawa, Kazutoyo; Robinson, James; Groeneweg, Mathijs; Turenchalk, Gregory S.; Adai, Alex; Holcomb, Cherie; Rozemuller, Erik H.; Penning, Maarten T.; Heuer, Michael L.; Wang, Chunlin; Salit, Marc L.; Schmidt, Alexander H.; Parham, Peter R.; Müller, Carlheinz; Hague, Tim; Fischer, Gottfried; Fernandez-Viňa, Marcelo; Hollenbach, Jill A; Norman, Paul J.; Maiers, Martin

2015-01-01

The development of next-generation sequencing (NGS) technologies for HLA and KIR genotyping is rapidly advancing knowledge of genetic variation of these highly polymorphic loci. NGS genotyping is poised to replace older methods for clinical use, but standard methods for reporting and exchanging these new, high quality genotype data are needed. The Immunogenomic NGS Consortium, a broad collaboration of histocompatibility and immunogenetics clinicians, researchers, instrument manufacturers and software developers, has developed the Minimum Information for Reporting Immunogenomic NGS Genotyping (MIRING) reporting guidelines. MIRING is a checklist that specifies the content of NGS genotyping results as well as a set of messaging guidelines for reporting the results. A MIRING message includes five categories of structured information – message annotation, reference context, full genotype, consensus sequence and novel polymorphism – and references to three categories of accessory information – NGS platform documentation, read processing documentation and primary data. These eight categories of information ensure the long-term portability and broad application of this NGS data for all current histocompatibility and immunogenetics use cases. In addition, MIRING can be extended to allow the reporting of genotype data generated using pre-NGS technologies. Because genotyping results reported using MIRING are easily updated in accordance with reference and nomenclature databases, MIRING represents a bold departure from previous methods of reporting HLA and KIR genotyping results, which have provided static and less-portable data. More information about MIRING can be found online at miring.immunogenomics.org. PMID:26407912

Referral recommendations for osteoarthritis of the knee incorporating patients' preferences

PubMed Central

Musila, Nyokabi; Underwood, Martin; McCaskie, Andrew W; Black, Nick; Clarke, Aileen; van der Meulen, Jan H

2011-01-01

Background. GPs have to respond to conflicting policy developments. As gatekeeper they are supposed to manage the growing demand for specialist services and as patient advocate they should be responsive to patients' preferences. We used an innovative approach to develop a referral guideline for patients with chronic knee pain that explicitly incorporates patients' preferences. Methods. A guideline development group of 12 members including patients, GPs, orthopaedic surgeons and other health care professionals used formal consensus development informed by systematic evidence reviews. They rated the appropriateness of referral for 108 case scenarios describing patients according to symptom severity, age, body mass, co-morbidity and referral preference. Appropriateness was expressed on scale from 1 (‘strongly disagree’) to 9 (‘strongly agree’). Results. Ratings of referral appropriateness were strongly influenced by symptom severity and patients' referral preferences. The influence of other patient characteristics was small. There was consensus that patients with severe knee symptoms who want to be referred should be referred and that patient with moderate or mild symptoms and strong preference against referral should not be referred. Referral preference had a greater impact on the ratings of referral appropriateness when symptoms were moderate or severe than when symptoms were mild. Conclusions. Referral decisions for patients with osteoarthritis of the knee should only be guided by symptom severity and patients' referral preferences. The guideline development group seemed to have given priority to avoiding inefficient resource use in patients with mild symptoms and to respecting patient autonomy in patients with severe symptoms. PMID:20817791

Reliable gene expression analysis by reverse transcription-quantitative PCR: reporting and minimizing the uncertainty in data accuracy.

PubMed

Remans, Tony; Keunen, Els; Bex, Geert Jan; Smeets, Karen; Vangronsveld, Jaco; Cuypers, Ann

2014-10-01

Reverse transcription-quantitative PCR (RT-qPCR) has been widely adopted to measure differences in mRNA levels; however, biological and technical variation strongly affects the accuracy of the reported differences. RT-qPCR specialists have warned that, unless researchers minimize this variability, they may report inaccurate differences and draw incorrect biological conclusions. The Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) guidelines describe procedures for conducting and reporting RT-qPCR experiments. The MIQE guidelines enable others to judge the reliability of reported results; however, a recent literature survey found low adherence to these guidelines. Additionally, even experiments that use appropriate procedures remain subject to individual variation that statistical methods cannot correct. For example, since ideal reference genes do not exist, the widely used method of normalizing RT-qPCR data to reference genes generates background noise that affects the accuracy of measured changes in mRNA levels. However, current RT-qPCR data reporting styles ignore this source of variation. In this commentary, we direct researchers to appropriate procedures, outline a method to present the remaining uncertainty in data accuracy, and propose an intuitive way to select reference genes to minimize uncertainty. Reporting the uncertainty in data accuracy also serves for quality assessment, enabling researchers and peer reviewers to confidently evaluate the reliability of gene expression data. © 2014 American Society of Plant Biologists. All rights reserved.

Guidelines for Preparation of a Scientific Paper

PubMed Central

Kosiba, Margaret M.

1988-01-01

Even the experienced scientific writer may have difficulty transferring research results to clear, concise, publishable words. To assist the beginning scientific writer, guidelines are proposed that will provide direction for determining a topic, developing protocols, collecting data, using computers for analysis and word processing, incorporating copyediting notations, consulting scientific writing manuals, and developing sound writing habits. Guidelines for writing each section of a research paper are described to help the writer prepare the title page, introduction, materials and methods, results, and discussion sections of the paper, as well as the acknowledgments and references. Procedures for writing the first draft and subsequent revisions include a checklist of structural and stylistic problems and common errors in English usage. PMID:3339646

Evidence-based clinical practice guidelines for chronic pancreatitis 2015.

PubMed

Ito, Tetsuhide; Ishiguro, Hiroshi; Ohara, Hirotaka; Kamisawa, Terumi; Sakagami, Junichi; Sata, Naohiro; Takeyama, Yoshifumi; Hirota, Morihisa; Miyakawa, Hiroyuki; Igarashi, Hisato; Lee, Lingaku; Fujiyama, Takashi; Hijioka, Masayuki; Ueda, Keijiro; Tachibana, Yuichi; Sogame, Yoshio; Yasuda, Hiroaki; Kato, Ryusuke; Kataoka, Keisho; Shiratori, Keiko; Sugiyama, Masanori; Okazaki, Kazuichi; Kawa, Shigeyuki; Tando, Yusuke; Kinoshita, Yoshikazu; Watanabe, Mamoru; Shimosegawa, Tooru

2016-02-01

Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.

Managing care pathways combining SNOMED CT, archetypes and an electronic guideline system.

PubMed

Bernstein, Knut; Andersen, Ulrich

2008-01-01

Today electronic clinical guideline systems exist, but they are not well integrated with electronic health records. This paper thus proposes that the patient's "position" in the pathway during the patient journey should be made visible to all involved healthcare parties and the patient. This requires that the generic knowledge, which is represented in the guidelines, is combined with the patient specific information - and then made accessible for all relevant parties. In addition to the decision support provided by the guideline system documentation support can be provided by templates based on archetypes. This paper provides a proposal for how the guideline system and the EHR can be integrated by the use of archetypes and SNOMED CT. SNOMED CT provides the common reference terminology and the semantic links between the systems. The proposal also includes the use of a National Patient Index for storing data about the patient's position in the pathway and for sharing this information by all involved parties.

Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis.

PubMed

Mayumi, Toshihiko; Okamoto, Kohji; Takada, Tadahiro; Strasberg, Steven M; Solomkin, Joseph S; Schlossberg, David; Pitt, Henry A; Yoshida, Masahiro; Gomi, Harumi; Miura, Fumihiko; Garden, O James; Kiriyama, Seiki; Yokoe, Masamichi; Endo, Itaru; Asbun, Horacio J; Iwashita, Yukio; Hibi, Taizo; Umezawa, Akiko; Suzuki, Kenji; Itoi, Takao; Hata, Jiro; Han, Ho-Seong; Hwang, Tsann-Long; Dervenis, Christos; Asai, Koji; Mori, Yasuhisa; Huang, Wayne Shih-Wei; Belli, Giulio; Mukai, Shuntaro; Jagannath, Palepu; Cherqui, Daniel; Kozaka, Kazuto; Baron, Todd H; de Santibañes, Eduardo; Higuchi, Ryota; Wada, Keita; Gouma, Dirk J; Deziel, Daniel J; Liau, Kui-Hin; Wakabayashi, Go; Padbury, Robert; Jonas, Eduard; Supe, Avinash Nivritti; Singh, Harjit; Gabata, Toshifumi; Chan, Angus C W; Lau, Wan Yee; Fan, Sheung Tat; Chen, Miin-Fu; Ker, Chen-Guo; Yoon, Yoo-Seok; Choi, In-Seok; Kim, Myung-Hwan; Yoon, Dong-Sup; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Inui, Kazuo; Sumiyama, Yoshinobu; Yamamoto, Masakazu

2018-01-01

Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Design and implementation of the GLIF3 guideline execution engine.

PubMed

Wang, Dongwen; Peleg, Mor; Tu, Samson W; Boxwala, Aziz A; Ogunyemi, Omolola; Zeng, Qing; Greenes, Robert A; Patel, Vimla L; Shortliffe, Edward H

2004-10-01

We have developed the GLIF3 Guideline Execution Engine (GLEE) as a tool for executing guidelines encoded in the GLIF3 format. In addition to serving as an interface to the GLIF3 guideline representation model to support the specified functions, GLEE provides defined interfaces to electronic medical records (EMRs) and other clinical applications to facilitate its integration with the clinical information system at a local institution. The execution model of GLEE takes the "system suggests, user controls" approach. A tracing system is used to record an individual patient's state when a guideline is applied to that patient. GLEE can also support an event-driven execution model once it is linked to the clinical event monitor in a local environment. Evaluation has shown that GLEE can be used effectively for proper execution of guidelines encoded in the GLIF3 format. When using it to execute each guideline in the evaluation, GLEE's performance duplicated that of the reference systems implementing the same guideline but taking different approaches. The execution flexibility and generality provided by GLEE, and its integration with a local environment, need to be further evaluated in clinical settings. Integration of GLEE with a specific event-monitoring and order-entry environment is the next step of our work to demonstrate its use for clinical decision support. Potential uses of GLEE also include quality assurance, guideline development, and medical education.

Digital chat reference in health science libraries: challenges in initiating a new service.

PubMed

Dee, Cheryl R; Newhouse, Joshua D

2005-01-01

Digital reference service adds a valuable new dimension to health science reference services, but the road to implementation can present questions that require carefully considered decisions. This article incorporates suggestions from the published literature, provides tips from interviews with practicing academic health science librarians, and reports on data from students' exploration of academic health science library Web sites' digital reference services. The goal of this study is to provide guidelines to plan new services, assess user needs, and select software, and to showcase potential benefits of collaboration and proactive and user-friendly marketing. In addition, tips for successful operation and evaluation of services are discussed.

Integrating the Master of Software Assurance Reference Curriculum into the Model Curriculum and Guidelines for Graduate Degree Programs in Information Systems

DTIC Science & Technology

2011-02-01

Model Curriculum and Guidelines for Graduate Degree Programs in Information Systems (MSIS) 2006 is the latest product of a project that has been...conducted for nearly 40 years [Gor- gone 2006]. Various organizations affiliated with the project have developed specifications for the teaching of...considerations helps ensure that an institution’s individual courses of study are relevant to the industry that its students are preparing to enter

Characterizing Gestational Weight Gain According to Institute of Medicine Guidelines in Women with Type 1 Diabetes Mellitus: Association with Maternal and Perinatal Outcome.

PubMed

Kawakita, Tetsuya; Bowers, Katherine; McWhorter, Ketrell; Rosen, Barak; Adams, Michelle; Miodovnik, Menachem; Khoury, Jane C

2016-11-01

Objective  This study aims to evaluate the association between gestational weight gain (GWG) defined by the current Institute of Medicine (IOM) guidelines and pregnancy outcomes in women with type 1 diabetes mellitus (DM). Study design  This is a secondary analysis of a cohort of 293 pregnancies of women with type 1 DM between 24 and 41 weeks' gestation. Women were categorized according to GWG per week over the second and third trimester: below, within, and above the IOM guidelines. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for maternal and neonatal outcomes, controlling for covariates and confounders (referent: GWG within the IOM guidelines). Results  Of the 293 women, there were 49 women (16.7%) with the GWG below the IOM guidelines, 86 women (29.4%) with the GWG within the IOM guidelines, and 158 women (53.9%) with the GWG above the IOM guidelines. Women with the GWG above the IOM guidelines had a higher risk of macrosomia and neonatal hyperbilirubinemia (aOR: 2.78; 95% CI: 1.23-6.30 and 2.31; 1.22-4.35, respectively). Conclusion  GWG above the IOM guidelines is associated with an increased risk of macrosomia and neonatal hyperbilirubinemia. Maintaining GWG within the IOM guidelines may decrease the risk of excessive fetal growth and neonatal hyperbilirubinemia in infants of women with type 1 DM. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nursing Reference Center: a point-of-care resource.

PubMed

Vardell, Emily; Paulaitis, Gediminas Geddy

2012-01-01

Nursing Reference Center is a point-of-care resource designed for the practicing nurse, as well as nursing administrators, nursing faculty, and librarians. Users can search across multiple resources, including topical Quick Lessons, evidence-based care sheets, patient education materials, practice guidelines, and more. Additional features include continuing education modules, e-books, and a new iPhone application. A sample search and comparison with similar databases were conducted.

Reference architecture of application services for personal wellbeing information management.

PubMed

Tuomainen, Mika; Mykkänen, Juha

2011-01-01

Personal information management has been proposed as an important enabler for individual empowerment concerning citizens' wellbeing and health information. In the MyWellbeing project in Finland, a strictly citizen-driven concept of "Coper" and related architectural and functional guidelines have been specified. We present a reference architecture and a set of identified application services to support personal wellbeing information management. In addition, the related standards and developments are discussed.

Clinical practice guidelines within the Southern African development community: a descriptive study of the quality of guideline development and concordance with best evidence for five priority diseases

PubMed Central

2012-01-01

Background Reducing the burden of disease relies on availability of evidence-based clinical practice guidelines (CPGs). There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aims to address this gap in knowledge and provide recommendations for regional guideline development. Methods We prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. Independent reviewers used the AGREE II tool to score six quality domains reporting the guideline development process. Alignment of the evidence-base of the guidelines was evaluated by comparing their content with key recommendations from accepted reference guidelines, identified with a content expert, and percentage scores were calculated. Findings We identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, median 58%(range 19-92) and 83%(range 17-100) respectively. 'Stakeholder involvement' followed with median 39%(range 6-75). 'Applicability', 'rigour of development' and 'editorial independence' scored poorly, all below 25%. Alignment with evidence was variable across member states, the lowest scores occurring in older guidelines or where the guideline being evaluated was part of broader primary healthcare CPG rather than a disease-specific guideline. Conclusion This review identified quality gaps and variable alignment with best evidence in available guidelines within SADC for five priority diseases. Future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders and transparency of process. A regional guideline support committee could harness local capacity to support context appropriate guideline development. PMID:22221856

An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy.

PubMed

Kreiner, D Scott; Hwang, Steven W; Easa, John E; Resnick, Daniel K; Baisden, Jamie L; Bess, Shay; Cho, Charles H; DePalma, Michael J; Dougherty, Paul; Fernand, Robert; Ghiselli, Gary; Hanna, Amgad S; Lamer, Tim; Lisi, Anthony J; Mazanec, Daniel J; Meagher, Richard J; Nucci, Robert C; Patel, Rakesh D; Sembrano, Jonathan N; Sharma, Anil K; Summers, Jeffrey T; Taleghani, Christopher K; Tontz, William L; Toton, John F

2014-01-01

The objective of the North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy is to provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of lumbar disc herniation with radiculopathy. The guideline is intended to reflect contemporary treatment concepts for symptomatic lumbar disc herniation with radiculopathy as reflected in the highest quality clinical literature available on this subject as of July 2011. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder. To provide an evidence-based educational tool to assist spine specialists in the diagnosis and treatment of lumbar disc herniation with radiculopathy. Systematic review and evidence-based clinical guideline. This guideline is a product of the Lumbar Disc Herniation with Radiculopathy Work Group of NASS' Evidence-Based Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English-language references found in Medline, Embase (Drugs and Pharmacology), and four additional evidence-based databases to identify articles. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Level I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline. Twenty-nine clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by strength of the supporting literature, which was stratified by levels of evidence. The clinical guideline has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients with symptomatic lumbar disc herniation with radiculopathy. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule. Copyright © 2014 Elsevier Inc. All rights reserved.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.

PubMed

Galletly, Cherrie; Castle, David; Dark, Frances; Humberstone, Verity; Jablensky, Assen; Killackey, Eóin; Kulkarni, Jayashri; McGorry, Patrick; Nielssen, Olav; Tran, Nga

2016-05-01

This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges. © The Royal Australian and New Zealand College of Psychiatrists 2016.

[From guidelines to practice: evaluation of the pediatric care provided by a service of secondary reference in the north of the State of Minas Gerais].

PubMed

Moreira, Laura Monteiro de Castro; Alves, Cláudia Regina Lindgren; Belisário, Soraya Almeida; Bueno, Mariana de Caux; de Moraes, Erica Furtado

2013-06-01

In the State of Minas Gerais, the Secondary Reference Viva Vida Centers (CVVRS) are one of the strategies deployed to tackle the problems in child health. This study sought to evaluate pediatric care provided in a CVVRS, using the guidelines defined when it was set up as a benchmark. A quantitative-qualitative approach was adopted, which included a cross-sectional study with stratified random sampling of 385 medical records of children registered with the program between 2007 and 2009, and analysis of focus groups with strategic actors of the initiative. There were divergences between the user profiles and the target audience in terms of age, hometown and clinical characteristics. Access and use of the service differed depending on the town, due to problems of misinformation concerning the proposal, difficulty of transportation and the fragility of the health network. The centers are considered an innovative and important initiative for the expansion and organization of the health network, though the intended logic is not effectively seen in practice. Interventions for articulation between the network services and adaptation of the agreed guidelines to the regional specificities are necessary.

[Blood transfusion audit methodology: the auditors, reference systems and audit guidelines].

PubMed

Chevrolle, F; Hadzlik, E; Arnold, J; Hergon, E

2000-12-01

The audit has become an essential aspect of the blood transfusion sector, and is a management tool that should be used judiciously. The main types of audit that can be envisaged in blood transfusion are the following: operational audit concerning a predetermined activity; systems quality audit; competence audit, combining the operational audit on a specific activity with quality management, e.g., laboratory accreditation; audit of the environmental management system; and social audit involving the organization of an activity and the management of human resources. However, the main type of audit considered in this article is the conformity audit, which in this context does not refer to internal control but to conformity with an internal guideline issued by the French National Blood Service. All audits are carried out on the basis of a predescribed method (contained in ISO 10 011). The audit is a system of investigation, evaluation and measurement, and also a means of continuous assessment and therefore improvement. The audit is based on set guidelines, but in fact consists of determining the difference between the directions given and what has actually been done. Auditing requires operational rigor and integrity, and has now become a profession in its own right.

In vitro evaluation of genotoxic effects under magnetic resonant coupling wireless power transfer.

PubMed

Mizuno, Kohei; Shinohara, Naoki; Miyakoshi, Junji

2015-04-07

Wireless power transfer (WPT) technology using the resonant coupling phenomenon has been widely studied, but there are very few studies concerning the possible relationship between WPT exposure and human health. In this study, we investigated whether exposure to magnetic resonant coupling WPT has genotoxic effects on WI38VA13 subcloned 2RA human fibroblast cells. WPT exposure was performed using a helical coil-based exposure system designed to transfer power with 85.4% efficiency at a 12.5-MHz resonant frequency. The magnetic field at the positions of the cell culture dishes is approximately twice the reference level for occupational exposure as stated in the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines. The specific absorption rate at the positions of the cell culture dishes matches the respective reference levels stated in the ICNIRP guidelines. For assessment of genotoxicity, we studied cell growth, cell cycle distribution, DNA strand breaks using the comet assay, micronucleus formation, and hypoxanthine-guanine phosphoribosyltransferase (HPRT) gene mutation, and did not detect any significant effects between the WPT-exposed cells and control cells. Our results suggest that WPT exposure under the conditions of the ICNIRP guidelines does not cause detectable cellular genotoxicity.

Adaptive Control with Reference Model Modification

NASA Technical Reports Server (NTRS)

Stepanyan, Vahram; Krishnakumar, Kalmanje

2012-01-01

This paper presents a modification of the conventional model reference adaptive control (MRAC) architecture in order to improve transient performance of the input and output signals of uncertain systems. A simple modification of the reference model is proposed by feeding back the tracking error signal. It is shown that the proposed approach guarantees tracking of the given reference command and the reference control signal (one that would be designed if the system were known) not only asymptotically but also in transient. Moreover, it prevents generation of high frequency oscillations, which are unavoidable in conventional MRAC systems for large adaptation rates. The provided design guideline makes it possible to track a reference commands of any magnitude from any initial position without re-tuning. The benefits of the method are demonstrated with a simulation example

Pregnancy and Fish: What's Safe to Eat?

MedlinePlus

... for Standard Reference, Release 28. U.S. Department of Agriculture, Agricultural Research Service. http://ndb.nal.usda.gov. ... Health and Human Services and U.S. Department of Agriculture. http://health.gov/dietaryguidelines/2015/guidelines. Accessed June ...

Physical Activity Guidelines for Americans Act of 2009

THOMAS, 111th Congress

Sen. Harkin, Tom [D-IA

2009-10-20

Senate - 10/20/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Turnkey Evaluation Guidelines

DOT National Transportation Integrated Search

1996-08-01

The Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA) requested that at least two urban transit investment projects be acquired by means of a process referred to as "turnkey", to demonstrate the concept and determine whether it can ser...

Methodological quality of systematic reviews referenced in clinical practice guidelines for the treatment of opioid use disorder.

PubMed

Ross, Andrew; Rankin, Justin; Beaman, Jason; Murray, Kelly; Sinnett, Philip; Riddle, Ross; Haskins, Jordan; Vassar, Matt

2017-01-01

With efforts to combat opioid use disorder, there is an increased interest in clinical practice guidelines (CPGs) for opioid use disorder treatments. No literature exists examining the quality of systematic reviews used in opioid use disorder CPGs. This study aims to describe the methodological quality and reporting clarity of systematic reviews (SRs) used to create CPGs for opioid use disorder. From June to July 2016 guideline clearinghouses and medical literature databases were searched for relevant CPGs used in the treatment of opioid use disorder. Included CPGs must have been recognized by a national organization. SRs from the reference section of each CPG was scored by using AMSTAR (a measurement tool to assess the methodological quality of systematic reviews) tool and PRISMA (preferred reporting items for systematic reviews and meta-analyses) checklist. Seventeen CPGs from 2006-2016 were included in the review. From these, 57 unique SRs were extracted. SRS comprised 0.28% to 17.92% of all references found in the CPGs. All SRs obtained moderate or high methodological quality score on the AMSTAR tool. All reviews met at least 70% of PRISMA criteria. In PRISMA, underperforming areas included accurate title labeling, protocol registration, and risk of bias. Underperforming areas in AMSTAR included conflicts of interest, funding, and publication bias. A positive correlation was found between AMSTAR and PRISMA scores (r = .79). Although the SRs in the CPGs were of good quality, there are still areas for improvement. Systematic reviewers should consult PRISMA and AMSTAR when conducting and reporting reviews. It is important for CPG developers to consider methodological quality as a factor when developing CPG recommendations, recognizing that the quality of systematic reviews underpinning guidelines does not necessarily correspond to the quality of the guideline itself.

Proposal Guidelines for Standardized Operating Procedures of Brain Autopsy: Brain Bank in South Korea.

PubMed

Lee, Kyung Hwa; Seo, Sang Won; Lim, Tae Sung; Kim, Eun Joo; Kim, Byeong Chae; Kim, Yeshin; Lee, Ho Won; Jeon, Jae Pil; Shim, Sung Mi; Na, Duk L; Huh, Gi Yeong; Lee, Min Cheol; Suh, Yeon Lim

2017-09-01

To obtain an in-depth understanding of brain diseases, including neurodegenerative diseases, psychiatric illnesses, and neoplasms, scientific approach and verification using postmortem human brain tissue with or without disease are essential. Compared to other countries that have run brain banks for decades, South Korea has limited experience with brain banking; nationwide brain banks started only recently. The goal of this study is to provide provisional guidelines for brain autopsy for hospitals and institutes that have not accumulated sufficient expertise. We hope that these provisional guidelines will serve as a useful reference for pathologists and clinicians who are involved and interested in the brain bank system. Also, we anticipate updating the provisional guidelines in the future based on collected data and further experience with the practice of brain autopsy in South Korea. © Copyright: Yonsei University College of Medicine 2017.

Methods for the guideline-based development of quality indicators--a systematic review

PubMed Central

2012-01-01

Background Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development. Methods We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables. Results From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement. Conclusions Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork. PMID:22436067

Framework for enhancing clinical practice guidelines through continuous patient engagement.

PubMed

Armstrong, Melissa J; Rueda, Juan-David; Gronseth, Gary S; Mullins, C Daniel

2017-02-01

Patient engagement in clinical practice guideline (CPG) development is recommended by multiple institutions and instruments measuring guideline quality. Approaches to engaging patients, however, vary between oversight organizations, quality tools and guideline developers. We propose a ten-step framework outlining steps and options for patient engagement in guideline development with the goal of highlighting steps for patient engagement and methods by which this can be achieved. This framework provides a model for continuous patient engagement in CPGs by outlining ten steps of guideline development occurring at the levels of the developer/committee and the individual guideline project. At the developer level, patients can assist in topic nomination (step 1), topic prioritization (step 2) and guideline development group selection (step 3). Within specific guideline projects, patients' opinions may be incorporated when framing the question (step 4), creating an analytic framework and research plan (step 5), conducting the systematic review and conclusion formation (step 6), development of recommendations (step 7) and dissemination and implementation (step 8). At the end of process, patients can again be engaged at the developer level by helping determine when guidelines need updating (step 9) and evaluating the developer's approach to patient engagement (step 10). Patient engagement at each CPG development step has different purposes, mechanisms, advantages and disadvantages, and implications for resource utilization. This framework can serve as a resource for guideline developers desiring to increase patient engagement and reference for researchers investigating engagement methodology at different steps of the CPG lifecycle. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST.

PubMed

Shaughnessy, Allen F; Vaswani, Akansha; Andrews, Bonnie K; Erlich, Deborah R; D'Amico, Frank; Lexchin, Joel; Cosgrove, Lisa

2017-09-01

Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST). A modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring. Twenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful. The 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians. © 2017 Annals of Family Medicine, Inc.

Methodologic quality and relevance of references in pharmaceutical advertisements in a Canadian medical journal.

PubMed

Lexchin, J; Holbrook, A

1994-07-01

To evaluate the methodologic quality and relevance of references in pharmaceutical advertisements in the Canadian Medical Association Journal (CMAJ). Analytic study. All 114 references cited in the first 22 distinct pharmaceutical advertisements in volume 146 of CMAJ. Mean methodologic quality score (modified from the 6-point scale used to assess articles in the American College of Physicians' Journal Club) and mean relevance score (based on a new 5-point scale) for all references in each advertisement. Twenty of the 22 companies responded, sending 78 (90%) of the 87 references requested. The mean methodologic quality score was 58% (95% confidence limits [CL] 51% and 65%) and the mean relevance score 76% (95% CL 72% and 80%). The two mean scores were statistically lower than the acceptable score of 80% (p < 0.05), and the methodologic quality score was outside the preset clinically significant difference of 15%. The poor rating for methodologic quality was primarily because of the citation of references to low-quality review articles and "other" sources (i.e., other than reports of clinical trials). Half of the advertisements had a methodologic quality score of less than 65%, but only five had a relevance score of less than 65%. Although the relevance of most of the references was within minimal acceptable limits, the methodologic quality was often unacceptable. Because advertisements are an important part of pharmaceutical marketing and education, we suggest that companies develop written standards for their advertisements and monitor their advertisements for adherence to these standards. We also suggest that the Pharmaceutical Advertising Advisory Board develop more stringent guidelines for advertising and that it enforce these guidelines in a consistent, rigorous fashion.

Methodologic quality and relevance of references in pharmaceutical advertisements in a Canadian medical journal.

PubMed Central

Lexchin, J; Holbrook, A

1994-01-01

OBJECTIVE: To evaluate the methodologic quality and relevance of references in pharmaceutical advertisements in the Canadian Medical Association Journal (CMAJ). DESIGN: Analytic study. DATA SOURCE: All 114 references cited in the first 22 distinct pharmaceutical advertisements in volume 146 of CMAJ. MAIN OUTCOME MEASURES: Mean methodologic quality score (modified from the 6-point scale used to assess articles in the American College of Physicians' Journal Club) and mean relevance score (based on a new 5-point scale) for all references in each advertisement. MAIN RESULTS: Twenty of the 22 companies responded, sending 78 (90%) of the 87 references requested. The mean methodologic quality score was 58% (95% confidence limits [CL] 51% and 65%) and the mean relevance score 76% (95% CL 72% and 80%). The two mean scores were statistically lower than the acceptable score of 80% (p < 0.05), and the methodologic quality score was outside the preset clinically significant difference of 15%. The poor rating for methodologic quality was primarily because of the citation of references to low-quality review articles and "other" sources (i.e., other than reports of clinical trials). Half of the advertisements had a methodologic quality score of less than 65%, but only five had a relevance score of less than 65%. CONCLUSIONS: Although the relevance of most of the references was within minimal acceptable limits, the methodologic quality was often unacceptable. Because advertisements are an important part of pharmaceutical marketing and education, we suggest that companies develop written standards for their advertisements and monitor their advertisements for adherence to these standards. We also suggest that the Pharmaceutical Advertising Advisory Board develop more stringent guidelines for advertising and that it enforce these guidelines in a consistent, rigorous fashion. PMID:8004560

Validation of diabetes mellitus and hypertension diagnosis in computerized medical records in primary health care

PubMed Central

2011-01-01

Background Computerized Clinical Records, which are incorporated in primary health care practice, have great potential for research. In order to use this information, data quality and reliability must be assessed to prevent compromising the validity of the results. The aim of this study is to validate the diagnosis of hypertension and diabetes mellitus in the computerized clinical records of primary health care, taking the diagnosis criteria established in the most prominently used clinical guidelines as the gold standard against which what measure the sensitivity, specificity, and determine the predictive values. The gold standard for diabetes mellitus was the diagnostic criteria established in 2003 American Diabetes Association Consensus Statement for diabetic subjects. The gold standard for hypertension was the diagnostic criteria established in the Joint National Committee published in 2003. Methods A cross-sectional multicentre validation study of diabetes mellitus and hypertension diagnoses in computerized clinical records of primary health care was carried out. Diagnostic criteria from the most prominently clinical practice guidelines were considered for standard reference. Sensitivity, specificity, positive and negative predictive values, and global agreement (with kappa index), were calculated. Results were shown overall and stratified by sex and age groups. Results The agreement for diabetes mellitus with the reference standard as determined by the guideline was almost perfect (κ = 0.990), with a sensitivity of 99.53%, a specificity of 99.49%, a positive predictive value of 91.23% and a negative predictive value of 99.98%. Hypertension diagnosis showed substantial agreement with the reference standard as determined by the guideline (κ = 0.778), the sensitivity was 85.22%, the specificity 96.95%, the positive predictive value 85.24%, and the negative predictive value was 96.95%. Sensitivity results were worse in patients who also had diabetes and in those aged 70 years or over. Conclusions Our results substantiate the validity of using diagnoses of diabetes and hypertension found within the computerized clinical records for epidemiologic studies. PMID:22035202

Guidelines for asbestos remediation at Italian superfund sites.

PubMed

Paglietti, F; Malinconico, S; Di Molfetta, V; Giangrasso, M

2012-01-01

Asbestos is now banned in 52 countries. Although Italy banned asbestos in 1992, up until that date it had been one of the main producer nations of asbestos and asbestos-containing materials, and asbestos-related contamination is still widespread in the country. To reduce asbestos-related health effects, Italy has adopted many laws and regulations regarding exposure thresholds and remediation tools. Even so, there are legislative gaps that are making it difficult to manage related risks especially in the operative phase. The lack of standard procedures at a national level regarding emergency shutdown and remediation as well as reference thresholds for specific risk situations creates difficulties and different actions when dealing with the cleanup of Italian asbestos superfund sites. The authors propose operative guidelines for asbestos remediation at Italian superfund sites. INAIL, the reference national organization for asbestos-related matters, acting as an advisor to a number of state, regional, and local authorities, examined the main asbestos-related risk situations in Italy and proposed the most appropriate actions to take. The detailed analysis of many actual cases of risk, in part through inspections and the management of cleanup actions at asbestos Italian superfund sites, resulted in proposals to modify existing procedures and thresholds, which were subsequently discussed with all national, regional, and local scientific bodies. After more than two years of work and discussion at a national level, INAIL-DIPIA-Asbestos Group drafted new Guidelines for Asbestos Remediation at Italian Superfund sites, and officially submitted them to the Environment Ministry. The Ministry then adopted the document in regard to all asbestos Italian superfunds. This recently released document is also a useful reference for contaminated sites at a regional and local level. The operative Guidelines for Asbestos Remediation at Italian Superfund sites may also be of use at an international level for countries that have already banned asbestos and are engaged in remediation activity and for countries that have not yet banned asbestos but wish to adopt risk prevention measures.

Reference intervals: current status, recent developments and future considerations.

PubMed

Ozarda, Yesim

2016-01-01

Reliable and accurate reference intervals (RIs) for laboratory analyses are an integral part of the process of correct interpretation of clinical laboratory test results. RIs given in laboratory reports have an important role in aiding the clinician in interpreting test results in reference to values for healthy populations. Since the 1980s, the International Federation of Clinical Chemistry (IFCC) has been proactive in establishing recommendations to clarify the true significance of the term 'RIs, to select the appropriate reference population and statistically analyse the data. The C28-A3 guideline published by the Clinical and Laboratory Standards Institute (CLSI) and IFCC is still the most widely-used source of reference in this area. In recent years, protocols additional to the Guideline have been published by the IFCC, Committee on Reference Intervals and Decision Limits (C-RIDL), including all details of multicenter studies on RIs to meet the requirements in this area. Multicentric RIs studies are the most important development in the area of RIs. Recently, the C-RIDL has performed many multicentric studies to obtain common RIs. Confusion of RIs and clinical decision limits (CDLs) remains an issue and pediatric and geriatric age groups are a significant problem. For future studies of RIs, the genetic effect would seem to be the most challenging area. 
The aim of the review is to present the current theory and practice of RIs, with special emphasis given to multicenter RIs studies, RIs studies for pediatric and geriatric age groups, clinical decision limits and partitioning by genetic effects on RIs.

Reference intervals: current status, recent developments and future considerations

PubMed Central

Ozarda, Yesim

2016-01-01

Reliable and accurate reference intervals (RIs) for laboratory analyses are an integral part of the process of correct interpretation of clinical laboratory test results. RIs given in laboratory reports have an important role in aiding the clinician in interpreting test results in reference to values for healthy populations. Since the 1980s, the International Federation of Clinical Chemistry (IFCC) has been proactive in establishing recommendations to clarify the true significance of the term ‘RIs, to select the appropriate reference population and statistically analyse the data. The C28-A3 guideline published by the Clinical and Laboratory Standards Institute (CLSI) and IFCC is still the most widely-used source of reference in this area. In recent years, protocols additional to the Guideline have been published by the IFCC, Committee on Reference Intervals and Decision Limits (C-RIDL), including all details of multicenter studies on RIs to meet the requirements in this area. Multicentric RIs studies are the most important development in the area of RIs. Recently, the C-RIDL has performed many multicentric studies to obtain common RIs. Confusion of RIs and clinical decision limits (CDLs) remains an issue and pediatric and geriatric age groups are a significant problem. For future studies of RIs, the genetic effect would seem to be the most challenging area.
The aim of the review is to present the current theory and practice of RIs, with special emphasis given to multicenter RIs studies, RIs studies for pediatric and geriatric age groups, clinical decision limits and partitioning by genetic effects on RIs. PMID:26981015

Reference values for heavy metals in soils of the Brazilian agricultural frontier in Southwestern Amazônia.

PubMed

dos Santos, Sabrina Novaes; Alleoni, Luís Reynaldo Ferracciú

2013-07-01

Guideline values are used to identify polluted or contaminated areas based on background values. Brazilian law establishes three guideline values for pollutants: a quality reference value (QRV), a prevention value, and an intervention value. Reference values refer to the natural concentration of an element or a substance in soils that have not been modified by anthropogenic impacts. These values inform assessments of soil quality and are used to establish maximum permissible limits. The objective of this study was to determine the natural levels and reference values for Cd, Co, Cr, Cu, Ni, Pb, and Zn in samples from the surface layer (0-20 cm) of 19 representative soils of the states of Mato Grosso and Rondônia, on Brazil's agricultural frontier. Pseudo-total metal concentrations were obtained following microwave-assisted digestion using the aqua regia and EPA3051 methods. QRVs were calculated for each element as the 75th and 90th percentiles of the frequency distribution of the data. Natural levels of heavy metals in the soil samples followed the order: Cr > Zn > Cu > Co > Pb > Ni > and Cd (aqua regia) and Cr > Co > Cu > Pb > Zn > Ni > Cd (EPA3051). These values are generally lower than those reported in the Brazilian and international literature, which highlights the importance of establishing reference values for each state or for each soil type, taking into account the geomorphological, pedological, and geological diversity of the region under study.

Adapting clinical guidelines in low‐resources countries: a study on the guideline on the management and prevention of type 2 diabetes mellitus in Indonesia

PubMed Central

Wangge, Grace; van der Graaf, Yolanda; van der Heijden, Geert J. M. G.

2016-01-01

Abstract Rationale, aims and objectives Most of the clinical guidelines in low‐resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence‐based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. Methods The “Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011” is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. Results Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on “rigor of development” and “applicability” and the lowest score in the “scope and purpose” domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. Conclusion Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence‐based practice principles should be followed and adhered to. PMID:27592587

Adapting clinical guidelines in low-resources countries: a study on the guideline on the management and prevention of type 2 diabetes mellitus in Indonesia.

PubMed

Widyahening, Indah S; Wangge, Grace; van der Graaf, Yolanda; van der Heijden, Geert J M G

2017-02-01

Most of the clinical guidelines in low-resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence-based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. The "Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011" is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on "rigor of development" and "applicability" and the lowest score in the "scope and purpose" domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence-based practice principles should be followed and adhered to. © 2016 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.

[Comparative evaluation of clinical practice guidelines for the treatment of schizophrenia].

PubMed

Delessert, D; Pomini, V; Grasset, F; Baumann, P

2008-01-01

Many clinical practice guidelines (CPG) have been published in reply to the development of the concept of "evidence-based medicine" (EBM) and as a solution to the difficulty of synthesizing and selecting relevant medical literature. Taking into account the expansion of new CPG, the question of choice arises: which CPG to consider in a given clinical situation? It is of primary importance to evaluate the quality of the CPG, but until recently, there has been no standardized tool of evaluation or comparison of the quality of the CPG. An instrument of evaluation of the quality of the CPG, called "AGREE" for appraisal of guidelines for research and evaluation was validated in 2002. The six principal CPG concerning the treatment of schizophrenia are compared with the help of the "AGREE" instrument: (1) "the Agence nationale pour le développement de l'évaluation médicale (ANDEM) recommendations"; (2) "The American Psychiatric Association (APA) practice guideline for the treatment of patients with schizophrenia"; (3) "The quick reference guide of APA practice guideline for the treatment of patients with schizophrenia"; (4) "The schizophrenia patient outcomes research team (PORT) treatment recommendations"; (5) "The Texas medication algorithm project (T-MAP)" and (6) "The expert consensus guideline for the treatment of schizophrenia". The results of our study were then compared with those of a similar investigation published in 2005, structured on 24 CPG tackling the treatment of schizophrenia. The "AGREE" tool was also used by two investigators in their study. In general, the scores of the two studies differed little and the two global evaluations of the CPG converged; however, each of the six CPG is perfectible. The rigour of elaboration of the six CPG was in general average. The consideration of the opinion of potential users was incomplete, and an effort made in the presentation of the recommendations would facilitate their clinical use. Moreover, there was little consideration by the authors regarding the applicability of the recommendations. Globally, two CPG are considered as strongly recommended: "the quick reference guide of the APA practice guideline for the treatment of patients with schizophrenia" and "the T-MAP".

Modelling guidelines--terminology and guiding principles

NASA Astrophysics Data System (ADS)

Refsgaard, Jens Christian; Henriksen, Hans Jørgen

2004-01-01

Some scientists argue, with reference to Popper's scientific philosophical school, that models cannot be verified or validated. Other scientists and many practitioners nevertheless use these terms, but with very different meanings. As a result of an increasing number of examples of model malpractice and mistrust to the credibility of models, several modelling guidelines are being elaborated in recent years with the aim of improving the quality of modelling studies. This gap between the views and the lack of consensus experienced in the scientific community and the strongly perceived need for commonly agreed modelling guidelines is constraining the optimal use and benefits of models. This paper proposes a framework for quality assurance guidelines, including a consistent terminology and a foundation for a methodology bridging the gap between scientific philosophy and pragmatic modelling. A distinction is made between the conceptual model, the model code and the site-specific model. A conceptual model is subject to confirmation or falsification like scientific theories. A model code may be verified within given ranges of applicability and ranges of accuracy, but it can never be universally verified. Similarly, a model may be validated, but only with reference to site-specific applications and to pre-specified performance (accuracy) criteria. Thus, a model's validity will always be limited in terms of space, time, boundary conditions and types of application. This implies a continuous interaction between manager and modeller in order to establish suitable accuracy criteria and predictions associated with uncertainty analysis.

Diagnosis and management of dementia in family practice.

PubMed

Wilcock, Jane; Jain, Priya; Griffin, Mark; Thuné-Boyle, Ingela; Lefford, Frances; Rapp, David; Iliffe, Steve

2016-01-01

Improving quality of care for people with dementia is a high priority. Considerable resources have been invested in financial incentives, guideline development, public awareness and educational programmes to promote earlier diagnosis and better management. Evaluating family physicians' concordance with guidelines on diagnosis and management of people with dementia, from first documentation of symptoms to formal diagnosis. Analysis of medical records of 136 people with dementia recruited by 19 family practices in NW London and surrounding counties. Practices invited 763 people with dementia to participate, 167 (22%) agreed. Complete records were available for 136 (18%). The majority of records included reference to recommended blood tests, informant history and caregiver concerns. Presence or absence of symptoms of depression, psychosis, other behavioural and psychological symptoms of dementia, and cognitive function tests were documented in 30%-40% of records. Documentation of discussions about signs and symptoms of dementia, treatment options, care, support, financial, legal and advocacy advice were uncommon. Comparison of these findings from a similar study in 2000-2002 suggests improvements in concordance with blood tests, recording informant history, presence or absence of depression or psychosis symptoms. There was no difference in documenting cognitive function tests. Immediate referral to specialists was more common in the recent study. Five years after UK dementia guidelines and immediately after the launch of the dementia strategy, family physicians appeared concordant with clinical guidelines for dementia diagnosis (other than cognitive function tests), and referred most patients immediately. However, records did not suggest systematic dementia management.

Chamber dimensions and functional assessment with coronary computed tomographic angiography as compared to echocardiography using American Society of Echocardiography guidelines

PubMed Central

Rose, Michael; Rubal, Bernard; Hulten, Edward; Slim, Jennifer N; Steel, Kevin; Furgerson, James L; Villines, Todd C

2014-01-01

Background: The correlation between normal cardiac chamber linear dimensions measured during retrospective coronary computed tomographic angiography as compared to transthoracic echocardiography using the American Society of Echocardiography guidelines is not well established. Methods: We performed a review from January 2005 to July 2011 to identify subjects with retrospective electrocardiogram-gated coronary computed tomographic angiography scans for chest pain and transthoracic echocardiography with normal cardiac structures performed within 90 days. Dimensions were manually calculated in both imaging modalities in accordance with the American Society of Echocardiography published guidelines. Left ventricular ejection fraction was calculated on echocardiography manually using the Simpson’s formula and by coronary computed tomographic angiography using the end-systolic and end-diastolic volumes. Results: We reviewed 532 studies, rejected 412 and had 120 cases for review with a median time between studies of 7 days (interquartile range (IQR25,75) = 0–22 days) with no correlation between the measurements made by coronary computed tomographic angiography and transthoracic echocardiography using Bland–Altman analysis. We generated coronary computed tomographic angiography cardiac dimension reference ranges for both genders for our population. Conclusion: Our findings represent a step towards generating cardiac chamber dimensions’ reference ranges for coronary computed tomographic angiography as compared to transthoracic echocardiography in patients with normal cardiac morphology and function using the American Society of Echocardiography guideline measurements that are commonly used by cardiologists. PMID:26770706

[Guidelines for management of epilepsy--commentary on Scottish ("SIGN") guidelines].

PubMed

Planjar-Prvan, Miljenka; Granić, Davorka

2005-01-01

The choice of AED (antiepileptic drug), worldwide and in Croatia, is been still based on the physician's subjective decision, personal experience, knowledge and marketing pressure made by big pharmaceutical industries. Therefore, according to some opinions, there is a need of treatment guidelines for epilepsy that would provide relevant information based on scientific evidence on the efficacy, tolerability and safety of AEDs. The guidelines, published by a competent source, should be designed as to allow for easy access to the information on the best practice in specific cases. An extensive background literature review was made to identify such a type of guidelines for the management of epilepsy. The literature review revealed a number of references with the recommendations for treating epilepsy in different groups of patients and from various, specific aspects of epilepsy treatment. However, only one comprehensive set of guidelines for the diagnosis and treatment of epilepsy treatment was found, i.e. the evidence-based guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN). The development of this set of guidelines is quite extensively described in order to illustrate how rigorous and long-lasting the process was, including a great number of health professionals at the national level. Such a type of well designed guidelines facilitates access to highest educational standards for all professionals involved in the primary and secondary care of people with epilepsy. However, it is clear that guidelines can fully replace the standards of clinical practice based on critical evaluation and integration of all clinical data of each individual patient. No guidelines can replace the physician's obligation to keep informed of the novel achievements in the epileptology either.

Cancer related fatigue: implementing guidelines for optimal management.

PubMed

Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E

2017-07-18

Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may be further enhanced with guideline adaptation, professional education and integration with existing practices.

Liquid and gaseous oxygen safety review, volume 2

NASA Technical Reports Server (NTRS)

Lapin, A.

1972-01-01

Guidelines, codes, regulations and special procedures used in the design, installation, fabrication, testing and operations for protection against hazards involved with production, transportation, storage and system handling of oxygen are presented with a list of related references.

29 CFR 2509.75-10 - Interpretive bulletin relating to the ERISA Guidelines and the Special Reliance Procedure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... compendium of authoritative rules (hereinafter referred to as the “ERISA Guidelines”) relating to ERISA... thus provide authoritative guidance in respect of the new statutory requirements bearing on...

Systematic reviews in the field of nutrition

USDA-ARS?s Scientific Manuscript database

Systematic reviews are valuable tools for staying abreast of evolving nutrition and aging -related topics, formulating dietary guidelines, establishing nutrient reference intakes, formulating clinical practice guidance, evaluating health claims, and setting research agendas. Basic steps of conductin...

A Course on Multimedia Environmental Transport, Exposure, and Risk Assessment.

ERIC Educational Resources Information Center

Cohen, Yoram; And Others

1990-01-01

Included are the general guidelines, outline, a summary of major intermedia transport processes, model features, a discussion of multimedia exposure and health risk, and a list of 50 suggested references for this course. (CW)

30 CFR 1210.104 - Must I submit these production reports electronically?

Code of Federal Regulations, 2011 CFR

2011-07-01

... (EDI)—The direct computer-to-computer interchange of data using standards set forth by the X12 American... be generated from a reporter's system application. (c) Refer to our electronic reporting guidelines...

Operating guidelines for TxDOT ramp control signals.

DOT National Transportation Integrated Search

2009-01-01

The Texas Department of Transportation (TxDOT) currently maintains a Traffic Signals Manual. : Originally published in 1999, this manual provides a guide and reference for handling requests : for traffic signals on the designated State Highway System...

Satellite power system concept development and evaluation program. Volume 2: System definition

NASA Technical Reports Server (NTRS)

1981-01-01

The system level results of the system definition studies performed by NASA as a part of the Department of Energy/NASA satellite power system concept development and evaluation program are summarized. System requirements and guidelines are discussed as well as the major elements that comprise the reference system and its design options. Alternative system approaches including different system sizes, solid state amplifier (microwave) concepts, and laser power transmission system cost summaries are reviewed. An overview of the system analysis and planning efforts is included. The overall study led to the conclusion that the reference satellite power system concept is a feasible baseload source of electrical power and, within the assumed guidelines, the minimum cost per kilowatt is achieved at the maximum output of 5 gigawatts to the utility grid. Major unresolved technical issues include maximum allowable microwave power density in the ionosphere and performance/mass characteristics of laser power transmission systems.

New Directions in Space: A Report on the Lunar and Mars Initiatives

NASA Technical Reports Server (NTRS)

Seitz, Frederick; Hawkins, Willis; Jastrow, Robert; Nierenberg, William A.

1990-01-01

This report focuses on one aspect of the current space program: The establishment of a manned base on the Moon and the manned exploration of Mars. These missions were announced by the President last year as a major U.S. space policy objective to be implemented under the leadership of the Vice President, acting as Chairman of the National Space Council. On March 8, 1990, the White House released Presidential guidelines for the execution of the lunar and Mars programs. The guidelines stressed the need for new approaches and the development of innovative technologies with a potential for major cost, schedule and performance improvements. They also called for a competitive environment, with several years allotted to the definition of at least two significantly different human space exploration "reference architectures." Selection of the final technical concepts for the mission is scheduled to occur only after the relative merits of the competing reference architectures have been evaluated.

[Impact of low-molecular-weight heparin practice guidelines in a geriatric hospital].

PubMed

d'Arailh, Lydie; Gaubert-Dahan, Marie-Line; Muller, Florence; Lechowski, Laurent; Teillet, Laurent

2011-06-01

The purpose of this study was to assess the impact of good use of anticoagulants guidelines implementation on low molecular weight heparin (LMWH) prescription in a french geriatric hospital. This interventional "before and after" study was conduced by the same geriatrician on a d-day in 2006 and 2009. Guidelines for anticoagulant's prescription based on selected references in the literature was established by an expert's consensus and implemented in 2008. Data were collected in all departments at the Sainte-Perine geriatric hospital for each patient with an LMWH prescription. Assessment was based on quality judgment criteria (indication, dosage, treatment duration, biological monitoring of LMWH). Data were collected for 72 prescriptions prior to the guidelines implementation and for 54 after. Sex-ratio, mean age and percentage of LMWH prescription did not differ significantly between the two periods. There was a better conformity for LMWH dosage prescription (p = 0.002) and biological monitoring prescription (p = 0.036) after the guidelines implementation. Conformity of LMWH indication and treatment duration were improved but the difference remained not significant (respectively p = 0.49 and p = 0.80). Implementing guidelines for LMWH use in geriatrics can improve quality of prescription. The impact was effective but limited. These guidelines are now in general use in the Sainte-Perine hospital.

European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society--first revision.

PubMed

2010-12-01

A European Federation of Neurological Societies/Peripheral Nerve Society consensus guideline on the definition, investigation, and treatment of multifocal motor neuropathy (MMN) was published in 2006. The aim is to revise this guideline. Disease experts considered references retrieved from MEDLINE and Cochrane Systematic Reviews published between August 2004 and July 2009 and prepared statements that were agreed to in an iterative fashion. The Task Force agreed on Good Practice Points to define clinical and electrophysiological diagnostic criteria for MMN, investigations to be considered, and principal recommendations for treatment. © 2010 Peripheral Nerve Society.

Renal-related adverse effects of intravenous contrast media in computed tomography

PubMed Central

Leow, Kheng Song; Wu, Yi Wei; Tan, Cher Heng

2015-01-01

Renal-related adverse effects of intravascular contrast media (CM) include contrast-induced nephropathy in computed tomography and angiography. While large retrospective studies have been published, the exact pathogenesis of this condition is still unknown. We review the main international guidelines, including the American College of Radiology white paper and the guidelines of European Society of Urogenital Radiology, Royal College of Radiologists and Canadian Association of Radiologists, as well as their references, regarding this subject. We present a simplified, concise approach to renal-related adverse effects of CM, taking into consideration the basis for each recommendation in these published guidelines. This will allow the reader to better understand the rationale behind appropriate patient preparation for cross-sectional imaging. PMID:25917468

Guidelines to identify abnormalities after childhood urinary tract infections: a prospective audit.

PubMed

Coulthard, Malcolm G; Lambert, Heather J; Vernon, Susan J; Hunter, Elizabeth W; Keir, Michael J

2014-05-01

To compare the childhood urinary tract infection (UTI) guidelines from the Royal College of Physicians (RCP) in 1991 and from National Institute of Health and Care Excellence (NICE) (CG54) in 2007 by measuring their efficiency at detecting urinary tract abnormalities. Children with UTIs within the Newcastle Primary Care Trust (population 70,800 children) were referred and imaged according to the RCP guidelines during 2008, and these were compared to the activity that would have been undertaken if we had implemented the CG54 guidelines, including following them through 2011 to identify those with recurrent UTIs. The numbers of children imaged, the imaging burden and efficiency, and urinary tract abnormalities detected by each guideline. Fewer children would have been imaged by CG54 than RCP (150 vs 427), but its sensitivity was lower, at 44% for detecting scarring, 10% for identifying vesicoureteric reflux and 40% for other abnormalities. Overall, it would have only detected one-quarter of the abnormal cases (8 vs 32) and would have missed five of nine children with scarring, including three with multiple lesions and one with renal impairment. Imposing an age restriction of <8 years to the RCP guidelines would reduce its screening rate by 20% and still detect 90% of the abnormalities. The CG54 guidelines do not alter the imaging efficiency compared to the RCP guidelines, but they are considerably less sensitive.

World Health Organization discontinues its drinking-water guideline for manganese.

PubMed

Frisbie, Seth H; Mitchell, Erika J; Dustin, Hannah; Maynard, Donald M; Sarkar, Bibudhendra

2012-06-01

The World Health Organization (WHO) released the fourth edition of Guidelines for Drinking-Water Quality in July 2011. In this edition, the 400-µg/L drinking-water guideline for manganese (Mn) was discontinued with the assertion that because "this health-based value is well above concentrations of manganese normally found in drinking water, it is not considered necessary to derive a formal guideline value." In this commentary, we review the WHO guideline for Mn in drinking water--from its introduction in 1958 through its discontinuation in 2011. For the primary references, we used the WHO publications that documented the Mn guidelines. We used peer-reviewed journal articles, government reports, published conference proceedings, and theses to identify countries with drinking water or potential drinking-water supplies exceeding 400 µg/L Mn and peer-reviewed journal articles to summarize the health effects of Mn. Drinking water or potential drinking-water supplies with Mn concentrations > 400 µg/L are found in a substantial number of countries worldwide. The drinking water of many tens of millions of people has Mn concentrations > 400 µg/L. Recent research on the health effects of Mn suggests that the earlier WHO guideline of 400 µg/L may have been too high to adequately protect public health. The toxic effects and geographic distribution of Mn in drinking-water supplies justify a reevaluation by the WHO of its decision to discontinue its drinking-water guideline for Mn.

EAU guidelines on surgical treatment of urinary incontinence.

PubMed

Lucas, M G; Bosch, R J L; Burkhard, F C; Cruz, F; Madden, T B; Nambiar, A K; Neisius, A; de Ridder, D J M K; Tubaro, A; Turner, W H; Pickard, R S

2013-09-01

The European Association of Urology (EAU) guidelines on urinary incontinence published in March 2012 have been rewritten based on an independent systematic review carried out by the EAU guidelines panel using a sustainable methodology. We present a short version here of the full guidelines on the surgical treatment of patients with urinary incontinence, with the aim of dissemination to a wider audience. Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches based on Population, Intervention, Comparator, Outcome (PICO) questions. The appraisal of papers was carried out by an international panel of experts, who also collaborated in a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. The full version of the guidance is available online (www.uroweb.org/guidelines/online-guidelines/). The guidance includes algorithms that refer the reader back to the supporting evidence and have greater accessibility in daily clinical practice. Two original meta-analyses were carried out specifically for these guidelines and are included in this report. These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where high-level evidence is lacking, they present a consensus of expert panel opinion. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

Attitudes and Perceptions about Clinical Guidelines: A Qualitative Study with Spanish Physicians

PubMed Central

Solà, Ivan; Carrasco, José Miguel; Díaz del Campo, Petra; Gracia, Javier; Orrego, Carola; Martínez, Flora; Kotzeva, Anna; Guillamón, Imma; Calderón, Enrique; de Gaminde, Idoia; Louro, Arturo; Rotaeche, Rafael; Salcedo, Flavia; Velázquez, Paola; Alonso-Coello, Pablo

2014-01-01

Background Clinical guidelines (CGs) are popular for healthcare decision making but their acceptability and use by healthcare providers is influenced by numerous factors. Some of these factors are professional-related, such as knowledge and perceptions of and attitudes toward CGs in general. The aim of our study was to evaluate attitudes and perceptions of Spanish physicians towards CGs. Methods We coordinated six discussion groups with a total of 46 physicians. The participants were drawn from 12 medical specialties from both specialized and primary care. We recorded the sessions and transcribed the content verbatim. We analyzed the data using an approach based on the grounded theory. Results We identified two main constructs that defined the physicians' perceptions towards guidelines: knowledge and usefulness. “Knowledge” defined the theoretical meanings of guidelines, while “Usefulness” referred to the pragmatic approach to guidelines. These constructs were interrelated through a series of categories such as confidence, usability, accessibility, dissemination and formats. Conclusions In our study, the constructs that impacted most on physician's attitudes to clinical guidelines were knowledge and usefulness. The tension between the theoretical and the pragmatic constructs determined the attitudes and how physicians use guidelines. Groups developing guidelines should ask relevant clinical questions and develop implementable and context specific recommendations. Developers should be explicit and consistent in the development and presentation of recommendations. PMID:24505253

A Guideline to Family-Wide Comparative State-of-the-Art Quantitative RT-PCR Analysis Exemplified with a Brassicaceae Cross-Species Seed Germination Case Study[W][OA

PubMed Central

Graeber, Kai; Linkies, Ada; Wood, Andrew T.A.; Leubner-Metzger, Gerhard

2011-01-01

Comparative biology includes the comparison of transcriptome and quantitative real-time RT-PCR (qRT-PCR) data sets in a range of species to detect evolutionarily conserved and divergent processes. Transcript abundance analysis of target genes by qRT-PCR requires a highly accurate and robust workflow. This includes reference genes with high expression stability (i.e., low intersample transcript abundance variation) for correct target gene normalization. Cross-species qRT-PCR for proper comparative transcript quantification requires reference genes suitable for different species. We addressed this issue using tissue-specific transcriptome data sets of germinating Lepidium sativum seeds to identify new candidate reference genes. We investigated their expression stability in germinating seeds of L. sativum and Arabidopsis thaliana by qRT-PCR, combined with in silico analysis of Arabidopsis and Brassica napus microarray data sets. This revealed that reference gene expression stability is higher for a given developmental process between distinct species than for distinct developmental processes within a given single species. The identified superior cross-species reference genes may be used for family-wide comparative qRT-PCR analysis of Brassicaceae seed germination. Furthermore, using germinating seeds, we exemplify optimization of the qRT-PCR workflow for challenging tissues regarding RNA quality, transcript stability, and tissue abundance. Our work therefore can serve as a guideline for moving beyond Arabidopsis by establishing high-quality cross-species qRT-PCR. PMID:21666000

Marine Fuel Cell Technology Verification Trainer Program: Operator Curriculum Development

DTIC Science & Technology

2004-06-01

collection of tnormiratin is estimiate to average 1 hour per response, Including the time INr reviewing InatruCtlona. ear-ching existing =ata aourcas...guidelines and standards are provided. With the anticipation that up to several years’ delay will occur between the time of this report and the maturity of...reference only, given as foundation sources available at the time of this project. The supplemental references to published materials are considered the

Man-Machine Interface (MMI) Requirements Definition and Design Guidelines

DTIC Science & Technology

1981-02-01

be provided to interrogate the user to resolve any input ambiguities resulting from hardware limitations; see Smith and Goodwin, 1971 . Reference...Smith, S. L. and Goodwin, N. C’. Alphabetic data v entry via the Touch-Tone pad: A comment. Human Factors, 1971 , 13(2), 189-190. 41 All~ 1.0 General (con...software designer. Reference: Miller, R. B. Response time in man-computer conversational transactions. In Proceedings of the AFIPS kall Joint Computer

Guiding the process of health technology disinvestment.

PubMed

Ibargoyen-Roteta, Nora; Gutiérrez-Ibarluzea, Iñaki; Asua, José

2010-12-01

To develop a guideline for health technology disinvestment. The Nominal Group Technique was used to determine relevant aspects of disinvestment decision-making. Ideas reaching consensus and previous Spanish guidelines on the acquisition of new health technologies (GANT) and new genetic tests (GEN) structures were used to develop the domains and contents of GuNFT (Guideline for Not Funding Health Technologies). The draft was peer reviewed by local and international experts and their suggestions were incorporated to the first GuNFT version. Thirty-five ideas reached consensus. The most relevant ones referred to the reasons for disinvesting in a technology and the key aspects that would facilitate disinvestment acceptance. Considering both consensus ideas and GANT and GEN guidelines, the first GuNFT draft was elaborated. After the review process, section numbers and contents were changed. The resulting GuNFT guideline was finally divided into six domains related to: (1) general preliminary recommendations, (2) completing the application form, (3) checking and prioritising applications, (4) assessment, (5) final decision and (6) action plan design. A software was also developed to facilitate GuNFT implementation. Disinvestment should be a guided process. Accordingly, we present the first guideline for that purpose. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

[Technical guideline for human rabies prevention and control (2016)].

PubMed

Zhou, H; Li, Y; Chen, R F; Tao, X Y; Yu, P C; Cao, S C; Li, L; Chen, Z H; Zhu, W Y; Yin, W W; Li, Y H; Wang, C L; Yu, H J

2016-02-01

In order to promote the prevention and control programs on rabies in our country, to regulate the prevention and disposition of rabies and to reduce the deaths caused by rabies, the Chinese Center for Disease Control and Prevention has organized a panel of experts, in the reference with Guidelines issued by WHO, American Advisory Committee on Immunization Practices, and the latest research progress from home and abroad, and compiled this document-"Technical Guidelines for Human Rabies Prevention and Control (2016)". The Guidelines conducted a systematic review on the etiology, clinical characteristics, laboratory diagnosis, epidemiology of rabies and provided evidence on varieties, mechanisms, effects, side-effects and security of rabies vaccine, as well as on other preparations on passive immunity of its kind, on methods related to prevention and disposition of exposure etc, finally to have come up with the recommendation on the above mentioned various techniques. The guidelines will be used by staff working on prevention and control of rabies from the Center for Disease Control and Prevention at all levels, from the departments of outpatient and divisions of infection and emergency control in all the medical institutions. The guideline will be updated and revised, following the research progress from home and abroad.

No. 354-Canadian HIV Pregnancy Planning Guidelines.

PubMed

Loutfy, Mona; Kennedy, V Logan; Poliquin, Vanessa; Dzineku, Frederick; Dean, Nicola L; Margolese, Shari; Symington, Alison; Money, Deborah M; Hamilton, Scot; Conway, Tracey; Khan, Sarah; Yudin, Mark H

2018-01-01

The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist Canadians affected by HIV with their fertility, preconception, and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible and take into account diverse and intersecting local/population needs based on the social determinants of health. EVIDENCE: Literature searches were conducted by a librarian using the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases for published articles in English and French related to HIV and pregnancy and HIV and pregnancy planning for each section of the guidelines. The full search strategy is available upon request. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. Guideline implementation should assist the practitioner in developing an evidence-based approach for the prevention of unplanned pregnancy, preconception, fertility, and pregnancy planning counselling in the context of HIV infection. These guidelines have been reviewed and approved by the Infectious Disease Committee and the Executive and Council of the SOGC. Canadian Institutes of Health Research Grant Planning and Dissemination grant (Funding Reference # 137186), which funded a Development Team meeting in 2016. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

The global impact of the DRACMA guidelines cow's milk allergy clinical practice.

PubMed

Fiocchi, Alessandro; Schunemann, Holger; Ansotegui, Ignacio; Assa'ad, Amal; Bahna, Sami; Canani, Roberto Berni; Bozzola, Martin; Dahdah, Lamia; Dupont, Christophe; Ebisawa, Motohiro; Galli, Elena; Li, Haiqi; Kamenwa, Rose; Lack, Gideon; Martelli, Alberto; Pawankar, Ruby; Said, Maria; Sánchez-Borges, Mario; Sampson, Hugh; Shamir, Raanan; Spergel, Jonathan; Terracciano, Luigi; Vandenplas, Yvan; Venter, Carina; Waserman, Susan; Wong, Gary; Brozek, Jan

2018-01-01

The 2010 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow's milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment. Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and international level. We describe some economic consequences of their application. DRACMA are the most cited CMA guidelines, and the second cited guidelines on food allergy. Many subsequent guidelines took stock of DRACMA's metanalyses adapting recommendations to the local context. Some of these chose not to consider OFC as an absolute requirement for the diagnosis of CMA. Studies on their implementation show that in this case, the treatment costs may increase and there is a risk of overdiagnosis. Interestingly, we observed a reduction in the cost of alternative formulas following the publication of the DRACMA guidelines. DRACMA reconciled international differences in the diagnosis and management of CMA. They promoted a cultural debate, improved clinician's knowledge of CMA, improved the quality of diagnosis and care, reduced inappropriate practices, fostered the efficient use of resources, empowered patients, and influenced some public policies. The accruing evidence on diagnosis and treatment of CMA necessitates their update in the near future.

The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD

PubMed Central

Moncrieff, Joanna; Timimi, Sami

2013-01-01

The current paper presents an analysis of the NICE guidelines on depression and attention deficit hyperactivity disorder (ADHD) from the perspective of the philosophy of science, guided particularly by Foucault's notion of the symbiosis of knowledge and power. It examines how data that challenged the orthodox position on the validity and drug treatment of these conditions was managed in the process of guideline development. The depression guideline briefly considered the complexity and heterogeneity of depression, and numerous methodological problems with evaluating treatments, including antidepressants. However, the guideline recommendations made no reference to these issues and ignored evidence that questioned the analysis of antidepressant trials. The guideline on ADHD reviewed validity, but did not consider evidence from the critical literature, and overlooked inconsistencies in the data. The guideline identified that drug trials have shown no long-term benefit in ADHD, but still recommended treatment with stimulant drugs for children with severe symptoms and for all adults claiming consensus for this position. Both guidelines demonstrate how contradictory data are managed so as not to jeopardise the currently predominant view that ADHD and depression are valid and un-contentious medical conditions that should be treated with drugs. The subjective nature of guideline formation that is revealed illustrates Foucault's suggestion that the authority of medicine operates to promote a technological view of the nature of certain human problems, which in turn strengthens medical hegemony over these areas. PMID:23496174

Evaluating an integrated approach to clinical quality improvement: clinical guidelines, quality measurement, and supportive system design.

PubMed

Cretin, S; Farley, D O; Dolter, K J; Nicholas, W

2001-08-01

Implementing clinical practice guidelines to change patient outcomes presents a challenge. Studies of single interventions focused on changing provider behavior demonstrate modest effects, suggesting that effective guideline implementation requires a multifaceted approach. Traditional biomedical research designs are not well suited to evaluating systems interventions. RAND and the Army Medical Department collaborated to develop and evaluate a system for implementing guidelines and documenting their effects on patient care. The evaluation design blended quality improvement, case study, and epidemiologic methods. A formative evaluation of implementation process and an outcome evaluation of patient impact were combined. Guidelines were implemented in 3 successive demonstrations targeting low back pain, asthma, and diabetes. This paper reports on the first wave of 4 facilities implementing a low back pain guideline. Organizational climate and culture, motivation, leadership commitment, and resources were assessed. Selected indicators of processes and outcomes of care were compared before, during, and after guideline implementation at the demonstration facilities and at comparison facilities. Logistic regression analysis was used to test for guideline effects on patient care. Process evaluation documented varied approaches to quality improvement across sites. Outcome evaluation revealed a significant downward trend in the percentage of acute low back pain patients referred to physical therapy or chiropractic care (10.7% to 7.2%) at demonstration sites and no such trend at control sites. Preliminary results suggest the power of this design to stimulate improvements in guideline implementation while retaining the power to evaluate rigorously effects on patient care.

Guidelines for randomized clinical trial protocol content: a systematic review

PubMed Central

2012-01-01

Background All randomized clinical trials (RCTs) require a protocol; however, numerous studies have highlighted protocol deficiencies. Reporting guidelines may improve the content of research reports and, if developed using robust methods, may increase the utility of reports to stakeholders. The objective of this study was to systematically identify and review RCT protocol guidelines, to assess their characteristics and methods of development, and to compare recommendations. Methods We conducted a systematic review of indexed literature (MEDLINE, EMBASE and the Cochrane Methodology Register from inception to September 2010; reference lists; related article features; forward citation searching) and a targeted search of supplementary sources, including a survey of major trial funding agencies in six countries. Records were eligible if they described a content guideline in English or French relevant to RCT protocols. Guidelines were excluded if they specified content for protocols for trials of specific procedures or conditions or were intended to assess trial quality. We extracted guideline characteristics and methods. Content was mapped for a subset of guidelines that described development methods or had institutional endorsement. Results Forty guidelines published in journals, books and institutional reports were included in the review; seven were specific to RCT protocols. Only eight (20%) described development methods which included informal consensus methods, pilot testing and formal validation; no guideline described all of these methods. No guideline described formal consensus methods or a systematic retrieval of empirical evidence to inform its development. The guidelines included a median of 23 concepts per guideline (interquartile range (IQR) = 14 to 34; range = 7 to 109). Among the subset of guidelines (n = 23) for which content was mapped, approximately 380 concepts were explicitly addressed (median concepts per guideline IQR = 31 (24,80); range = 16 to 150); most concepts were addressed in a minority of guidelines. Conclusions Existing guidelines for RCT protocol content varied substantially in their recommendations. Few reports described the methods of guideline development, limiting comparisons of guideline validity. Given the importance of protocols to diverse stakeholders, we believe a systematically developed, evidence-informed guideline for clinical trial protocols is needed. PMID:23006870

Guidelines for randomized clinical trial protocol content: a systematic review.

PubMed

Tetzlaff, Jennifer M; Chan, An-Wen; Kitchen, Jessica; Sampson, Margaret; Tricco, Andrea C; Moher, David

2012-09-24

All randomized clinical trials (RCTs) require a protocol; however, numerous studies have highlighted protocol deficiencies. Reporting guidelines may improve the content of research reports and, if developed using robust methods, may increase the utility of reports to stakeholders. The objective of this study was to systematically identify and review RCT protocol guidelines, to assess their characteristics and methods of development, and to compare recommendations. We conducted a systematic review of indexed literature (MEDLINE, EMBASE and the Cochrane Methodology Register from inception to September 2010; reference lists; related article features; forward citation searching) and a targeted search of supplementary sources, including a survey of major trial funding agencies in six countries. Records were eligible if they described a content guideline in English or French relevant to RCT protocols. Guidelines were excluded if they specified content for protocols for trials of specific procedures or conditions or were intended to assess trial quality. We extracted guideline characteristics and methods. Content was mapped for a subset of guidelines that described development methods or had institutional endorsement. Forty guidelines published in journals, books and institutional reports were included in the review; seven were specific to RCT protocols. Only eight (20%) described development methods which included informal consensus methods, pilot testing and formal validation; no guideline described all of these methods. No guideline described formal consensus methods or a systematic retrieval of empirical evidence to inform its development. The guidelines included a median of 23 concepts per guideline (interquartile range (IQR) = 14 to 34; range = 7 to 109). Among the subset of guidelines (n = 23) for which content was mapped, approximately 380 concepts were explicitly addressed (median concepts per guideline IQR = 31 (24,80); range = 16 to 150); most concepts were addressed in a minority of guidelines. Existing guidelines for RCT protocol content varied substantially in their recommendations. Few reports described the methods of guideline development, limiting comparisons of guideline validity. Given the importance of protocols to diverse stakeholders, we believe a systematically developed, evidence-informed guideline for clinical trial protocols is needed.

Recommended safety guides for industrial laboratories and shops

NASA Technical Reports Server (NTRS)

Allison, W. W.

1971-01-01

Booklet provides references to 29 publications providing information on hazard control and approved safety practices. Areas include pressurized gas and vacuum systems. Guidelines are presented for safeguarding facilities where machinery, equipment, electrical devices, or hazardous chemicals are used.

Pavement Recycling Guidelines for State and Local Governments: Participant's Reference Book

DOT National Transportation Integrated Search

1998-03-01

Recycling or reuse of existing asphalt pavement materials to produce new pavement materials has the following advantages: (a) reduce costs of construction, (b) conservation of aggregate and binder, (c) preservation of the existing pavement geometrics...

14 CFR 1203.603 - Systematic review for declassification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... INFORMATION SECURITY PROGRAM Declassification and Downgrading § 1203.603 Systematic review for... review guidelines. The Chairperson, NASA Information Security Program Committee, shall develop, in... custodian and referred to the Chairperson, NASA Information Security Program Committee. This listing shall...

Citing Legal Material in APA Journals.

ERIC Educational Resources Information Center

Osborne, Allan G., Jr.

1992-01-01

Guidelines are offered to authors on the correct citation format for legal references, including statutes and regulations, court decisions, and law review articles. Standards are based on those published by the Harvard Law Review Association and the American Psychological Association. (DB)

77 FR 18865 - Workforce Investment Act of 1998 (WIA); Lower Living Standard Income Level (LLSIL)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... higher level of the poverty line or 70 percent of the LLSIL. This issuance provides the Secretary's annual LLSIL for 2012 and references the current 2012 Health and Human Services ``Poverty Guidelines...

[Experiences with synopses of clinical guidelines using the example of synopses for Disease Management Programmes (DMP)].

PubMed

Siering, Ulrich; Rüther, Alric

2014-01-01

Guideline synopses, i.e. the systematic synthesis of clinical practice guidelines, are used as a basis for Disease Management Programmes (DMPs) in Germany. One of the responsibilities of the German Institute for Quality and Efficiency in Health Care (IQWiG) is the preparation of guideline synopses for DMPs. The article describes the experiences with this methodology. For the preparation of guideline synopses, a systematic search for evidence-based guidelines is conducted, and their recommendations are extracted and synthesised. In parallel, the quality of the guidelines is assessed using the AGREE instrument. The need for updating or supplementing a DMP is justified by means of the Grade of Recommendation (GoR) or, alternatively, the Level of Evidence (LoE). Since 2006 IQWiG has synthesised recommendations from 256 evidence-based guidelines in 12 guideline synopses for DMPs. The results are then used by the Federal Joint Committee (G-BA) to update DMPs. Using the example of the 12 synopses, several analyses were conducted. It was determined that a search for guidelines in guideline databases is sufficient and that a search in bibliographic databases can be dispensed with. Furthermore, the analyses showed that a large proportion of recommendations in evidence-based guidelines are not clearly linked to a GoR or LoE. If GoR and LoE are provided, only about 42% of recommendations with a strong GoR also refer to a strong LoE. It was also shown that only 21 % of the analysed guideline providers supplied information on the handling of unpublished data. With consistent average to high values, the assessment of the methodological quality across all of the prepared synopses allows for the conclusion of a basically acceptable guideline quality, but with a need for improvement. A guideline synopsis is an established tool for identifying health care standards as a basis for developing and updating DMPs. Further methodological development, particularly in collaboration with guideline providers, appears to be reasonable. It should be examined whether guideline synopses are suitable not only for guideline and DMP development, but also for other health care issues. Copyright © 2014. Published by Elsevier GmbH.

[Classifications in forensic medicine and their logical basis].

PubMed

Kovalev, A V; Shmarov, L A; Ten'kov, A A

2014-01-01

The objective of the present study was to characterize the main requirements for the correct construction of classifications used in forensic medicine, with special reference to the errors that occur in the relevant text-books, guidelines, and manuals and the ways to avoid them. This publication continues the series of thematic articles of the authors devoted to the logical errors in the expert conclusions. The preparation of further publications is underway to report the results of the in-depth analysis of the logical errors encountered in expert conclusions, text-books, guidelines, and manuals.

Biosafety: guidelines for working with pathogenic and infectious microorganisms.

PubMed

Coico, Richard; Lunn, George

2005-11-01

This unit, in conjunction with local and national guidelines and regulations, provides the basic biosafety information needed to perform the procedures detailed in this manual. Topics discussed include routine precautions when working with biohazards, disinfectants, disposal of biohazards, biosafety levels (as established by the U.S. National Institutes of Health, and the Centers for Disease Control and Prevention), animal facilities, and clinical laboratories. In addition, resources for more information are provided in the Literature Cited and Key References sections and in URLs given text and within the Internet Resources section.

EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy.

PubMed

Muraro, A; Werfel, T; Hoffmann-Sommergruber, K; Roberts, G; Beyer, K; Bindslev-Jensen, C; Cardona, V; Dubois, A; duToit, G; Eigenmann, P; Fernandez Rivas, M; Halken, S; Hickstein, L; Høst, A; Knol, E; Lack, G; Marchisotto, M J; Niggemann, B; Nwaru, B I; Papadopoulos, N G; Poulsen, L K; Santos, A F; Skypala, I; Schoepfer, A; Van Ree, R; Venter, C; Worm, M; Vlieg-Boerstra, B; Panesar, S; de Silva, D; Soares-Weiser, K; Sheikh, A; Ballmer-Weber, B K; Nilsson, C; de Jong, N W; Akdis, C A

2014-08-01

Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Report: new guidelines for characterization of municipal solid waste: the Portuguese case.

PubMed

da Graça Madeira Martinho, Maria; Silveira, Ana Isabel; Fernandes Duarte Branco, Elsa Maria

2008-10-01

This report proposes a new set of guidelines for the characterization of municipal solid waste. It is based on an analysis of reference methodologies, used internationally, and a case study of Valorsul (a company that handles recovery and treatment of solid waste in the North Lisbon Metropolitan Area). In particular, the suggested guidelines present a new definition of the waste to be analysed, change the sampling unit and establish statistical standards for the results obtained. In these new guidelines, the sampling level is the waste collection vehicle and contamination and moisture are taken into consideration. Finally, focus is on the quality of the resulting data, which is essential for comparability of data between countries. These new guidelines may also be applicable outside Portugal because the methodology includes, besides municipal mixed waste, separately collected fractions of municipal waste. They are a response to the need for information concerning Portugal (e.g. Eurostat or OECD inquiries) and follow European Union municipal solid waste management policies (e.g. packaging waste recovery and recycling targets and the reduction of biodegradable waste going to landfill).

[Exploration of how to formulate guidelines on post-marketing traditional Chinese medicine surveillance].

PubMed

Zhang, Wen; Xie, Yan-Ming; Yu, Wen-Ya

2013-09-01

Combining the world health organization's (WHO), the United States and the European union's relevant laws and guidelines on post-marketing drug surveillance to judge the status of post-marketing surveillance of traditional Chinese medicine(TCM) in China. We found that due to the late start of post-marketing surveillance of traditional Chinese medicine, the appropriate guidelines are yet to be developed. Hence, hospitals, enterprises and research institutions do not have a shared foundation from which to compare their research results. Therefore there is an urgent need to formulate such post-marketing surveillance guidelines. This paper has used as guidance various technical documents such as, "procedures to formulate national standards" and "testing methods of management in formulating traditional Chinese medicine standards" and has combined these to produce a version of post-marketing surveillance particular to Chinese medicine in China. How to formulate these guidelines is discussed and procedures and methods to formulate technical specifications are introduced. These provide a reference for future technical specifications and will assist in the development of TCM.

A survey of the awareness, knowledge, policies and views of veterinary journal Editors-in-Chief on reporting guidelines for publication of research

PubMed Central

2014-01-01

Background Wider adoption of reporting guidelines by veterinary journals could improve the quality of published veterinary research. The aims of this study were to assess the knowledge and views of veterinary Editors-in-Chief on reporting guidelines, identify the policies of their journals, and determine their information needs. Editors-in-Chief of 185 journals on the contact list for the International Association of Veterinary Editors (IAVE) were surveyed in April 2012 using an online questionnaire which contained both closed and open questions. Results The response rate was 36.8% (68/185). Thirty-six of 68 editors (52.9%) stated they knew what a reporting guideline was before receiving the questionnaire. Editors said they had found out about reporting guidelines primarily through articles in other journals, via the Internet and through their own journal. Twenty of 57 respondents (35.1%) said their journal referred to reporting guidelines in its instructions to authors. CONSORT, REFLECT, and ARRIVE were the most frequently cited. Forty-four of 68 respondents (68.2%) believed that reporting guidelines should be adopted by all refereed veterinary journals. Qualitative analysis of the open questions revealed that lack of knowledge, fear, resistance to change, and difficulty in implementation were perceived as barriers to the adoption of reporting guidelines by journals. Editors suggested that reporting guidelines be promoted through communication and education of the veterinary community, with roles for the IAVE and universities. Many respondents believed a consensus policy on guideline implementation was needed for veterinary journals. Conclusions Further communication and education about reporting guidelines for editors, authors and reviewers has the potential to increase their adoption by veterinary journals in the future. PMID:24410882

Organ and tissue donation in a regional paediatric intensive care unit: evaluation of practice.

PubMed

Carone, Laura; Alurkar, Shrirang; Kigozi, Phoebe; Vyas, Harish

2018-05-01

Approximately 2% of those on the organ transplant list in the UK are children. Early identification of donors and referral to organ donation teams (ODT) has proven to increase both the success rate of gaining consent and the number of organs actually retrieved. To evaluate the practice relating to organ donation for children receiving end-of-life care on a paediatric intensive care unit (PICU) measured against the National Guidelines. All children 0-18 who received their end-of-life care and died on the PICU. A retrospective cohort study of organ donation patterns including referral, approach, consent and donation. This involved a review of case notes on PICU between the years 2009 and 2014. One hundred five deaths were identified and 100 notes were examined and data analysed to ascertain if religion, age and length of stay on PICU impacted on practice. Eighty-six children met the early identification criteria for potential donors, 40 (46.5%) children were referred to the ODT and 33 (38.3%) families were approached regarding donation. Twenty-one (24.4%) families consented to donation. Seventeen donations took place with a total of 41 sets of organs/tissues retrieved. Despite the majority of children meeting early identification for potential donors, many were not being referred. All children on end-of-life care should be referred for potential organ donation. Organ donation needs to be seen as a priority for hospitals as a part of routine end-of-life care to help increase referral rates and give families the opportunity to donate. Many paediatric deaths are not referred for consideration of organ donation, despite guidelines stating that this process should be standard of care. Further optimization of referral rates may aid in increasing the number of organs available for donation. What is Known: • Shortage of organs continues to be a national problem. • NICE guidelines state that all patients who are on end-of-life care should have the option of organ donation explored. • Required referral both increases the number of donors and organs donated. What is New: • The process of identifying and referring children for paediatric organ donation. • Identifies that children are still not being referred for organ donation. • Organ donation is still not a priority for hospitals.

Children and adults exposed to electromagnetic fields at the ICNIRP reference levels: theoretical assessment of the induced peak temperature increase.

PubMed

Bakker, J F; Paulides, M M; Neufeld, E; Christ, A; Kuster, N; van Rhoon, G C

2011-08-07

To avoid potentially adverse health effects of electromagnetic fields (EMF), the International Commission on Non-Ionizing Radiation Protection (ICNIRP) has defined EMF reference levels. Restrictions on induced whole-body-averaged specific absorption rate (SAR(wb)) are provided to keep the whole-body temperature increase (T(body, incr)) under 1 °C during 30 min. Additional restrictions on the peak 10 g spatial-averaged SAR (SAR(10g)) are provided to prevent excessive localized tissue heating. The objective of this study is to assess the localized peak temperature increase (T(incr, max)) in children upon exposure at the reference levels. Finite-difference time-domain modeling was used to calculate T(incr, max) in six children and two adults exposed to orthogonal plane-wave configurations. We performed a sensitivity study and Monte Carlo analysis to assess the uncertainty of the results. Considering the uncertainties in the model parameters, we found that a peak temperature increase as high as 1 °C can occur for worst-case scenarios at the ICNIRP reference levels. Since the guidelines are deduced from temperature increase, we used T(incr, max) as being a better metric to prevent excessive localized tissue heating instead of localized peak SAR. However, we note that the exposure time should also be considered in future guidelines. Hence, we advise defining limits on T(incr, max) for specified durations of exposure.

21 CFR 320.26 - Guidelines on the design of a single-dose in vivo bioavailability or bioequivalence study.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE BIOAVAILABILITY AND BIOEQUIVALENCE... test product and the reference material should be administered to subjects in the fasting state, unless...

Genetics Home Reference: inclusion body myopathy with early-onset Paget disease and frontotemporal dementia

MedlinePlus

... condition damages parts of the brain that control reasoning, personality, social skills, speech, and language. Personality changes, ... Clearinghouse: Paget's Disease of Bone: An Endocrine Society Clinical Practice Guideline Genetic Testing (1 link) Genetic Testing ...

Guidelines for development : Transportation Improvement Programs (TIPs) and the Iowa Statewide Transportation Improvement Program (STIP).

DOT National Transportation Integrated Search

2011-02-01

This document serves as a reference guide to local planning agencies for the development of their regional Transportation Improvement Program (TIP) and the Statewide Transportation Improvement Program (STIP). Any questions regarding content or relati...

Course Syllabus: Christianity in a Technological Society.

ERIC Educational Resources Information Center

Kaiser, Christopher

1984-01-01

Explains a course designed to develop student skills to rethink the concept of ministry in a culture dominated by technological structures. An assignment involving national and local news events is described. Also presents lecture topics, guidelines for class discussions, and references. (DH)

Environmental assessment: Reference repository location, Hanford site, Washington

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

none,

1986-05-01

In February 1983, the US Department of Energy (DOE) identified a reference repository location at the Hanford Site in Washington as one of the nine potentially acceptable sites for a mined geologic repository for spent nuclear fuel and high-level radioactive waste. The site is in the Columbia Plateau, which is one of five distinct geohydrologic settings considered for the first repository. To determine their suitability, the Hanford Site and the eight other potentially acceptable sites have been evaluated in accordance with the DOE's General Guidelines for the Recommendation of Sites for the Nuclear Waste Repositories. These evaluations were reported inmore » draft environmental assessments (EAs), which were issued for public review and comment. After considering the comments received on the draft EAs, the DOE prepared the final EAs. On the basis of the evaluations reported in this EA, the DOE has found that the Hanford site is not disqualified under the guidelines. The DOE has also found that it is suitable for site characterization because the evidence does not support a conclusion that the site will not be able to meet each of the qualifying conditions specified in the guidelines. On the basis of these findings, the DOE is nominating the Hanford site as one of five sites suitable for characterization.« less

Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

PubMed

Wood, M E; Flynn, B S; Stockdale, A

2013-01-01

Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

Audit of sweat testing: a first report from Italian Cystic Fibrosis Centres.

PubMed

Cirilli, Natalia; Padoan, Rita; Raia, Valeria

2008-09-01

Cystic Fibrosis diagnosis is confirmed using sweat test. The aim of our study was to evaluate current techniques and methodologies in use at Italian CF Care Centres. A series of questions related to the performance of the sweat test was collected by all CF Care Centres in Italy. Answers were compared with UK and NCCLS guidelines. 39/41 Centres replied to the questionnaire. A good adherence to guidelines was registered for storing samples before analysis in 90.9%, while performing CF diagnosis by at least two sweat tests, and chloride analysis were reported respectively in 100% and 75.7% of Centres. Some inconsistencies were registered for minimum acceptable sweat quantity and time to collect sweat inadequate in respectively 42.5% and 24.2% of Centres, while performing quality control procedures and referring to an external quality assessment scheme were found inadequate in respectively 54.6% and 100%. 57.6% didn't provide any appropriate analytical ranges and only 15.1% of Centres offered proper information to patients/parents. A report form, including sweat quantity, reference ranges and interpretation, was adequate only for 9.4 up to 41.4% of CF Centres. Our study showed areas of inconsistencies in sweat testing current practices in Italy and highlights the need for evidence based national guidelines to improve practice and management strategies.

Towards European urinalysis guidelines. Introduction of a project under European Confederation of Laboratory Medicine.

PubMed

Kouri, T T; Gant, V A; Fogazzi, G B; Hofmann, W; Hallander, H O; Guder, W G

2000-07-01

Improved standardized performance is needed because urinalysis continues to be one of the most frequently requested laboratory tests. Since 1997, the European Confederation of Laboratory Medicine (ECLM) has been supporting an interdisciplinary project aiming to produce European urinalysis guidelines. More than seventy clinical chemists, microbiologists and ward-based clinicians, as well as representatives of manufacturers are taking part. These guidelines aim to improve the quality and consistency of chemical urinalysis, particle counting and bacterial culture by suggesting optimal investigative processes that could be applied in Europe. The approach is based on medical needs for urinalysis. The importance of the pre-analytical stage for total quality is stressed by detailed illustrative advice for specimen collection. Attention is also given to emerging automated technology. For cost containment reasons, both optimum (ideal) procedures and minimum analytical approaches are suggested. Since urinalysis mostly lacks genuine reference methods (primary reference measurement procedures; Level 4), a novel classification of the methods is proposed: comparison measurement procedures (Level 3), quantitative routine procedures (Level 2), and ordinal scale examinations (Level 1). Stepwise strategies are suggested to save costs, applying different rules for general and specific patient populations. New analytical quality specifications have been created. After a consultation period, the final written text will be published in full as a separate document.

Developing the Clarity and Openness in Reporting: E3-based (CORE) Reference user manual for creation of clinical study reports in the era of clinical trial transparency.

PubMed

Hamilton, Samina; Bernstein, Aaron B; Blakey, Graham; Fagan, Vivien; Farrow, Tracy; Jordan, Debbie; Seiler, Walther; Shannon, Anna; Gertel, Art

2016-01-01

Interventional clinical studies conducted in the regulated drug research environment are reported using International Council for Harmonisation (ICH) regulatory guidance documents: ICH E3 on the structure and content of clinical study reports (CSRs) published in 1995 and ICH E3 supplementary Questions & Answers (Q & A) published in 2012.Since the ICH guidance documents were published, there has been heightened awareness of the importance of disclosure of clinical study results. The use of the CSR as a key source document to fulfil emerging obligations has resulted in a re-examination of how ICH guidelines are applied in CSR preparation. The dynamic regulatory and modern drug development environments create emerging reporting challenges. Regulatory medical writing and statistical professionals developed Clarity and Openness in Reporting: E3-based (CORE) Reference over a 2-year period. Stakeholders contributing expertise included a global industry association, regulatory agency, patient advocate, academic and Principal Investigator representatives. CORE Reference should help authors navigate relevant guidelines as they create CSR content relevant for today's studies. It offers practical suggestions for developing CSRs that will require minimum redaction and modification prior to public disclosure.CORE Reference comprises a Preface, followed by the actual resource. The Preface clarifies intended use and underlying principles that inform resource utility. The Preface lists references contributing to development of the resource, which broadly fall into 'regulatory' and 'public disclosure' categories. The resource includes ICH E3 guidance text, ICH E3 Q & A 2012-derived guidance text and CORE Reference text, distinguished from one another through the use of shading. Rationale comments are used throughout for clarification purposes.A separate mapping tool comparing ICH E3 sectional structure and CORE Reference sectional structure is also provided.Together, CORE Reference and the mapping tool constitute the user manual. This publication is intended to enhance the use, understanding and dissemination of CORE Reference.The CORE Reference user manual and the associated website (http://www.core-reference.org) should improve the reporting of interventional clinical studies.Periodic updates of CORE Reference are planned to maintain its relevance. CORE Reference was registered with http://www.equator-network.org on 23 March 2015.

Initial, successful implementation of sepsis guidelines in an emergency department.

PubMed

Plambech, Morten Z; Lurie, Andrew I; Ipsen, Helle L

2012-12-01

Early screening and treatment of sepsis can reduce mortality. Region Zealand established guidelines for the diagnosis and treatment of sepsis. We assess an interdisciplinary intervention for implementation of these guidelines at the Department of Emergency Medicine at Nykøbing Falster Hospital from July 2009 to August 2010. Structured training was imparted to personnel during the first 18 weeks. Electronically accessible guidelines, posters with diagnostic and treatment algorithms, pocket references and checklists were made available to encourage adherence to the guidelines. Key nurses and doctors encouraged compliance. Journal audits (at baseline, 18 weeks and one year) were undertaken to measure adherence to six elements of the sepsis guidelines: lactate measurement, oxygen and fluid treatment, timely antibiotic treatment, blood culture and planning of treatment monitoring. A total of 27 (baseline), 29 (18 weeks) and 48 (one year) patients were included for analysis. Adherence to 3-5 of the elements of the sepsis guidelines' six elements increased from 37% to 65% from baseline to the first follow-up at 18 weeks (p = 0.03). Adherence to 3-5 of the elements decreased from the first to the second follow-up at one year. Lactate measurement, blood culture and antibiotic administration increased from baseline to the one-year follow-up. The intervention had a positive effect on the implementation of guidelines. This effect was reduced one year after the baseline audit, possibly due to a decline in the focus on the intervention and/or personnel turnover in the department.

Guidelines to identify abnormalities after childhood urinary tract infections: a prospective audit

PubMed Central

Coulthard, Malcolm G; Lambert, Heather J; Vernon, Susan J; Hunter, Elizabeth W; Keir, Michael J

2014-01-01

Objective To compare the childhood urinary tract infection (UTI) guidelines from the Royal College of Physicians (RCP) in 1991 and from National Institute of Health and Care Excellence (NICE) (CG54) in 2007 by measuring their efficiency at detecting urinary tract abnormalities. Design Children with UTIs within the Newcastle Primary Care Trust (population 70 800 children) were referred and imaged according to the RCP guidelines during 2008, and these were compared to the activity that would have been undertaken if we had implemented the CG54 guidelines, including following them through 2011 to identify those with recurrent UTIs. Main outcome measures The numbers of children imaged, the imaging burden and efficiency, and urinary tract abnormalities detected by each guideline. Results Fewer children would have been imaged by CG54 than RCP (150 vs 427), but its sensitivity was lower, at 44% for detecting scarring, 10% for identifying vesicoureteric reflux and 40% for other abnormalities. Overall, it would have only detected one-quarter of the abnormal cases (8 vs 32) and would have missed five of nine children with scarring, including three with multiple lesions and one with renal impairment. Imposing an age restriction of <8 years to the RCP guidelines would reduce its screening rate by 20% and still detect 90% of the abnormalities. Interpretation The CG54 guidelines do not alter the imaging efficiency compared to the RCP guidelines, but they are considerably less sensitive. PMID:24436366

World Health Organization Discontinues Its Drinking-Water Guideline for Manganese

PubMed Central

Frisbie, Seth H.; Mitchell, Erika J.; Dustin, Hannah; Maynard, Donald M.

2012-01-01

Background: The World Health Organization (WHO) released the fourth edition of Guidelines for Drinking-Water Quality in July 2011. In this edition, the 400-µg/L drinking-water guideline for manganese (Mn) was discontinued with the assertion that because “this health-based value is well above concentrations of manganese normally found in drinking water, it is not considered necessary to derive a formal guideline value.” Objective: In this commentary, we review the WHO guideline for Mn in drinking water—from its introduction in 1958 through its discontinuation in 2011. Methods: For the primary references, we used the WHO publications that documented the Mn guidelines. We used peer-reviewed journal articles, government reports, published conference proceedings, and theses to identify countries with drinking water or potential drinking-water supplies exceeding 400 µg/L Mn and peer-reviewed journal articles to summarize the health effects of Mn. Discussion: Drinking water or potential drinking-water supplies with Mn concentrations > 400 µg/L are found in a substantial number of countries worldwide. The drinking water of many tens of millions of people has Mn concentrations > 400 µg/L. Recent research on the health effects of Mn suggests that the earlier WHO guideline of 400 µg/L may have been too high to adequately protect public health. Conclusions: The toxic effects and geographic distribution of Mn in drinking-water supplies justify a reevaluation by the WHO of its decision to discontinue its drinking-water guideline for Mn. PMID:22334150

Comparison of Dissolution Similarity Assessment Methods for Products with Large Variations: f2 Statistics and Model-Independent Multivariate Confidence Region Procedure for Dissolution Profiles of Multiple Oral Products.

PubMed

Yoshida, Hiroyuki; Shibata, Hiroko; Izutsu, Ken-Ichi; Goda, Yukihiro

2017-01-01

The current Japanese Ministry of Health Labour and Welfare (MHLW)'s Guideline for Bioequivalence Studies of Generic Products uses averaged dissolution rates for the assessment of dissolution similarity between test and reference formulations. This study clarifies how the application of model-independent multivariate confidence region procedure (Method B), described in the European Medical Agency and U.S. Food and Drug Administration guidelines, affects similarity outcomes obtained empirically from dissolution profiles with large variations in individual dissolution rates. Sixty-one datasets of dissolution profiles for immediate release, oral generic, and corresponding innovator products that showed large variation in individual dissolution rates in generic products were assessed on their similarity by using the f 2 statistics defined in the MHLW guidelines (MHLW f 2 method) and two different Method B procedures, including a bootstrap method applied with f 2 statistics (BS method) and a multivariate analysis method using the Mahalanobis distance (MV method). The MHLW f 2 and BS methods provided similar dissolution similarities between reference and generic products. Although a small difference in the similarity assessment may be due to the decrease in the lower confidence interval for expected f 2 values derived from the large variation in individual dissolution rates, the MV method provided results different from those obtained through MHLW f 2 and BS methods. Analysis of actual dissolution data for products with large individual variations would provide valuable information towards an enhanced understanding of these methods and their possible incorporation in the MHLW guidelines.

Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children

PubMed Central

Murad, Mohammad H.; Pringsheim, Tamara; Feinstein, Anthony; Chang, Anne B.; Newcombe, Peter A.; Rubin, Bruce K.; McGarvey, Lorcan P.; Weir, Kelly; Altman, Kenneth W.; Weinberger, Miles; Irwin, Richard S.; Adams, Todd M.; Altman, Kenneth W.; Barker, Alan F.; Birring, Surinder S.; Blackhall, Fiona; Bolser, Donald C.; Boulet, Louis-Philippe; Braman, Sidney S.; Brightling, Christopher; Callahan-Lyon, Priscilla; Canning, Brendan J.; Chang, Anne B.; Coeytaux, Remy; Cowley, Terrie; Davenport, Paul; Diekemper, Rebecca L.; Ebihara, Satoru; El Solh, Ali A.; Escalante, Patricio; Feinstein, Anthony; Field, Stephen K.; Fisher, Dina; French, Cynthia T.; Gibson, Peter; Gold, Philip; Gould, Michael K.; Grant, Cameron; Harding, Susan M.; Harnden, Anthony; Hill, Adam T.; Irwin, Richard S.; Kahrilas, Peter J.; Keogh, Karina A.; Lane, Andrew P.; Lim, Kaiser; Malesker, Mark A.; Mazzone, Peter; Mazzone, Stuart; McCrory, Douglas C.; McGarvey, Lorcan; Molasiotis, Alex; Murad, M. Hassan; Newcombe, Peter; Nguyen, Huong Q.; Oppenheimer, John; Prezant, David; Pringsheim, Tamara; Restrepo, Marcos I.; Rosen, Mark; Rubin, Bruce; Ryu, Jay H.; Smith, Jaclyn; Tarlo, Susan M.; Vertigan, Anne E.; Wang, Gang; Weinberger, Miles; Weir, Kelly; Wiener, Renda Soylemez

2015-01-01

BACKGROUND: We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. METHODS: We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients’ values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology. RESULTS: The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate. CONCLUSIONS: Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality. PMID:25856777

Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario.

PubMed

Mehta, Yatin; Sunavala, J D; Zirpe, Kapil; Tyagi, Niraj; Garg, Sunil; Sinha, Saswati; Shankar, Bhuvaneshwari; Chakravarti, Sanghamitra; Sivakumar, M N; Sahu, Sambit; Rangappa, Pradeep; Banerjee, Tanmay; Joshi, Anshu; Kadhe, Ganesh

2018-04-01

Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.

Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario

PubMed Central

Mehta, Yatin; Sunavala, J. D.; Zirpe, Kapil; Tyagi, Niraj; Garg, Sunil; Sinha, Saswati; Shankar, Bhuvaneshwari; Chakravarti, Sanghamitra; Sivakumar, M. N.; Sahu, Sambit; Rangappa, Pradeep; Banerjee, Tanmay; Joshi, Anshu; Kadhe, Ganesh

2018-01-01

Background and Aim: Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. Methods: Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. Results: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. Conclusion: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols. PMID:29743765

Physiotherapy in asthma--seeking consensus.

PubMed

Nowobilski, Roman; Plaszewski, Maciej; Wloch, Tomasz; Mika, Piotr; Gajewski, Piotr; Brożek, Jan L

2013-08-01

The evidence base for or against physiotherapy interventions in asthmatic adults remains ambiguous, and there are discrepancies between different clinical practice guidelines. We evaluated the level of agreement between the recommendations about physiotherapy for adults with asthma in two major clinical practice guidelines: the Global Initiative for Asthma (GINA 2011) and the British Thoracic Society and the Association of Chartered Physiotherapists in Respiratory Care (BTS/ACPRC 2009). We used the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument to assess the methodological rigor of the guideline development, the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Physiotherapy Evidence Database (PEDro) scale to assess the methodological quality of systematic reviews and clinical trials included in the analyzed documents. Additionally, we compared the reference lists of the analyzed sections to establish the overlap in included primary and secondary studies. We observed no agreement between the two guidelines in the choice of source research articles. Only two studies out of 18 used in BTS guidelines were used in the GINA. The reason why GINA developers did not use the body of evidence included in BTS is that it is not clear. Three independent investigators indicated higher scores in all domains of the AGREE II in the BTS/ACPRC document in comparison with the GINA guidelines. The significant differences in the content and in the development processes of the examined sections of the two guidelines suggest the need for more frequent and careful updating or directing the readers of the GINA to the BTS/ACPRC, a guideline addressing specifically and more comprehensively physiotherapy interventions in asthma.

WHO Expert Committee on Specifications for Pharmaceutical Preparations.

PubMed

2011-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use: procedure for adoption of International Chemical Reference Substances; WHO good practices for pharmaceutical microbiology laboratories; good manufacturing practices: main principles for pharmaceutical products; good manufacturing practices for blood establishments (jointly with the Expert Committee on Biological Standardization); guidelines on good manufacturing practices for heating, ventilation and air-conditioning systems for non-sterile pharmaceutical dosage forms; good manufacturing practices for sterile pharmaceutical products; guidelines on transfer of technology in pharmaceutical manufacturing; good pharmacy practice: standards for quality of pharmacy services (joint FIP/WHO); model guidance for the storage and transport of time- and temperature-sensitive pharmaceutical products (jointly with the Expert Committee on Biological Standardization); procedure for prequalification of pharmaceutical products; guide on submission of documentation for prequalification of innovator finished pharmaceutical products approved by stringent regulatory authorities; prequalification of quality control laboratories: procedure for assessing the acceptability, in principle, of quality control laboratories for use by United Nations agencies; guidelines for preparing a laboratory information file; guidelines for drafting a site master file; guidelines on submission of documentation for a multisource (generic) finished product: general format: preparation of product dossiers in common technical document format.

International experts' practice in the antibiotic therapy of infective endocarditis is not following the guidelines.

PubMed

Tissot-Dupont, H; Casalta, J P; Gouriet, F; Hubert, S; Salaun, E; Habib, G; Fernandez-Gerlinger, M P; Mainardi, J L; Tattevin, P; Revest, M; Lucht, F; Botelho-Nevers, E; Gagneux-Brunon, A; Snygg-Martin, U; Chan, K L; Bishara, J; Vilacosta, I; Olmos, C; San Román, J A; López, J; Tornos, P; Fernández-Hidalgo, N; Durante-Mangoni, E; Utili, R; Paul, M; Baddour, L M; DeSimone, D C; Sohail, M R; Steckelberg, J M; Wilson, W R; Raoult, D

2017-10-01

The management of infective endocarditis (IE) may differ from international guidelines, even in reference centres. This is probably because most recommendations are not based on hard evidence, so the consensus obtained for the guidelines does not represent actual practices. For this reason, we aimed to evaluate this question in the particular field of antibiotic therapy. Thirteen international centres specialized in the management of IE were selected, according to their reputation, clinical results, original research publications and quotations. They were asked to detail their actual practice in terms of IE antibiotic treatment in various bacteriological and clinical situations. They were also asked to declare their IE-related in-hospital mortality for the year 2015. The global compliance with guidelines concerning antibiotic therapy was 58%, revealing the differences between theoretical 'consensus', local recommendations and actual practice. Some conflicts of interest were also probably expressed. The adherence to guidelines was 100% when the protocol was simple, and decreased with the seriousness of the situation (Staphylococus spp. 54%-62%) or in blood-culture-negative endocarditis (0%-15%) that requires adaptation to clinical and epidemiological data. Worldwide experts in IE management, although the majority of them were involved and co-signed the guidelines, do not follow international consensus guidelines on the particular point of the use of antibiotics. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary care: a systematic review of current COPD guidelines.

PubMed

Laue, Johanna; Reierth, Eirik; Melbye, Hasse

2015-02-19

Not all patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) benefit from treatment with systemic corticosteroids and antibiotics. The aim of the study was to identify criteria recommended in current COPD guidelines for treating acute exacerbations with systemic corticosteroids and antibiotics and to assess the underlying evidence. Current COPD guidelines were identified by a systematic literature search. The most recent guidelines as per country/organisation containing recommendations about treating acute exacerbations of COPD were included. Guideline development and criteria for treating acute exacerbations with systemic corticosteroids and antibiotics were appraised. Randomised controlled trials directly referred to in context with the recommendations were evaluated in terms of study design, setting, and study population. A total of 19 COPD guidelines were included. Systemic corticosteroids were often universally recommended to all patients with acute exacerbations. Criteria for treatment with antibiotics were mainly an increase in respiratory symptoms. Objective diagnostic tests or clinical examination were only rarely recommended. Only few criteria were directly linked to underlying evidence, and the trial patients represented a highly specific group of COPD patients. Current COPD guidelines are of little help in primary care to identify patients with acute exacerbations probably benefitting from treatment with systemic corticosteroids and antibiotics in primary care, and might contribute to overuse or inappropriate use of either treatment.

Accordance of Online Health Information on Prostate Cancer with the European Association of Urology Guidelines.

PubMed

Bruendl, Johannes; Rothbauer, Clemens; Ludwig, Bernd; Dotzler, Bernhard; Wolff, Christian; Reimann, Sandra; Borgmann, Hendrik; Burger, Maximilian; Breyer, Johannes

2018-01-01

The internet is an emerging source of information for prostate cancer (PCa) patients. Since little is known about the quality of information on PCa provided online, we investigated its accordance to the latest European Association of Urology (EAU) guidelines. A total of 89 German web pages were included for analysis. A quality model classifying the provider of information and its expertise was introduced. Correctness of provided information was systematically compared to the EAU guidelines. Information was provided by medical experts (41%), media (11%), and pharmaceutical companies (6%). Certificates were found in 23% with a significantly higher rate if provided by medical experts (p = 0.003). The minority of web pages showed information in accordance with the EAU guidelines regarding screening (63%), diagnosis (32%), classification (39%), therapy (36%), complications (8%), and follow-up (27%). Web pages by medical experts as well as websites with any kind of certification showed a significantly higher guideline conformity regarding diagnosis (p = 0.027, p = 0.002), therapy (p = 0.010, p = 0.011), follow-up (p = 0.005, p < 0.001), and availability of references (p = 0.017, p = 0.003). The present study reveals that online health information on PCa lacks concordance to current guidelines. Certified websites or websites provided by medical experts showed a significantly higher quality and accordance with guidelines. © 2018 S. Karger AG, Basel.

Management of palpable breast lumps. Consensus guideline for family physicians.

PubMed Central

Heisey, R.; Mahoney, L.; Watson, B.

1999-01-01

OBJECTIVE: To describe an approach to managing women who present with palpable breast lumps. QUALITY OF EVIDENCE: Databases were searched from 1990 to 1998 using the search terms breast lumps, breast diseases, and breast cysts. Bibliographies of the articles obtained were searched for further relevant titles. Most evidence on management of breast cysts was obtained from cohort studies. Evidence on family physicians' approach to managing breast lumps is based on a review of the 1998 Canadian consensus guidelines and a review of a 1998 consensus guideline by 12 University of Toronto surgical oncologists (U of T guidelines). MAIN MESSAGE: Family physicians can manage women presenting with breast lumps if they have skill in breast cyst aspiration. Most breast cysts can be cured in minutes, thus avoiding unwarranted anxiety and eliminating unnecessary additional investigations and referrals. Women presenting with solid lesions should be referred to a surgeon. CONCLUSIONS: Breast cyst aspiration is a simple technique family physicians can use to either cure breast lumps or define appropriate cases for referral. PMID:10463093

WHO expert committee on specifications for pharmaceutical preparations. Fortieth report.

PubMed

2006-01-01

This report presents the recommendations of an international group of experts convened by the World Health Organization to consider matters concerning the quality assurance of pharmaceuticals and specifications for drug substances and dosage forms. The report is complemented by a number of annexes. These include: a list of available International Chemical Reference Substances and International Infrared Spectra; supplementary guidelines on good manufacturing practices for heating, ventilation and air-conditioning systems for non-sterile pharmaceutical dosage forms; updated supplementary guidelines on good manufacturing practices for the manufacture of herbal medicines; supplementary guidelines on good manufacturing practices for validation; good distribution practices for pharmaceutical products; a model quality assurance system for procurement agencies (recommendations for quality assurance systems focusing on prequalification of products and manufacturers, purchasing, storage and distribution of pharmaceutical products); multisource (generic) pharmaceutical products: guidelines on registration requirements to establish interchangeability; a proposal to waive in vivo bioequivalence requirements for WHO Model List of Essential Medicines immediate-release, solid oral dosage forms; and additional guidance for organizations performing in vivo bioequivalence studies.

Managing Asthma in Primary Care: Putting New Guideline Recommendations Into Context

PubMed Central

Wechsler, Michael E.

2009-01-01

Many patients with asthma are treated in the primary care setting. The primary care physician is therefore in a key position to recognize poorly controlled asthma and to improve asthma management for these patients. However, current evidence continues to show that, for a substantial number of patients, asthma control is inadequate for a wide variety of reasons, both physician-related and patient-related. The most recently updated treatment guidelines from the National Asthma Education and Prevention Program were designed to help clinicians, including primary care physicians, manage asthma more effectively with an increased focus on achieving and maintaining good asthma control over time. The current review is intended to assist primary care physicians in improving asthma control among their patients; this review clarifies the new guidelines and provides a specialist's perspective on diagnosis, appropriate therapy, disease control surveillance, and appropriate referral when necessary. This discussion is based primarily on the new guidelines and the references cited therein, supplemented by the author's own clinical experience. PMID:19648388

A Critical Commentary on the 2017 AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology.

PubMed

de Leon, Jose

2018-01-01

In 2004, 2011, and 2017, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), a group of German-speaking psychiatric researchers and psychiatrists, published successive versions of therapeutic drug monitoring (TDM) expert group consensus guidelines. The 2017 version has as a major strength its encyclopedic nature, including 1358 references. The guideline has 3 major sections: 1) theoretical aspects of TDM, 2) drug concentration levels in blood to guide neuropsychopharmacotherapy, and 3) practical aspects of TDM in psychiatry and neurology. The writer hopes the time is right for a TDM guideline in psychiatry, which is indicated for: 1) psychiatric researchers ready to value how TDM can contribute to moving psychopharmacology forward, 2) flexible clinicians ready to improve their patient care by personalizing dosing, and 3) today's psychiatry residents prepared as a new generation ready to be trained in TDM and willing to continue incorporating TDM as new psychiatric drugs are marketed. © Georg Thieme Verlag KG Stuttgart · New York.

Employee Protection Guidelines, Section 5333(b), Federal Transit Law

DOT National Transportation Integrated Search

1995-12-07

The Federal Transit law, Title 49 U.S.C., Chapter 53, provides, in general, at Section 5333(b) (commonly referred to as ''Section 13(c)'', that, as a condition of certain Federal financial assistance by the Department of Transportation's Federal Tran...

43 CFR 11.18 - Incorporation by reference.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Values of Freshwater Fish and Fish-Kill Guidelines,” American Fisheries Society Special Publication... Type A Natural Resource Damage Assessment Model for Coastal and Marine Environments Technical... the U.S. Department of the Interior by Applied Science Associates, Inc., and Hagler Bailly Consulting...

43 CFR 11.18 - Incorporation by reference.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Values of Freshwater Fish and Fish-Kill Guidelines,” American Fisheries Society Special Publication... Type A Natural Resource Damage Assessment Model for Coastal and Marine Environments Technical... the U.S. Department of the Interior by Applied Science Associates, Inc., and Hagler Bailly Consulting...

43 CFR 11.18 - Incorporation by reference.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Values of Freshwater Fish and Fish-Kill Guidelines,” American Fisheries Society Special Publication... Type A Natural Resource Damage Assessment Model for Coastal and Marine Environments Technical... the U.S. Department of the Interior by Applied Science Associates, Inc., and Hagler Bailly Consulting...

43 CFR 11.18 - Incorporation by reference.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Values of Freshwater Fish and Fish-Kill Guidelines,” American Fisheries Society Special Publication... Type A Natural Resource Damage Assessment Model for Coastal and Marine Environments Technical... the U.S. Department of the Interior by Applied Science Associates, Inc., and Hagler Bailly Consulting...

43 CFR 11.18 - Incorporation by reference.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Values of Freshwater Fish and Fish-Kill Guidelines,” American Fisheries Society Special Publication... Type A Natural Resource Damage Assessment Model for Coastal and Marine Environments Technical... the U.S. Department of the Interior by Applied Science Associates, Inc., and Hagler Bailly Consulting...

Liquid and gaseous oxygen safety review

NASA Technical Reports Server (NTRS)

Lapin, A.

1973-01-01

Materials used in oxygen systems and allowable oxygen environments are specified for each material. Design criteria, cleaning procedures and quality control methods are covered. Guidelines for protection against hazards involved with production, transportation, storage and use of oxygen are presented. Study also lists extensive references.

Are some people suffering as a result of increasing mass exposure of the public to ultrasound in air?

PubMed

Leighton, T G

2016-01-01

New measurements indicate that the public are being exposed, without their knowledge, to airborne ultrasound. Existing guidelines are insufficient for such exposures; the vast majority refers to occupational exposure only (where workers are aware of the exposure, can be monitored and can wear protection). Existing guidelines are based on an insufficient evidence base, most of which was collected over 40 years ago by researchers who themselves considered it insufficient to finalize guidelines, but which produced preliminary guidelines. This warning of inadequacy was lost as nations and organizations issued 'new' guidelines based on these early guidelines, and through such repetition generated a false impression of consensus. The evidence base is so slim that few reports have progressed far along the sequence from anecdote to case study, to formal scientific controlled trials and epidemiological studies. Early studies reported hearing threshold shifts, nausea, headache, fatigue, migraine and tinnitus, but there is insufficient research on human subjects, and insufficient measurement of fields, to assess what health risk current occupational and public exposures might produce. Furthermore, the assumptions underpinning audiology and physical measurements at high frequencies must be questioned: simple extrapolation of approaches used at lower frequencies does not address current unknowns. Recommendations are provided.

Diagnosis, Management And Prevention Of Hepatitis C In Pakistan 2017.

PubMed

Umar, Muhammad; Khaar, Hamama-Tul-Bushra; Akhter, Tayyab Saeed; Aslam, Faiza; Ahmad, Syed Irfan; Asghar, Rai Mohammad; Khurram, Mohammad; Hussain, Tassawar; Salamat, Amjad; Khan, Anwar A; Fazal-E-Hadi; Minhas, Zahid Mahmood; Shah, Hasnain Ali; Farooqui, Javed; Naqvi, Asif Abbas; Mohsin, Aftab; Waseem-Ud-Din; Bhutta, Sohail Iqbal; Hasnain Syed, Sibt Ul; Qureshi, Saleem; Adam, Tashfeen; Uddin, Moazzam; Tayyab, Ghias-U-Nabi; Najeeb Ul Haq; Shoaib, Atifa; Ambreen, Saima; Shahzad, Arslan; Ikram, Nadeem; Nisar, Gul; Khan, Mohammad Mujeeb; Osama, Mohammad

2016-01-01

Since the advent of direct acting antiviral agents, there is a revolutionary change in the management of HCV infection. Newer drugs with different mechanism of action are being introduced and are expected to be available in coming few months in Pakistan as well. The main purpose of the guideline is to review and induct the latest research in field of HCV infection in Pakistani perspective so that our healthcare professionals can apply the new recommendations in timely and judicial manner. Target groups of guidelines are general physicians treating hepatitis C, hepatologists and gastroenterologists. Other beneficiaries of these guidelines are public health institutions of Pakistan, which provide free treatment to deserving patients under National Hepatitis Prevention and Control Program and Pakistan Bait-ul- Mal Program. These guidelines are based on the review of National consensus practice guidelines: Diagnosis, Management and Prevention of Hepatitis C Pakistan 2009. Published data in National and International Journals searched with the help of Google search and pub med, and 2015-16 guidelines of HCV by AASLD, EASL, APASL and WHO. Local studies are preferably added with references to enhance the Pakistani perspective. Evidence was also taken from published studies. Recommendations have been based upon evidence from national publications on the subject and scientific presentations at national liver meeting as well from experts' personal experience and opinion.

Are some people suffering as a result of increasing mass exposure of the public to ultrasound in air?

PubMed Central

Leighton, T. G.

2016-01-01

New measurements indicate that the public are being exposed, without their knowledge, to airborne ultrasound. Existing guidelines are insufficient for such exposures; the vast majority refers to occupational exposure only (where workers are aware of the exposure, can be monitored and can wear protection). Existing guidelines are based on an insufficient evidence base, most of which was collected over 40 years ago by researchers who themselves considered it insufficient to finalize guidelines, but which produced preliminary guidelines. This warning of inadequacy was lost as nations and organizations issued ‘new’ guidelines based on these early guidelines, and through such repetition generated a false impression of consensus. The evidence base is so slim that few reports have progressed far along the sequence from anecdote to case study, to formal scientific controlled trials and epidemiological studies. Early studies reported hearing threshold shifts, nausea, headache, fatigue, migraine and tinnitus, but there is insufficient research on human subjects, and insufficient measurement of fields, to assess what health risk current occupational and public exposures might produce. Furthermore, the assumptions underpinning audiology and physical measurements at high frequencies must be questioned: simple extrapolation of approaches used at lower frequencies does not address current unknowns. Recommendations are provided. PMID:26997897

A selective annotated bibliography for clinical audiology (1988-2008): reference works.

PubMed

Ferrer-Vinent, Susan T; Ferrer-Vinent, Ignacio J

2009-06-01

This is the 1st in a series of 3 planned companion articles that present a selected, annotated, and indexed bibliography of clinical audiology publications from 1988 to 2008. Research and preparation of the bibliography were based on published guidelines, professional audiology experience, and professional librarian experience. This article presents reference works (dictionaries, encyclopedias, handbooks, and manuals). The future planned articles will cover other monographs, periodicals, and online resources. Audiologists and librarians can use these lists as a guide when seeking clinical audiology literature.

ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff.

PubMed

Gameiro, S; Boivin, J; Dancet, E; de Klerk, C; Emery, M; Lewis-Jones, C; Thorn, P; Van den Broeck, U; Venetis, C; Verhaak, C M; Wischmann, T; Vermeulen, N

2015-11-01

Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial care they would like to receive at clinics and how this care is associated with their well-being. The second section of the guideline provides information about the psychosocial needs patients experience across their treatment pathway (before, during and after treatment) and how fertility clinic staff can detect and address these. Needs refer to conditions assumed necessary for patients to have a healthy experience of the fertility treatment. Needs can be behavioural (lifestyle, exercise, nutrition and compliance), relational (relationship with partner if there is one, family friends and larger network, and work), emotional (well-being, e.g. anxiety, depression and quality of life) and cognitive (treatment concerns and knowledge). We identified many areas in care for which robust evidence was lacking. Gaps in evidence were addressed by formulating good practice points, based on the expert opinion of the GDG, but it is critical for such recommendations to be empirically validated. The evidence presented in this guideline shows that providing routine psychosocial care is associated with or has potential to reduce stress and concerns about medical procedures and improve lifestyle outcomes, fertility-related knowledge, patient well-being and compliance with treatment. As only 45 (36.0%) of the 125 recommendations were based on high-quality evidence, the guideline group formulated recommendations to guide future research with the aim of increasing the body of evidence. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Reevaluating reference ranges of oxygen saturation for healthy full-term neonates using pulse oximetry.

PubMed

Lu, Ying-Chun; Wang, Chih-Chien; Lee, Chuen-Ming; Hwang, Kwei-Shuai; Hua, Yi-Ming; Yuh, Yeong-Seng; Chiu, Yu-Lung; Hsu, Wan-Fu; Chou, Ya-Ling; Huang, Shao-Wei; Lee, Yih-Jing; Fan, Hueng-Chuen

2014-12-01

We compared our clinical experience with currently available reference oxygen saturation level (SpO(2)) values from the American Academy of Pediatrics/American Heart Association (AAP/AHA) neonatal resuscitation program guidelines. We enrolled 145 healthy full-term neonates; infants showing respiratory distress and those with serious congenital anomalies were excluded. SpO(2) values at every 1 minute until 10 minutes after birth were measured and recorded. Infants were classified into the cesarean section (CS) and normal spontaneous delivery (NSD) groups for evaluating differences. The 10(th) percentiles of SpO(2) at each minute were used as the lower limits of normal oxygen saturation, and these were compared with the lowest target values recommended in the AAP/AHA guidelines. Overall, 130 vigorous full-term neonates (median gestational age: 38 5/7 weeks; body weight at birth: 2405-3960 g) were analyzed. The median SpO(2) were 67% and 89% at the 1(st) and 4(th) minute, respectively. On average, SpO(2) values reached >90% at the 5(th) minute. No statistical differences were noted in the SpO(2) values between the CS and NSD groups after 5 minutes; however, a trend of higher SpO(2) was observed in the NSD group. We noted a gradually increasing trend for SpO(2) values over time, similar to that noted in the AAP/AHA guidelines. However, SpO(2) values at the 10(th) percentiles of each minute within the first 5 minutes in our study were equal to or significantly lower than those in the AAP/AHA guidelines; moreover, at the 10(th) minute, SpO(2) values at the 10(th) percentiles were significantly higher than those in the guidelines. The delivery modes did not affect the SpO(2) values of full-term healthy neonates. Discrepancies in SpO(2) changes in full-term neonates not requiring resuscitation between this study and the AAP/AHA guidelines were significant. SpO(2) ranges for each time point within the first 10 minutes after birth should therefore be reevaluated locally. Copyright © 2014. Published by Elsevier B.V.

Have guidelines about smoking cessation support in pregnancy changed practice in Victoria, Australia?

PubMed

Perlen, Susan; Brown, Stephanie J; Yelland, Jane

2013-06-01

Antenatal smoking cessation guidelines have been available in Victoria, Australia, for the past decade. The objective of this study was to assess to what extent introduction of smoking cessation guidelines in pregnancy changed practice in Victorian public hospitals. Two population-based postal surveys of women giving birth in the state of Victoria, conducted in 2000 and 2008 before and after implementation of smoking cessation guidelines. Self-administered questionnaires were distributed by hospitals and home birth practitioners to women 5-6 months postpartum. Surveys were completed and returned by 67 percent of eligible women (1,616/2,412) in 2000 and 51% (2,900/5,681) in 2008. Compared with the 2000 survey, women in the 2008 survey attending public sector care were more likely: to receive advice on how to stop smoking (Adjusted Odds Ratio: 2.2, 95% CI 1.5-3.2); to be given written information (Adj OR: 2.7, 95% CI 1.8-4.0); to be referred to stop smoking programs (Adj OR: 6.1, 95% CI 3.1-11.7); and to have discussed smoking cessation at more than one visit (Adj OR: 1.5, 95% CI 1.0-2.2). While the majority of women in both surveys were asked about smoking in early pregnancy, about half of those smoking did not receive advice on how to stop or cut down; were not given written information; were not told about/referred to stop smoking programs and were not asked again about smoking at subsequent visits. The significant shift in women's reports of receiving smoking cessation advice and support between the two surveys occurred predominantly at public hospitals where women received all or some antenatal care. Smoking cessation guidelines in Victorian public hospitals have increased the extent to which pregnant women receive advice and support to stop or reduce smoking. However, half of smokers did not receive the full complement of advice and support according to state guidelines, with marked variability according to where and from whom women received antenatal care. Further efforts are needed to implement smoking cessation advice and support in clinical practice. © 2013, Copyright the Authors, Journal compilation © 2013, Wiley Periodicals, Inc.

Guidelines Regarding §16 of the German Transplantation Act - Initial Experiences with Structured Reporting.

PubMed

Pinto Dos Santos, Daniel; Arnhold, Gordon; Mildenberger, Peter; Düber, Christoph; Kloeckner, Roman

2017-12-01

Purpose  To transfer the report sheet from the guidelines regarding the German Transplantation Act to a standards-compliant report template and to evaluate it in the clinical routine. Materials and Methods  The template was developed using the freely available software brackets.io. It was implemented in the clinical routine using a reporting platform developed in-house. Interfaces to the department RIS and PACS allowed for integration into the usual reporting workflow. The evaluation period was 70 days. Results  Developing the template for implementation of the guidelines was possible without any difficulties. The content of the report sheet provided in the guidelines was transferred one to one. Additionally, a text field was included to allow for further remarks. In the period under review, 7 radiologists performed 44 evaluations in line with § 16 of the German Transplantation Act. Users of the template, referring physicians and the employees of the transplantation office reported a high degree of satisfaction. Conclusion  Implementing report sheets that are required by law (e. g. in the guidelines regarding § 16 of the German Transplantation Act) in the clinical routine electronically is easy and achieves a high degree of acceptance. The standard supported by the German Radiological Society (IHE - "Management of radiology report templates") allows for a quick response to the growing demand for structured and standardized reporting. Key Points   · Report sheets as required by law can easily be incorporated electronically into the clinical routine.. · Templates for structured reporting as supported by the German Radiological Society allow for a quick response to the growing demand for standardized reporting.. · Radiologists as well as referring physicians report a high degree of satisfaction with the electronic version of the report sheet.. Citation Format · Pinto dos Santos D, Arnhold G, Mildenberger P et al. Guidelines Regarding §16 of the German Transplantation Act - Initial Experiences with Structured Reporting. Fortschr Röntgenstr 2017; 189: 1145 - 1151. © Georg Thieme Verlag KG Stuttgart · New York.

Real-world echocardiography in patients referred for mitral valve surgery: the gap between guidelines and clinical practice.

PubMed

De Groot-de Laat, Lotte E; Ren, Ben; McGhie, Jackie; Oei, Frans B S; Raap, Goris Bol; Bogers, J J C; Geleijnse, Marcel L

2014-11-01

Mitral regurgitation (MR) is a common disorder for which mitral valve surgery is an established therapy. Although surgical indications are clearly defined for the management of valvular heart disease, a gap exists between current guidelines and their effective application. The study aim was to provide an insight into the diagnostic information provided for cardiac surgeons before performing mitral valve surgery. The source documents and echocardiographic studies of 100 patients, referred by nine hospitals, were screened for arguments for MR severity justifying referral for surgery. Details of the documented MR mechanism, mitral annulus (MA) size, tricuspid regurgitation (TR) severity and annulus size were also noted. According to the referring physician, MR was severe in 83% and moderate-to-severe in 17%. In the great majority of patients (98%) the MR mechanism was mentioned, although specific information on the prolapsing scallops was available in only 17% of cases. The recommended primary determinants of MR severity, vena contracta and proximal isovelocity surface area (PISA) were measured in only 22% and 31% of patients, respectively. In 94% of patients with available PISA information this was described only qualitatively. Correct image expansion using the zoom mode was performed in only 25% of these patients, and a correct adaptation of the Nyquist limit in only 6%. Tricuspid annulus measurements guiding the need for concomitant tricuspid valvuloplasty in patients with less than severe TR were reported in only 6% of patients. These data demonstrate a clear and important gap between current guidelines and real-world practice with regards to the echocardiographic diagnostic information provided to the surgeon before performing mitral valve surgery.

The management of Gaucher disease in developing countries: a successful experience in Southern Brazil.

PubMed

Krug, B C; Schwartz, I V; Lopes de Oliveira, F; Alegra, T; Campos Martins, N L; Todeschini, L A; Picon, P D

2010-01-01

Gaucher disease (GD) is a genetic disease caused by glucocerebrosidase deficiency. GD is treated by enzyme replacement therapy (ERT) with imiglucerase, a high-cost drug provided by the Brazilian Ministry of Health (BMH). This study reports the implementation of the BMH guidelines for GD in the southernmost state of the country. We review the clinical and laboratorial data for patients seen at the reference center for GD from Rio Grande do Sul, Brazil (July 2003 to June 2006). Twenty-five patients were included in this study. At baseline, 19/20 were on ERT (mean dosage of imiglucerase = 51.8 U/kg/infusion), 3/17 presented anemia, and 5/16 thrombocytopenia. The amount of imiglucerase prescribed to these patients was adjusted according to the guidelines in July 2003; out of them, 18 were receiving ERT in the reference center at month 36 (mean dosage of imiglucerase = 27.5 U/kg/infusion), 2/18 presented anemia, and 4/18 presented thrombocytopenia. The analysis of the liver, spleen, and bone data presented some limitations, but the available information suggests that patients did not deteriorate. GD patients who initiated ERT after July 2003 (n = 5) received lower dosage of imiglucerase since the beginning of the treatment; most of them demonstrated clinical and laboratorial response. From baseline to month 36, the consumption of imiglucerase by the reference center showed a significant reduction, which represented savings of USD 3 million to the public health system. The model of care of GD patients suggested by the BMH guidelines appears to be cost-effective and could be an example for management of rare diseases in underdeveloped countries. Copyright © 2009 S. Karger AG, Basel.

Appraisal Tools for Clinical Practice Guidelines: A Systematic Review

PubMed Central

Siering, Ulrich; Eikermann, Michaela; Hausner, Elke; Hoffmann-Eßer, Wiebke; Neugebauer, Edmund A.

2013-01-01

Introduction Clinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools. Methods Among others we searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from 1995 to May 2011 for relevant primary and secondary publications. We also handsearched the reference lists of relevant publications. On the basis of the available literature we firstly generated 34 items to be used in the comparison of appraisal tools and grouped them into thirteen quality dimensions. We then extracted formal characteristics as well as questions and statements of the appraisal tools and assigned them to the items. Results We identified 40 different appraisal tools. They covered between three and thirteen of the thirteen possible quality dimensions and between three and 29 of the possible 34 items. The main focus of the appraisal tools were the quality dimensions “evaluation of evidence” (mentioned in 35 tools; 88%), “presentation of guideline content” (34 tools; 85%), “transferability” (33 tools; 83%), “independence” (32 tools; 80%), “scope” (30 tools; 75%), and “information retrieval” (29 tools; 73%). The quality dimensions “consideration of different perspectives” and “dissemination, implementation and evaluation of the guideline” were covered by only twenty (50%) and eighteen tools (45%) respectively. Conclusions Most guideline appraisal tools assess whether the literature search and the evaluation, synthesis and presentation of the evidence in guidelines follow the principles of evidence-based medicine. Although conflicts of interest and norms and values of guideline developers, as well as patient involvement, affect the trustworthiness of guidelines, they are currently insufficiently considered. Greater focus should be placed on these issues in the further development of guideline appraisal tools. PMID:24349397

Quality of Author Guidelines in Nursing Journals

PubMed Central

Nicoll, Leslie H.; Chinn, Peggy L.; Conklin, Jamie L.; McCarty, Midori; Amarasekara, Sathya

2018-01-01

Abstract Purpose The aims of this study were to (a) describe the information provided in author guidelines in nursing journals, (b) assess the completeness of this information, and (c) identify the extent and types of reporting guidelines used in nursing journals. Design Content analysis of author guidelines for 245 nursing journals included in the Directory of Nursing Journals maintained at the International Academy of Nursing Editors website. Methods Using Research Electronic Data Capture, data on 19 criteria for completeness were extracted from published author guidelines. Additional details about journal requirements, such as allowed length of manuscripts and format for the abstract, were also recorded. Reliability was established by simultaneous review of 25 journals (10%) by the research assistant and a senior member of the research team. Findings Author guidelines were easily accessible at journal websites or through links to download the information. A majority (73.5%) had completeness scores of 75% or higher; six journals had guidelines that were 100% complete. Half of the journals used the American Psychological Association reference style, and 26.3% used the American Medical Association style. Less than one fourth had stated requirements to use reporting guidelines such as Consolidated Standards of Reporting Trials (CONSORT) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Conclusions Author guidelines for nursing journals are generally complete and informative. Although specific reporting guidelines such as CONSORT and PRISMA improve the accuracy and completeness of manuscripts on various types of studies, most nursing journals do not indicate use of these for manuscript preparation. Editors who want to improve their author guidelines should use the 19 criteria for completeness as a gauge for updating and revision. Clinical Relevance Nurses rely on the published literature to inform their practice and ensure that it is based on evidence. Guidelines for publishing in the scholarly literature assist clinicians and scholars to ensure that published articles are complete, current, concise, and accurate. PMID:29645403

Quality of Author Guidelines in Nursing Journals.

PubMed

Oermann, Marilyn H; Nicoll, Leslie H; Chinn, Peggy L; Conklin, Jamie L; McCarty, Midori; Amarasekara, Sathya

2018-04-12

The aims of this study were to (a) describe the information provided in author guidelines in nursing journals, (b) assess the completeness of this information, and (c) identify the extent and types of reporting guidelines used in nursing journals. Content analysis of author guidelines for 245 nursing journals included in the Directory of Nursing Journals maintained at the International Academy of Nursing Editors website. Using Research Electronic Data Capture, data on 19 criteria for completeness were extracted from published author guidelines. Additional details about journal requirements, such as allowed length of manuscripts and format for the abstract, were also recorded. Reliability was established by simultaneous review of 25 journals (10%) by the research assistant and a senior member of the research team. Author guidelines were easily accessible at journal websites or through links to download the information. A majority (73.5%) had completeness scores of 75% or higher; six journals had guidelines that were 100% complete. Half of the journals used the American Psychological Association reference style, and 26.3% used the American Medical Association style. Less than one fourth had stated requirements to use reporting guidelines such as Consolidated Standards of Reporting Trials (CONSORT) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Author guidelines for nursing journals are generally complete and informative. Although specific reporting guidelines such as CONSORT and PRISMA improve the accuracy and completeness of manuscripts on various types of studies, most nursing journals do not indicate use of these for manuscript preparation. Editors who want to improve their author guidelines should use the 19 criteria for completeness as a gauge for updating and revision. Nurses rely on the published literature to inform their practice and ensure that it is based on evidence. Guidelines for publishing in the scholarly literature assist clinicians and scholars to ensure that published articles are complete, current, concise, and accurate. © 2018 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

Developing a guideline to standardize the citation of bioresources in journal articles (CoBRA).

PubMed

Bravo, Elena; Calzolari, Alessia; De Castro, Paola; Mabile, Laurence; Napolitani, Federica; Rossi, Anna Maria; Cambon-Thomsen, Anne

2015-02-17

Many biomedical publications refer to data obtained from collections of biosamples. Sharing such bioresources (biological samples, data, and databases) is paramount for the present governance of research. Recognition of the effort involved in generating, maintaining, and sharing high quality bioresources is poorly organized, which does not encourage sharing. At publication level, the recognition of such resources is often neglected and/or highly heterogeneous. This is a true handicap for the traceability of bioresource use. The aim of this article is to propose, for the first time, a guideline for reporting bioresource use in research articles, named CoBRA: Citation of BioResources in journal Articles. As standards for citing bioresources are still lacking, the members of the journal editors subgroup of the Bioresource Research Impact Factor (BRIF) initiative developed a standardized and appropriate citation scheme for such resources by informing stakeholders about the subject and raising awareness among scientists and in science editors' networks, mapping this topic among other relevant initiatives, promoting actions addressed to stakeholders, launching surveys, and organizing focused workshops. The European Association of Science Editors has adopted BRIF's suggestion to incorporate statements on biobanks in the Methods section of their guidelines. The BRIF subgroup agreed upon a proposed citation system: each individual bioresource that is used to perform a study and that is mentioned in the Methods section should be cited as an individual "reference [BIORESOURCE]" according to a delineated format. The EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network mentioned the proposed reporting guideline in their "guidelines under development" section. Evaluating bioresources' use and impact requires that publications accurately cite such resources. Adopting the standard citation scheme described here will improve the quality of bioresource reporting and will allow their traceability in scientific publications, thus increasing the recognition of bioresources' value and relevance to research. Please see related article: http://dx.doi.org/10.1186/s12916-015-0284-9.

[Antibacterial therapy for acute cystitis in the age of growing pathogen resistance].

PubMed

Siniakova, L A

2014-01-01

Acute cystitis refers to uncomplicated lower urinary tract infections, with the recurrence rates after the first cystitis episode being 50%. The basic treatment for the above diseases is antibacterial therapy, whose efficiency depends entirely on the right choice of a drug during initial empiric therapy. The paper gives the European Association of Urology guidelines and Russian guidelines, which are based on the results of both international (ARESC) and Russian (DARMIS) studies of urinary tract infection pathogens and their susceptibility to antibacterial drugs. Phosphomycin trometamol and furasidine potassium are the drugs of choice to treat acute cystitis in Russia now.

Biosafety: guidelines for working with pathogenic and infectious microorganisms.

PubMed

Burnett, LouAnn C; Lunn, George; Coico, Richard

2009-05-01

This unit, in conjunction with local and national guidelines and regulations (see APPENDIX 1B), provides the basic biosafety information needed to perform the procedures detailed in this manual. Topics discussed include routine precautions when working with biohazards, disinfectants, disposal of biohazards, biosafety levels (as established by the U.S. National Institutes of Health and the U.S. Centers for Disease Control and Prevention), animal facilities, and clinical laboratories. In addition, resources for more information are provided in the Literature Cited and Key References sections and in URLs given within the text, as well as the Internet Resources section.

[Hypothyroidism during pregnancy risks the child's neurocognitive development. New guidelines and remaining knowledge gaps].

PubMed

Skalkidou, Alkistis; Bixo, Marie; Sköldebrand Sparre, Ann-Charlotte; Strandell, Annika; Lindén Hirschberg, Angelica; Filipsson Nyström, Helena

2016-02-05

Thyroid abnormalities are common during pregnancy and can affect pregnancy outcome. In 2012, the working group for endocrinology was assigned by SFOG to develop evidence based guidelines for their management. There is high quality evidence that untreated clinical hypothyroidism increases the risk of pregnancy and fetal complications. Subclinical hypothyroidism is associated with pregnancy complications. The presence of TPO-antibodies is linked to miscarriage and premature birth. It is uncertain whether subclinical hypothyroidism/maternal TPO-antibodies adversely affect the child's neurocognitive development. Reference intervals for TSH among pregnant women in Sweden need to be established.

Reference Values for the Six-Minute Walk Test in Healthy Children and Adolescents: a Systematic Review.

PubMed

Cacau, Lucas de Assis Pereira; de Santana-Filho, Valter Joviniano; Maynard, Luana G; Gomes, Mansueto; Fernandes, Marcelo; Carvalho, Vitor Oliveira

2016-01-01

The aim of the study is to compare the available reference values and the six-minute walk test equations in healthy children/adolescents. Our systematic review was planned and performed in accordance with the PRISMA guidelines. We included all studies that established reference values for the six-minute walk test in healthy children/adolescents. To perform this review, a research was performed in PubMed, EMBASE (via SCOPUS) and Cochrane (LILACS), Bibliographic Index Spanish in Health Sciences, Organization Collection Pan-American Health Organization, Publications of the World Health Organization and Scientific Electronic Library Online (SciELO) via Virtual Health Library until June 2015 without language restriction. The initial research identified 276 abstracts. Twelve studies met the inclusion criteria and were fully reviewed and approved by both reviewers. None of the selected studies presented sample size calculation. Most of the studies recruited children and adolescents from school. Six studies reported the use of random samples. Most studies used a corridor of 30 meters. All studies followed the American Thoracic Society guidelines to perform the six-minute walk test. The walked distance ranged 159 meters among the studies. Of the 12 included studies, 7 (58%) reported descriptive data and 6 (50%) established reference equation for the walked distance in the six-minute walk test. The reference value for the six-minute walk test in children and adolescents ranged substantially from studies in different countries. A reference equation was not provided in all studies, but the ones available took into account well established variables in the context of exercise performance, such as height, heart rate, age and weight. Countries that did not established reference values for the six-minute walk test should be encouraged to do because it would help their clinicians and researchers have a more precise interpretation of the test.

Reference Values for the Six-Minute Walk Test in Healthy Children and Adolescents: a Systematic Review

PubMed Central

Cacau, Lucas de Assis Pereira; de Santana-Filho, Valter Joviniano; Maynard, Luana G.; Gomes Neto, Mansueto; Fernandes, Marcelo; Carvalho, Vitor Oliveira

2016-01-01

Objective The aim of the study is to compare the available reference values and the six-minute walk test equations in healthy children/adolescents. Our systematic review was planned and performed in accordance with the PRISMA guidelines. We included all studies that established reference values for the six-minute walk test in healthy children/adolescents. Methods To perform this review, a research was performed in PubMed, EMBASE (via SCOPUS) and Cochrane (LILACS), Bibliographic Index Spanish in Health Sciences, Organization Collection Pan-American Health Organization, Publications of the World Health Organization and Scientific Electronic Library Online (SciELO) via Virtual Health Library until June 2015 without language restriction. Results The initial research identified 276 abstracts. Twelve studies met the inclusion criteria and were fully reviewed and approved by both reviewers. None of the selected studies presented sample size calculation. Most of the studies recruited children and adolescents from school. Six studies reported the use of random samples. Most studies used a corridor of 30 meters. All studies followed the American Thoracic Society guidelines to perform the six-minute walk test. The walked distance ranged 159 meters among the studies. Of the 12 included studies, 7 (58%) reported descriptive data and 6 (50%) established reference equation for the walked distance in the six-minute walk test. Conclusion The reference value for the six-minute walk test in children and adolescents ranged substantially from studies in different countries. A reference equation was not provided in all studies, but the ones available took into account well established variables in the context of exercise performance, such as height, heart rate, age and weight. Countries that did not established reference values for the six-minute walk test should be encouraged to do because it would help their clinicians and researchers have a more precise interpretation of the test. PMID:27982347

Indexing. ERIC Processing Manual, Section VII.

ERIC Educational Resources Information Center

Houston, Jim, Ed.

Rules and guidelines are provided for subject indexing in the ERIC system. The principle of "subject access" is discussed with particular reference to "coordinate indexing," which involves designating subject content by unit terms (or tags) that may be put together or "coordinated" for subsequent retrieval. The nature…

Guidelines for Sheep and Goat Husbandry.

USDA-ARS?s Scientific Manuscript database

The Guide for the Care and Use of Agricultural Animals in Agricultural Research and Teaching (Guide) is considered the standard for reference when protocols are developed for using agricultural animals in agricultural research or teaching. The Animal Welfare Act (CFR, 1992) regulates the use of agr...

Installation package - home solar heater

NASA Technical Reports Server (NTRS)

1980-01-01

Installation of commerical solar-heating system at two story, three bedroom house in New Hampshire is described in 65 page report. System collectors are integrated part of building replacing conventional roofing or siding. Report also includes general description of system, its operation and guidelines, orientation and references.

42 CFR 488.110 - Procedural guidelines.

Code of Federal Regulations, 2010 CFR

2010-10-01

... interactions with other staff members as well as with residents for insight into matters such as resident... Restorative/rehabilitation care and services Activities Social services Resident rights Refer to the Care..., particularly for those who require eating assistance. This task also yields information about staff interaction...

Migrant Education Administrative Handbook. Revised April 1973.

ERIC Educational Resources Information Center

North Carolina State Dept. of Public Instruction, Raleigh. Div. of Compensatory Education.

The revised handbook provides specific references to the legislation and the National Migrant Program Guidelines, while setting forth the administrative procedures required for migrant projects in North Carolina. Specific topics of discussion in migrant program administration cover Public Law 89-750, state and local educational agency…

Difficulties Associated with the Diagnosis of Emotional Disturbance.

ERIC Educational Resources Information Center

Welch, Frances C.

School psychologists have traditionally experienced difficulty in assessing children referred for special services. In order to determine if the diagnosis of emotional disturbance in South Carolina schools follows the guidelines provided by the South Carolina Department of Education publication "Procedures for the Survey, Screening,…

Safety Standard for Hydrogen and Hydrogen Systems: Guidelines for Hydrogen System Design, Materials Selection, Operations, Storage and Transportation. Revision

NASA Technical Reports Server (NTRS)

1997-01-01

The NASA Safety Standard, which establishes a uniform process for hydrogen system design, materials selection, operation, storage, and transportation, is presented. The guidelines include suggestions for safely storing, handling, and using hydrogen in gaseous (GH2), liquid (LH2), or slush (SLH2) form whether used as a propellant or non-propellant. The handbook contains 9 chapters detailing properties and hazards, facility design, design of components, materials compatibility, detection, and transportation. Chapter 10 serves as a reference and the appendices contained therein include: assessment examples; scaling laws, explosions, blast effects, and fragmentation; codes, standards, and NASA directives; and relief devices along with a list of tables and figures, abbreviations, a glossary and an index for ease of use. The intent of the handbook is to provide enough information that it can be used alone, but at the same time, reference data sources that can provide much more detail if required.

Guidelines for Good Epidemiology Practices for Occupational and Environmental Epidemiologic Research. The Chemical Manufacturers Association's Epidemiology Task Group.

PubMed

1991-12-01

The Guidelines for Good Epidemiology Practices (GEPs) for Occupational and Environmental Epidemiologic Research address the conduct of studies generally undertaken to answer questions about human health in relationship to the work place or the environment. The GEPs propose minimum practices and procedures that should be considered to help ensure the quality and integrity of data used in epidemiologic research and to provide adequate documentation of the research methods. The GEPs address the process of conducting individual epidemiologic studies and do not prescribe specific research methods. The Guidelines for Good Epidemiology Practices propose minimum practices and procedures in the following areas: I. Organization and Personnel II. Facilities, Resource Commitment, and Contractors III. Protocol IV. Review and Approval V. Study Conduct VI. Communication VII. Archiving VIII. Quality Assurance Although the Guidelines for Good Epidemiology Practices will not guarantee good epidemiology, they do provide a useful framework for ensuring that all research issues are adequately addressed. This framework is proposed as a first step in improving epidemiologic research practices through adherence to sound scientific research principles. Appendices provide an overview of standard operating procedures, a glossary of terms used in the Guidelines, and suggested references on occupational epidemiology methods.

Clinical practice guidelines for the diagnosis and management of melanoma: melanomas that lack classical clinical features.

PubMed

Mar, Victoria J; Chamberlain, Alex J; Kelly, John W; Murray, William K; Thompson, John F

2017-10-16

A Cancer Council Australia multidisciplinary working group is currently revising and updating the 2008 evidence-based clinical practice guidelines for the management of cutaneous melanoma. While there have been many recent improvements in treatment options for metastatic melanoma, early diagnosis remains critical to reducing mortality from the disease. Improved awareness of the atypical presentations of this common malignancy is required to achieve this. A chapter of the new guidelines was therefore developed to aid recognition of atypical melanomas. Main recommendations: Because thick, life-threatening melanomas may lack the more classical ABCD (asymmetry, border irregularity, colour variegation, diameter > 6 mm) features of melanoma, a thorough history of the lesion with regard to change in morphology and growth over time is essential. Any lesion that is changing in morphology or growing over a period of more than one month should be excised or referred for prompt expert opinion. Changes in management as a result of the guidelines: These guidelines provide greater emphasis on improved recognition of the atypical presentations of melanoma, in particular nodular, desmoplastic and acral lentiginous subtypes, with particular awareness of hypomelanotic and amelanotic lesions.

Guidelines for catastrophic emergency situations involving asbestos

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

Not Available

These guidelines are intended to assist regional, state, and local agencies in managing potential asbestos hazards resulting from a catastrophic accident or disaster. The guidelines may be used as a reference for advanced planning or, once the emergency presents itself, to help ensure that, to the extent feasible and compatible with other emergency measures, all appropriate steps are taken to safely handle and dispose of all asbestos, while avoiding unnecessary exposures to asbestos. The guidelines provide information that may be helpful to EPA Regional offices and delegated NESHAP agencies that must respond to emergencies involving asbestos. The guidelines review themore » experiences of EPA Regional and state enforcement agencies in dealing with asbestos during recent emergencies. Information is included on statutes and regulations that may be applicable in emergency situations, including the emergency provisions of the asbestos NESHAP. Lines of communication within EPA and between EPA and emergency management agencies are discussed. A list of contacts responsible at the state level for emergency and disaster activities is provided. Information is provided to help identify potential sources of asbestos releases, and factors are identified that should be considered in planning for the cleanup and disposal of asbestos.« less

Guideline on the use of new anticancer drugs for the treatment of Hepatocellular Carcinoma 2010 update.

PubMed

Kaneko, Shuichi; Furuse, Junji; Kudo, Masatoshi; Ikeda, Kenji; Honda, Masao; Nakamoto, Yasunari; Onchi, Morikazu; Shiota, Goshi; Yokosuka, Osamu; Sakaida, Isao; Takehara, Tetsuo; Ueno, Yoshiyuki; Hiroishi, Kazumasa; Nishiguchi, Shuhei; Moriwaki, Hisataka; Yamamoto, Kazuhide; Sata, Michio; Obi, Shuntaro; Miyayama, Shiro; Imai, Yukinori

2012-06-01

The "Guideline on the Use of New Anticancer Drugs for the Treatment of Hepatocellular Carcinoma" was prepared by the Study Group on New Liver Cancer Therapies established by the "Research Project on Emergency Measures to Overcome Hepatitis" under the auspices of the Health and Labour Sciences Research Grant. The Guideline brings together data collected by the Study Group on the use and incidence of adverse events in 264 patients with advanced hepatocellular carcinoma (HCC) treated using sorafenib and in 535 patients with advanced HCC treated using miriplatin at 16 participating institutions up until 22 December 2010, as well as referring to the published studies, academic presentations, and reports from the private sector. The aim of this Guideline is to facilitate understanding and current thinking regarding the proper usage of new anticancer drugs towards actual use in therapy. In terms of the format, the Guideline presents "clinical questions" on issues pertaining to medical care, makes "recommendations" on diagnosis and treatment in response to each of these clinical questions, and provides a rationale for these recommendations in the form of "scientific statements". © 2012 The Japan Society of Hepatology.

Community-acquired pneumonia requiring hospitalization: rational decision making and interpretation of guidelines.

PubMed

Postma, Douwe F; van Werkhoven, Cornelis H; Oosterheert, Jan Jelrik

2017-05-01

This review focuses on the evidence base for guideline recommendations on the diagnosis, the optimal choice, timing and duration of empirical antibiotic therapy, and the use of microbiological tests for patients hospitalized with community-acquired pneumonia (CAP): issues for which guidelines are frequently used as a quick reference. Furthermore, we will discuss possibilities for future research in these topics. Many national and international guideline recommendations, even on critical elements of CAP management, are based on low-to-moderate quality evidence. The diagnosis and management of CAP has hardly changed for decades. The recommendation to cover atypical pathogens in all hospitalized CAP patients is based on observational studies only and is challenged by two recent trials. The following years, improved diagnostic testing, radiologically by low-dose Computed Tomography or ultrasound and/or microbiologically by point-of-care multiplex PCR, has the potential to largely influence the choice and start of antibiotic therapy in hospitalized CAP patients. Rapid microbiological testing will hopefully improve antibiotic de-escalation or early pathogen-directed therapy, both potent ways of reducing broad-spectrum antibiotic use. Current guideline recommendations on the timing and duration of antibiotic therapy are based on limited evidence, but will be hard to improve.

Comparison and critical appraisal of dengue clinical guidelines and their use in Asia and Latin America.

PubMed

Santamaria, R; Martinez, E; Kratochwill, S; Soria, C; Tan, L H; Nuñez, A; Dimaano, E; Villegas, E; Bendezú, H; Kroeger, A; Castelobranco, I; Siqueira, J B; Jaenisch, T; Horstick, O; Lum, L C S

2009-12-01

The World Health Organization (WHO) dengue classification scheme for dengue fever (DF) and dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) has been adopted as the standard for diagnosis, clinical management and reporting. In recent years, difficulties in applying the WHO case classification have been reported in several countries. A multicenter study was carried out in Asia and Latin America to analyze the variation and utility of dengue clinical guidelines (DCGs) taking as reference the WHO/PAHO guidelines (1994) and the WHO/SEARO guidelines (1998). A document analysis of 13 dengue guidelines was followed by a questionnaire and Focus Group discussions (FGDs) with 858 health care providers in seven countries. Differences in DCGs of the 13 countries were identified including the concept of warning signs, case classification, use of treatment algorithms and grading into levels of severity. The questionnaires and FGDs revealed (1) inaccessibility of DCGs, (2) lack of training, (3) insufficient number of staff to correctly apply the DCGs at the frontline and (4) the unavailability of diagnostic tests. The differences of the DCGs and the inconsistency in their application suggest a need to re-evaluate and standardise DCGs. This applies especially to case classification and case management.

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

Savy, J.

New design and evaluation guidelines for department of energy facilities subjected to natural phenomena hazard, are being finalized. Although still in draft form at this time, the document describing those guidelines should be considered to be an update of previously available guidelines. The recommendations in the guidelines document mentioned above, and simply referred to as the guidelines'' thereafter, are based on the best information at the time of its development. In particular, the seismic hazard model for the Princeton site was based on a study performed in 1981 for Lawrence Livermore National Laboratory (LLNL), which relied heavily on the resultsmore » of the NRC's Systematic Evaluation Program and was based on a methodology and data sets developed in 1977 and 1978. Considerable advances have been made in the last ten years in the domain of seismic hazard modeling. Thus, it is recommended to update the estimate of the seismic hazard at the DOE sites whenever possible. The major differences between previous estimates and the ones proposed in this study for the PPPL are in the modeling of the strong ground motion at the site, and the treatment of the total uncertainty in the estimates to include knowledge uncertainty, random uncertainty, and expert opinion diversity as well. 28 refs.« less

An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery.

PubMed

Bono, Christopher M; Watters, William C; Heggeness, Michael H; Resnick, Daniel K; Shaffer, William O; Baisden, Jamie; Ben-Galim, Peleg; Easa, John E; Fernand, Robert; Lamer, Tim; Matz, Paul G; Mendel, Richard C; Patel, Rajeev K; Reitman, Charles A; Toton, John F

2009-12-01

The objective of the North American Spine Society (NASS) Evidence-Based Clinical Guideline on antithrombotic therapies in spine surgery was to provide evidence-based recommendations to address key clinical questions surrounding the use of antithrombotic therapies in spine surgery. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of February 2008. The goal of the guideline recommendations was to assist in delivering optimum, efficacious treatment with the goal of preventing thromboembolic events. To provide an evidence-based, educational tool to assist spine surgeons in minimizing the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). Systematic review and evidence-based clinical guideline. This report is from the Antithrombotic Therapies Work Group of the NASS Evidence-Based Guideline Development Committee. The work group was composed of multidisciplinary spine care specialists, all of whom were trained in the principles of evidence-based analysis. Each member of the group was involved in formatting a series of clinical questions to be addressed by the group. The final questions agreed on by the group are the subject of this report. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE, EMBASE (Drugs and Pharmacology), and four additional, evidence-based databases. The relevant literature was then independently rated by at least three reviewers using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final grades of recommendation for the answers to each clinical question were arrived at via Web casts among members of the work group using standardized grades of recommendation. When Level I to IV evidence was insufficient to support a recommendation to answer a specific clinical question, expert consensus was arrived at by the work group through the modified nominal group technique and is clearly identified as such in the guideline. Fourteen clinical questions were formulated, addressing issues of incidence of DVT and PE in spine surgery and recommendations regarding utilization of mechanical prophylaxis and chemoprophylaxis in spine surgery. The answers to these 14 clinical questions are summarized in this article. The respective recommendations were graded by the strength of the supporting literature that was stratified by levels of evidence. A clinical guideline addressing the use of antithrombotic therapies in spine surgery has been created using the techniques of evidence-based medicine and using the best available evidence as a tool to assist spine surgeons in minimizing the risk of DVT and PE. The entire guideline document, including the evidentiary tables, suggestions for future research, and all references, is available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.

Management of immune thrombocytopenia: Korean experts recommendation in 2017.

PubMed

Jang, Jun Ho; Kim, Ji Yoon; Mun, Yeung-Chul; Bang, Soo-Mee; Lim, Yeon Jung; Shin, Dong-Yeop; Choi, Young Bae; Yhim, Ho-Young; Lee, Jong Wook; Kook, Hoon

2017-12-01

Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.

[Draft guideline regarding appropriate use of 131I-MIBG radiotherapy for neuroendocrine tumors Drafting Committee for Guideline of Radiotherapy with 131I-MIBG, Committee for Nuclear Oncology and Immunology, The Japanese Society of Nuclear Medicine].

PubMed

Kinuya, Seigo; Yoshinaga, Keiichiro; Higuchi, Tetsuya; Jinguji, Megumi; Kawamoto, Hiroshi; Kurihara, Hiroaki

2015-02-01

131I-MIBG radiotherapy has been used for unresectable nueroendocrine tumors including malignant pheochromocytomas and neuroblastomas in foreign countries since the '80s when clinical therapeutic trials were initiated. In Japan, 131I-MIBG radiotherapy has not been approved by Ministry of Health, Labor and Welfare, however, personally imported 131I-MIBG is now available in limited institutions for therapeutic purpose. This updated guideline draft aims to provide useful information concerning 131I-MIBG radiotherapy, to prevent side effects, and to protect physicians, nurses, other health care professionals, patients and their families from radiation exposure. The committee also provides appendices including practical guidance for attending physicians, patient management and referring physicians for their conveniences.

A new device for performing reference point indentation without a reference probe

NASA Astrophysics Data System (ADS)

Bridges, Daniel; Randall, Connor; Hansma, Paul K.

2012-04-01

Here we describe a novel, hand-held reference point indentation (RPI), instrument that is designed for clinical measurements of bone material properties in living patients. This instrument differs from previous RPI instruments in that it requires neither a reference probe nor removal of the periosteum that covers the bone, thus significantly simplifying its use in patient testing. After describing the instrument, we discuss five guidelines for optimal and reproducible results. These are: (1) the angle between the normal to the surface and the axis of the instrument should be less than 10°, (2) the compression of the main spring to trigger the device must be performed slowly (>1 s), (3) the probe tip should be sharper than 10 μm; however, a normalized parameter with a calibration phantom can correct for dull tips up to a 100 μm radius, (4) the ambient room temperature should be between 4 °C and 37 °C, and (5) the effective mass of the bone or material under test must exceed 1 kg, or if under 1 kg, the specimen should be securely anchored in a fixation device with sufficient mass (which is not a requirement of previous RPI instruments). Our experience is that a person can be trained with these guidelines in about 5 min and thereafter obtain accurate and reproducible results. The portability, ease of use, and minimal training make this instrument suitable to measure bone material properties in a clinical setting.

Multi-Stakeholder Informed Guidelines for Direct Admission of Children to Hospital.

PubMed

Leyenaar, JoAnna K; Shevenell, Megan; Rizzo, Paul A; Hill, Vanessa L; Lindenauer, Peter K

2018-04-25

To develop pediatric direct admission guidelines and prioritize outcomes to evaluate the safety and effectiveness of hospital admission processes. We conducted deliberative discussions at 1 children's hospital and 2 community hospitals, engaging parents of hospitalized children and inpatient, outpatient, and emergency department physicians and nurses to identify shared and dissenting perspectives regarding direct admission processes and outcomes. Discussions were audio-recorded, professionally transcribed, and analyzed using a general inductive approach. We then convened a national panel to prioritize guideline components and outcome measures using a RAND/UCLA Modified Delphi approach. Forty-eight stakeholders participated in 6 deliberative discussions. Emergent themes related to effective multistakeholder communication, resources needed for high quality direct admissions, written direct admission guidelines, including criteria to identify children appropriate for and inappropriate for direct admission, and families' needs. Building on these themes, Delphi panelists endorsed 71 guideline components as both appropriate and necessary at children's hospitals and community hospitals and 13 outcomes to evaluate hospital admission systems. Guideline components include (1) pre-admission communication, (2) written guidelines, (3) hospital resources to optimize direct admission processes, (4) special considerations for pediatric populations that may be at particular risk of nosocomial infection and/or stress in emergency departments, (5) communication with families referred for direct admission, and (6) quality reviews to evaluate admission systems. These direct admission guidelines can be adapted by hospitals and health systems to inform hospital admission policies and protocols. Multistakeholder engagement in evaluation of hospital admission processes may improve transitions of care and health system integration. Copyright © 2018 Elsevier Inc. All rights reserved.

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).

PubMed

Bhattacharyya, Neil; Gubbels, Samuel P; Schwartz, Seth R; Edlow, Jonathan A; El-Kashlan, Hussam; Fife, Terry; Holmberg, Janene M; Mahoney, Kathryn; Hollingsworth, Deena B; Roberts, Richard; Seidman, Michael D; Steiner, Robert W Prasaad; Do, Betty Tsai; Voelker, Courtney C J; Waguespack, Richard W; Corrigan, Maureen D

2017-03-01

Objective This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV.

10 CFR 300.1 - General.

Code of Federal Regulations, 2014 CFR

2014-01-01

... CLIMATE CHANGE VOLUNTARY GREENHOUSE GAS REPORTING PROGRAM: GENERAL GUIDELINES § 300.1 General. (a) Purpose... under the Climate Leaders or Climate VISION programs to reduce its entity-wide emissions relative to a... (incorporated by reference, see § 300.13) and base its registered reductions on an assessment of annual changes...

10 CFR 300.1 - General.

Code of Federal Regulations, 2012 CFR

2012-01-01

... CLIMATE CHANGE VOLUNTARY GREENHOUSE GAS REPORTING PROGRAM: GENERAL GUIDELINES § 300.1 General. (a) Purpose... under the Climate Leaders or Climate VISION programs to reduce its entity-wide emissions relative to a... (incorporated by reference, see § 300.13) and base its registered reductions on an assessment of annual changes...

10 CFR 300.1 - General.

Code of Federal Regulations, 2013 CFR

2013-01-01

... CLIMATE CHANGE VOLUNTARY GREENHOUSE GAS REPORTING PROGRAM: GENERAL GUIDELINES § 300.1 General. (a) Purpose... under the Climate Leaders or Climate VISION programs to reduce its entity-wide emissions relative to a... (incorporated by reference, see § 300.13) and base its registered reductions on an assessment of annual changes...

10 CFR 300.1 - General.

Code of Federal Regulations, 2011 CFR

2011-01-01

... CLIMATE CHANGE VOLUNTARY GREENHOUSE GAS REPORTING PROGRAM: GENERAL GUIDELINES § 300.1 General. (a) Purpose... under the Climate Leaders or Climate VISION programs to reduce its entity-wide emissions relative to a... (incorporated by reference, see § 300.13) and base its registered reductions on an assessment of annual changes...

Meeting the Pepsi Challenge: Preparing Evaluation Programs for Scholastic Improvement.

ERIC Educational Resources Information Center

Hopkins, Mona S.

This document provides guidelines for preparing evaluation programs for scholastic improvement. The philosophy underlying assessment and accountability is discussed, with specific reference to the positive and negative aspects of assessment. The design of a curriculum evaluation model is presented, including goal identification, data gathering,…

Preschool Assessment. Principles and Practices

ERIC Educational Resources Information Center

Brassard, Marla R.; Boehm, Ann E.

2007-01-01

Comprehensive and user-friendly, this ideal graduate text and professional reference provides a developmentally informed framework for assessing 3- to 6-year-olds in accordance with current best practices and IDEA guidelines. The authors are leading clinician-researchers who take the reader step by step through selecting appropriate measures,…

Curriculum Guidelines for Exceptional Children: EMR 1970-71 Revision.

ERIC Educational Resources Information Center

Escambia County Board of Public Instruction, Pensacola, FL.

This document provides curriculum guides for teaching educable mentally retarded middle school (prevocational level) and high school (vocational level) students in Escambia County, Florida. It includes a definition of mental retardation, characteristics of mentally handicapped (MH) children, a mental age reference chart, and suggestions for…

Developing guidelines for elementary flow nomenclature

EPA Science Inventory

In general, a flow in life cycle inventory data refers to an input or output to a process. Flows may be of two broad types: elementary flows or intermediate (known as “technosphere”) flows according to ISO 14044 (ISO 14044 2006). Elementary flows may be defined as mat...

10 CFR 300.1 - General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CLIMATE CHANGE VOLUNTARY GREENHOUSE GAS REPORTING PROGRAM: GENERAL GUIDELINES § 300.1 General. (a) Purpose... under the Climate Leaders or Climate VISION programs to reduce its entity-wide emissions relative to a... (incorporated by reference, see § 300.13) and base its registered reductions on an assessment of annual changes...

STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 3 - BASIN BEST MANAGEMENT PRACTICES

EPA Science Inventory

This manual provides design guidelines for a group of stormwater management (SWM) best management practices (BMPs) broadly referred to as basin or pond BMPs. Basin BMPs are the mainstay of stormwater management. Water resources engineers have designed small and large ponds for ma...

36 CFR 910.51 - Access.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AREA Glossary of Terms § 910.51 Access. Access, when used in reference to parking or loading, means... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false Access. 910.51 Section 910.51 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL GUIDELINES AND...

36 CFR 910.51 - Access.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AREA Glossary of Terms § 910.51 Access. Access, when used in reference to parking or loading, means... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Access. 910.51 Section 910.51 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL GUIDELINES AND...

36 CFR 910.51 - Access.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AREA Glossary of Terms § 910.51 Access. Access, when used in reference to parking or loading, means... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Access. 910.51 Section 910.51 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL GUIDELINES AND...

36 CFR 910.51 - Access.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AREA Glossary of Terms § 910.51 Access. Access, when used in reference to parking or loading, means... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Access. 910.51 Section 910.51 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL GUIDELINES AND...

Computer-Based Training Starter Kit.

ERIC Educational Resources Information Center

Federal Interagency Group for Computer-Based Training, Washington, DC.

Intended for use by training professionals with little or no background in the application of automated data processing (ADP) systems, processes, or procurement requirements, this reference manual provides guidelines for establishing a computer based training (CBT) program within a federal agency of the United States government. The manual covers:…

A bill to amend the Fair Credit Reporting Act to provide for an exclusion from Red Flag Guidelines for certain businesses.

THOMAS, 111th Congress

Sen. Thune, John [R-SD

2010-05-25

Senate - 05/25/2010 Read twice and referred to the Committee on Banking, Housing, and Urban Affairs. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Do guidelines offer implementation advice to target users? A systematic review of guideline applicability.

PubMed

Gagliardi, Anna R; Brouwers, Melissa C

2015-02-18

Providers and patients are most likely to use and benefit from guidelines accompanied by implementation support. Guidelines published in 2007 and earlier assessed with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument scored poorly for applicability, which reflects the inclusion of implementation instructions or tools. The purpose of this study was to examine the applicability of guidelines published in 2008 or later and identify factors associated with applicability. Systematic review of studies that used AGREE to assess guidelines published in 2008 or later. MEDLINE and EMBASE were searched from 2008 to July 2014, and the reference lists of eligible items. Two individuals independently screened results for English language studies that reviewed guidelines using AGREE and reported all domain scores, and extracted data. Descriptive statistics were calculated across all domains. Multilevel regression analysis with a mixed effects model identified factors associated with applicability. Of 245 search results, 53 were retrieved as potentially relevant and 20 studies were eligible for review. The mean and median domain scores for applicability across 137 guidelines published in 2008 or later were 43.6% and 42.0% (IQR 21.8-63.0%), respectively. Applicability scored lower than all other domains, and did not markedly improve compared with guidelines published in 2007 or earlier. Country (UK) and type of developer (disease-specific foundation, non-profit healthcare system) appeared to be associated with applicability when assessed with AGREE II (not original AGREE). Despite increasing recognition of the need for implementation tools, guidelines continue to lack such resources. To improve healthcare delivery and associated outcomes, further research is needed to establish the type of implementation tools needed and desired by healthcare providers and consumers, and methods for developing high-quality tools. 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.

Use of cardiocerebral resuscitation or AHA/ERC 2005 Guidelines is associated with improved survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.

PubMed

Salmen, Marcus; Ewy, Gordon A; Sasson, Comilla

2012-01-01

To determine whether the use of cardiocerebral resuscitation (CCR) or AHA/ERC 2005 Resuscitation Guidelines improved patient outcomes from out-of-hospital cardiac arrest (OHCA) compared to older guidelines. Systematic review and meta-analysis. MEDLINE, EMBASE, Web of Science and the Cochrane Library databases. We also hand-searched study references and consulted experts. Design: randomised controlled trials and observational studies. OHCA patients, age >17 years. 'Control' protocol versus 'Study' protocol. 'Control' protocol defined as AHA/ERC 2000 Guidelines for cardiopulmonary resuscitation (CPR). 'Study' protocol defined as AHA/ERC 2005 Guidelines for CPR, or a CCR protocol. Survival to hospital discharge. High-quality or medium-quality studies, as measured by the Newcastle Ottawa Scale using predefined categories. Twelve observational studies met inclusion criteria. All the three studies using CCR demonstrated significantly improved survival compared to use of AHA 2000 Guidelines, as did five of the nine studies using AHA/ERC 2005 Guidelines. Pooled data demonstrate that use of a CCR protocol has an unadjusted OR of 2.26 (95% CI 1.64 to 3.12) for survival to hospital discharge among all cardiac arrest patients. Among witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) patients, CCR increased survival by an OR of 2.98 (95% CI 1.92 to 4.62). Studies using AHA/ERC 2005 Guidelines showed an overall trend towards increased survival, but significant heterogeneity existed among these studies. We demonstrate an association with improved survival from OHCA when CCR protocols or AHA/ERC 2005 Guidelines are compared to use of older guidelines. In the subgroup of patients with witnessed VF/VT, there was a threefold increase in OHCA survival when CCR was used. CCR appears to be a promising resuscitation protocol for Emergency Medical Services providers in increasing survival from OHCA. Future research will need to be conducted to directly compare AHA/ERC 2010 Guidelines with the CCR approach.

Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey.

PubMed

Yaşar, Ilknur; Kahveci, Rabia; Baydar Artantaş, Aylin; Ayhan Başer, Duygu; Gökşin Cihan, Fatma; Şencan, Irfan; Koç, Esra Meltem; Özkara, Adem

2016-01-01

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the "Statistical Yearbook of Turkey 2012" were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. This is the first study in Turkey regarding quality appraisal of guidelines developed by the local professional societies. It adds to the limited amount of information in the literature that comes from Turkey as well as other developing countries.

Gap Between Clinical Practice and Guidelines: A National Survey of the Knowledge of Recommended Heart Failure Guidelines Among Chinese Physicians.

PubMed

Gan, Tianyi; Zhang, Yuhui; Liu, Nini; Huang, Yuhui; Liang, Tuo; Zhao, Xuemei; Zhang, Jian

We investigated the current level of knowledge of Chinese heart failure (HF) guidelines among physicians, as a reference for the promotion and transformation of HF knowledge. Physicians from 88 hospitals in 27 provinces of China completed our survey between July and December 2014. The questions covered the main points included in the Chinese HF diagnosis and treatment guidelines (2014). A total of 2146 physicians, aged 20 to 62 years (35.6 ± 7.6 years), completed the survey. The correctness rate of their answers to the 15 multiple-choice questions in the HF questionnaire was generally low (mean 32.6%). The mean correctness rate for 10 blank-filling questions about the target doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and β-blockers was 42.5%. On the basis of their responses, physicians whose knowledge of the guidelines was "excellent," "good," "medium," and "bad" accounted for 1.1%, 11.4%, 14.2%, and 73.4%, respectively. Physicians who possessed a higher level of qualifications had significantly greater awareness of HF guidelines than those with relatively low qualifications (P < .001). A statistically significant association was found between hospital level and adherence to treatment guidelines (P < .001). A significant difference was also observed among physicians in different practice scopes (P < .001). The survey found an obvious deficiency in physicians' mastery of fundamental knowledge about HF. There is a need to improve physicians' education about HF in China.

[Guidelines for the management of hypertension].

PubMed

Prieto-Díaz, Miguel Ángel

2014-09-01

In the last year, several scientific societies have published guidelines for the management of arterial hypertension. In Spain, two clinical practice guidelines have had a strong impact and have been closely followed in the last few years: the first is the Guideline of the National Heart, Lung and Blood Institute, although their last report (JNC 7) was published in 2003; the second is the clinical practice guideline for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH), whose latest version was published in 2007, although an update was published in 2009. A new ESC/ESH document, published in 2013, adopts a mainly educational stance, closely rooted in clinical practice. Many of the recommendations maintain the same criteria as previous guidelines. However, the new publication shows greater rigor and contains major contributions such as specification of the level of evidence and grade of recommendation for each recommendation, which was lacking in the previous guidelines of these societies. The document is both practical and easy to consult, consisting of 17 tables, 5 figures and 18 blocks of recommendations. The JNC 8 report, however, has a single objective: to respond to three questions that are considered a priority and which refer exclusively to drug therapy. Nine recommendations are made relating to these three questions. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN). All rights reserved.

Compliance to guidelines for the prescribing of antibiotics in acute infections at Namibia's national referral hospital: a pilot study and the implications.

PubMed

Nakwatumbah, S; Kibuule, D; Godman, B; Haakuria, V; Kalemeera, F; Baker, A; Mubita, M

2017-07-01

Sub-optimal antibiotic prescribing remains a public health concern in Namibia. The objective was to determine the level and predictors of compliance to guidelines in the prescribing of antibiotics in acute infections at a national referral hospital in Namibia to improve future prescribing. An analytical cross-sectional survey design. The clinical records of patients receiving care were reviewed. Prescribing practices were assessed using a self- administered questionnaire with reference to Namibia Standard Treatment Guidelines (NSTG). The majority of prescriptions (62%) complied with the NSTGs; however, lower than national targets (95%). Most prescriptions were empiric and prescribers typically made reference to the NSTG (58%). Diagnosed infections were principally respiratory infections (58%) and penicillins were the most used antibiotics. Good concurrence between signs and symptoms with the diagnosis indicated on the prescription - OR=5.2 (95% CI: 1.4, 19.2), a diagnosis of upper respiratory tract (p=0.001), oral-dental OR=0.1(95% CI: 0.03,0.3) and urogenital infections OR=0.3(95% CI: 0.1,0.95) and the prescribing of penicillins (p=0.001) or combination antibiotics and amphenicols were independent predictors of compliance to the NSTGs. The main behaviours associated with antibiotic prescribing were patient influences, clinical state, and access to guidelines. Compliance with NSTGs is suboptimal. Prescribing of combination antibiotics, penicillins and diagnosis of oral dental, genitourinary and ear, nose and throat infections were important predictors for NSTG compliance. There is a need to implement antibiotic indicators and stewardship programmes, and ensure access to NSTGs, to improve future antibiotic prescribing in Namibia.

Evaluation of the uncertainty in an oral reference dose for methylmercury due to interindividual variability in pharmacokinetics.

PubMed

Clewell, H J; Gearhart, J M; Gentry, P R; Covington, T R; VanLandingham, C B; Crump, K S; Shipp, A M

1999-08-01

An analysis of the uncertainty in guidelines for the ingestion of methylmercury (MeHg) due to human pharmacokinetic variability was conducted using a physiologically based pharmacokinetic (PBPK) model that describes MeHg kinetics in the pregnant human and fetus. Two alternative derivations of an ingestion guideline for MeHg were considered: the U.S. Environmental Protection Agency reference dose (RfD) of 0.1 microgram/kg/day derived from studies of an Iraqi grain poisoning episode, and the Agency for Toxic Substances and Disease Registry chronic oral minimal risk level (MRL) of 0.5 microgram/kg/day based on studies of a fish-eating population in the Seychelles Islands. Calculation of an ingestion guideline for MeHg from either of these epidemiological studies requires calculation of a dose conversion factor (DCF) relating a hair mercury concentration to a chronic MeHg ingestion rate. To evaluate the uncertainty in this DCF across the population of U.S. women of child-bearing age, Monte Carlo analyses were performed in which distributions for each of the parameters in the PBPK model were randomly sampled 1000 times. The 1st and 5th percentiles of the resulting distribution of DCFs were a factor of 1.8 and 1.5 below the median, respectively. This estimate of variability is consistent with, but somewhat less than, previous analyses performed with empirical, one-compartment pharmacokinetic models. The use of a consistent factor in both guidelines of 1.5 for pharmacokinetic variability in the DCF, and keeping all other aspects of the derivations unchanged, would result in an RfD of 0.2 microgram/kg/day and an MRL of 0.3 microgram/kg/day.

Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America.

PubMed

Clemente, Wanessa Trindade; Pierrotti, Lígia Camera; Abdala, Edson; Morris, Michele I; Azevedo, Luiz S; López-Vélez, Rogelio; Cuenca-Estrella, Manuel; Torre-Cisneros, Julian; Petersen, Eskild; Camargo, Luis Fernando A; Wright, Alissa Jade; Beeching, Nicholas J; Vilela, Eduardo Garcia; Santoro-Lopes, Guilherme; Len, Oscar; Stucchi, Raquel S B; Manuel, Oriol; Faria, Luciana Costa; Leblebicioglu, Hakan; Huprikar, Shirish; Molina, Israel; Mourão, Paulo Henrique Orlandi; Kotton, Camille N; Aguado, José María

2018-02-01

The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly located in the tropics. These recommendations are based on both systematic reviews of relevant literature and expert opinion from both transplant ID and travel medicine specialists. The guidelines provide recommendations for risk evaluation and laboratory investigation, as well as management and prevention of infection of the most relevant endemic diseases of Latin America. This summary includes a brief description of the guideline recommendations but does not include the complete rationale and references for each recommendation, which is available in the online version of the article, published in this journal as a supplement. The supplement contains 10 reviews referring to endemic or travel diseases (eg, tuberculosis, Chagas disease [ChD], leishmaniasis, malaria, strongyloidiasis and schistosomiasis, travelers diarrhea, arboviruses, endemic fungal infections, viral hepatitis, and vaccines) and an illustrative section with maps (http://www.pmourao.com/map/). Contributors included experts from 13 countries (Brazil, Canada, Chile, Denmark, France, Italy, Peru, Spain, Switzerland, Turkey, United Kingdom, United States, and Uruguay) representing four continents (Asia, the Americas and Europe), along with scientific and medical societies.

Care of adults with developmental disabilities: Effects of a continuing education course for primary care providers.

PubMed

Balogh, Robert; Wood, Jessica; Lunsky, Yona; Isaacs, Barry; Ouellette-Kuntz, Hélène; Sullivan, William

2015-07-01

To evaluate the effects of an interdisciplinary, guideline-based continuing education course on measures related to the care of adults with developmental disabilities (DD). Before-and-after study with a control group. Ontario. Forty-seven primary care providers (physicians, registered nurses, and nurse practitioners). Participants either only received reference material about primary care of people with DD (control group) or participated in a continuing education course on primary care of people with DD in addition to receiving the reference material (intervention group). Participants reported on 5 key measures related to care of adults with DD: frequency of using guidelines, frequency of performing periodic health examinations, frequency of assessing patients who present with behaviour changes, level of comfort while caring for adults with DD, and knowledge of primary care related to adults with DD. Over time, the intervention group showed significant increases in 4 of the 5 key measures of care compared with the control group: the frequency of guideline use (P < .001), frequency of assessment of patients' behaviour change (P = .03), comfort level in caring for people with DD (P = .01), and knowledge of primary care related to adults with DD (P = .01). A continuing education course on primary care of adults with DD is a useful interdisciplinary model to train health professionals who provide primary care services to these patients.

The psychological and social characteristics of patients referred for NHS cosmetic surgery: quantifying clinical need.

PubMed

Cook, Sharon A; Rosser, Robert; Toone, Helen; James, M Ian; Salmon, Peter

2006-01-01

Elective cosmetic surgery is expanding in the UK in both the public and private sectors. Because resources are constrained, many cosmetic procedures are being excluded within the National Health Service. If guidelines on who can receive such surgery are to be evidence-based, information is needed about the level of dysfunction in patients referred for elective surgery and whether this is related to their degree of physical abnormality. Consecutive patients referred to a regional plastic surgery and burns unit for assessment for elective cosmetic surgery completed standardised measures of physical and psychosocial dysfunction, and indicated their perception of the degree of their abnormality and their preoccupation with it. We distinguished between patients referred for physical reasons or appearance reasons only, and compared levels of physical and psychosocial dysfunction in each with published values for community and clinical samples. Surgeons indicated patients' degree of objective abnormality, and we identified the relationship of dysfunction with perceived and objective abnormality and preoccupation. Whether patients sought surgery for physical or appearance reasons, physical function was normal. Those seeking surgery for appearance reasons only had moderate psychosocial dysfunction, but were not as impaired as clinical groups with psychological problems. Patients seeking the correction of minor skin lesions for purely appearance reasons reported excellent physical and psychosocial function. Level of function was related (negatively) to patients' preoccupation with abnormality rather than to their perceived or objective abnormality. In general, patients referred for elective cosmetic surgery did not present with significant levels of dysfunction. Moreover, levels of functioning were related to preoccupation rather than to objective abnormality. Therefore, for most patients, whether surgical treatment is generally appropriate is questionable. Future guidelines must seek to identify the small minority who do have a clinical need for surgery.

The Nuremberg Code–A critique

PubMed Central

Ghooi, Ravindra B.

2011-01-01

The Nuremberg Code drafted at the end of the Doctor’s trial in Nuremberg 1947 has been hailed as a landmark document in medical and research ethics. Close examination of this code reveals that it was based on the Guidelines for Human Experimentation of 1931. The resemblance between these documents is uncanny. It is unfortunate that the authors of the Nuremberg Code passed it off as their original work. There is evidence that the defendants at the trial did request that their actions be judged on the basis of the 1931 Guidelines, in force in Germany. The prosecutors, however, ignored the request and tried the defendants for crimes against humanity, and the judges included the Nuremberg Code as a part of the judgment. Six of ten principles in Nuremberg Code are derived from the 1931 Guidelines, and two of four newly inserted principles are open to misinterpretation. There is little doubt that the Code was prepared after studying the Guidelines, but no reference was made to the Guidelines, for reasons that are not known. Using the Guidelines as a base document without giving due credit is plagiarism; as per our understanding of ethics today, this would be considered unethical. The Nuremberg Code has fallen by the wayside; since unlike the Declaration of Helsinki, it is not regularly reviewed and updated. The regular updating of some ethics codes is evidence of the evolving nature of human ethics. PMID:21731859

The Nuremberg Code-A critique.

PubMed

Ghooi, Ravindra B

2011-04-01

The Nuremberg Code drafted at the end of the Doctor's trial in Nuremberg 1947 has been hailed as a landmark document in medical and research ethics. Close examination of this code reveals that it was based on the Guidelines for Human Experimentation of 1931. The resemblance between these documents is uncanny. It is unfortunate that the authors of the Nuremberg Code passed it off as their original work. There is evidence that the defendants at the trial did request that their actions be judged on the basis of the 1931 Guidelines, in force in Germany. The prosecutors, however, ignored the request and tried the defendants for crimes against humanity, and the judges included the Nuremberg Code as a part of the judgment. Six of ten principles in Nuremberg Code are derived from the 1931 Guidelines, and two of four newly inserted principles are open to misinterpretation. There is little doubt that the Code was prepared after studying the Guidelines, but no reference was made to the Guidelines, for reasons that are not known. Using the Guidelines as a base document without giving due credit is plagiarism; as per our understanding of ethics today, this would be considered unethical. The Nuremberg Code has fallen by the wayside; since unlike the Declaration of Helsinki, it is not regularly reviewed and updated. The regular updating of some ethics codes is evidence of the evolving nature of human ethics.

Practice guidelines for acupuncturists using acupuncture as an adjunctive treatment for anorexia nervosa.

PubMed

Fogarty, Sarah; Ramjan, Lucie Michelle

2015-02-01

Anorexia nervosa is a potentially life-threatening eating disorder where people intentionally refuse to eat sufficient amounts to maintain a healthy body-weight for fear of becoming fat. The intense preoccupation with restriction of food and control of body weight makes this one of the most complex and confusing conditions for practitioners to treat. While no single treatment has been found to be superior to another in the treatment of anorexia nervosa, general practice guidelines are available to guide mainstream treatment, however there are no guidelines for practitioners of complementary therapies. Complementary therapies such as acupuncture show promise as an adjunctive therapy in improving co-morbidities such as depression and anxiety levels among people with anorexia nervosa, by strengthening mind, body and overall well-being. The aim of this guideline is to assist and support acupuncture practitioners to deliver effective and safe adjunctive acupuncture treatments to people with anorexia nervosa, by providing a practice guideline that is underpinned by an ethical and evidence-based framework. The use of complementary therapies and specifically acupuncture in the treatment of anorexia nervosa may provide important adjunctive care to allow a comprehensive treatment approach that potentially improves quality of life, reduces anxiety and instils hope for recovery. It is hoped that acupuncture practitioners treating patients with anorexia nervosa will refer to these guidelines and apply the guidance (as deemed appropriate). Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary.

PubMed

Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C

2018-03-01

Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Differences from Prior Guideline (1) Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia.

A Modified Content Analysis of Existing School Psychology Reports

ERIC Educational Resources Information Center

Mallin, Barry; Schellenberg, Miriam E.; Smith, Christiane

2012-01-01

Discrepancies between our university's training program's report-writing guidelines and common practice in Manitoba could not be resolved by reference to the literature. To inform the discussion, we collected a sample of local real world school psychology reports and undertook a modified content analysis to operationally define and measure…

Development of protocols to inventory or monitor wildlife, fish, or rare plants

Treesearch

David Vesely; Brenda C. McComb; Christina D. Vojta; Lowell H. Suring; Jurai Halaj; Richard S. Holthausen; Benjamin Zuckerberg; Patricia M. Manley

2006-01-01

The purpose of this technical guide (hereafter referred to as the Species Protocol Technical Guide) is to provide guidelines for developing inventory and monitoring (I&M) protocols for wildlife, fish, and rare plants (WFRP) using the U.S. Department of Agriculture (USDA) Forest Service technical guide format.

Planning and Troubleshooting Guide.

ERIC Educational Resources Information Center

1994

This reference guide serves as an index for an 11-volume series of handbooks that offer guidelines to school administrators on the application and implementation of Total Quality Management (TQM) principles to education--Total Quality Education (TQE). The topics are listed in alphabetical order to show the corresponding volume and page number(s).…

45 CFR 1160.13 - Indemnification limits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES FEDERAL COUNCIL ON THE ARTS AND THE HUMANITIES INDEMNITIES UNDER THE ARTS AND ARTIFACTS INDEMNITY... the guidelines referred to in § 1160.1 and are based upon the statutory limits in the Arts and...

What Counts as Inclusion?

ERIC Educational Resources Information Center

Walton, E.; Nel, N.

2012-01-01

In the years since the publication in South Africa of White Paper Six: Special needs education (Department of Education (DoE) 2001) various schools in the state and independent sectors have begun to implement inclusive policies and practices. With reference to the Guidelines for full-service/inclusive schools issued in 2009, and by discussing a…

Supervisor's Guide for Transporting Children with Special Health Needs.

ERIC Educational Resources Information Center

Maryland State Dept. of Health and Mental Hygiene, Baltimore.

This guide is intended to provide local school district supervisors of transportation in Maryland with a ready reference on the transportation of children with special health care needs. An introduction offers decision guidelines and legal definitions under Maryland regulations. Basic information on the following conditions are then summarized:…

Yellow-Poplar: Characteristics and Management

Treesearch

Donald E. Beck; Lino Della-Bianca

1981-01-01

This reference tool and field guide for foresters and other landmanagers includes a synthesis of information on the characteristics of yellow-poplar with guidelines for managing the species. It is based on research conducted by many individuals in State and Federal forestry organizations and in universities throughout the Eastern United States. This handbook...

Letter Writing as a Tool To Increase Client Motivation To Change: Application to an Inpatient Crisis Unit.

ERIC Educational Resources Information Center

Tubman, Jonathan G.; Montgomery, Marilyn J.; Wagner, Eric F.

2001-01-01

Describes the application of a letter writing exercise as a motivational technique for group counseling in contemporary crisis unit settings. Discusses guidelines and implications for clinical practice with clients with multiple, chronic problems. (Contains 37 references and 1 table.) (GCP)

Perspective: The case for an evidence-based reference interval for serum magnesium: The time has come

USDA-ARS?s Scientific Manuscript database

The 2015 Dietary Guidelines Advisory Committee indicated magnesium was a shortfall nutrient that was underconsumed relative to the Estimated Average Requirement (EAR) for many Americans. Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially...

IBPAT/OSHA Health and Safety Education Book.

ERIC Educational Resources Information Center

International Brotherhood of Painters and Allied Trades, Washington, DC.

Designed for paint and allied trade workers, this manual/reference guide contains information and guidelines for (1) workers in general occupational health hazards, (2) hazards particular to each trade group, (3) control of occupational hazards, (4) worker rights and responsibilities, (5) how to call in outside help, and (6) Occupational Safety…

Tornado: Accounts of tornadoes in Iowa, second edition

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

Stanford, J.L.

1987-01-01

Explains known facts about tornadoes in general and specifically in Iowa; provides safety guidelines to surviving a tornado; and discusses the history of tornadoes in the state along with experiences of Iowans who survived them. Includes 75 black-and-white photographs and a removable tornado safety reference card.

45 CFR 1160.13 - Indemnification limits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES FEDERAL COUNCIL ON THE ARTS AND THE HUMANITIES INDEMNITIES UNDER THE ARTS AND ARTIFACTS INDEMNITY... the guidelines referred to in § 1160.1 and are based upon the statutory limits in the Arts and...

The Leadership Potential of School Librarians

ERIC Educational Resources Information Center

Smith, Angela Powers

2013-01-01

Since their origin in 1925, standards for elementary school library programs have outlined role expectations for the school librarian. As the passage of time introduced new technologies into the world of education, these standards were reviewed and revised. After each revision, the standards, which were later referred to as guidelines, reflected…

To amend the Fair Credit Reporting Act to provide for an exclusion from Red Flag Guidelines for certain businesses.

THOMAS, 111th Congress

Rep. Adler, John H. [D-NJ-3

2009-10-08

Senate - 10/21/2009 Received in the Senate and Read twice and referred to the Committee on Banking, Housing, and Urban Affairs. (All Actions) Tracker: This bill has the status Passed HouseHere are the steps for Status of Legislation:

Healthy Water Healthy People Field Monitoring Guide

ERIC Educational Resources Information Center

Project WET Foundation, 2003

2003-01-01

This 100-page manual serves as a technical reference for the "Healthy Water, Healthy People Water Quality Educators Guide" and the "Healthy Water Healthy People Testing Kits". Yielding in-depth information about ten water quality parameters, it answers questions about water quality testing using technical overviews, data interpretation guidelines,…

Strategic Design of an Interactive Video Learning Lab (IVL).

ERIC Educational Resources Information Center

Switzer, Ralph V., Jr.; Switzer, Jamie S.

1993-01-01

Describes a study that researched elements necessary for the design of an interactive video learning (IVL) lab for business courses. Highlights include a review of pertinent literature; guidelines for the use of an IVL lab; IVL systems integration; system specifications; hardware costs; and system software. (five references) (LRW)

USAF Damage Tolerant Design Handbook: Guidelines for the Analysis and Design of Damage Tolerant Aircraft Structures. Revision B

DTIC Science & Technology

1984-05-01

Effect of Block Programming and Block Size on Crack Growth Life (All Histories Have Same Cycle Content) Alloy : 2024 -T3 Aluminum (Reference 27...1 I 6 o T 1 >0 100 Crack Growth Life for l-in. Crack Growth 1000 Figure 5.1.10, Effect of Humidity on Fatigue Crack Propagation...Growth Life (All Histories Have Same Cycle Content) Alloy : 2024 -T3 Aluminum (Reference 27). 5.2.6 Yield Zone Due to Overload (r T), Current Crack

Radiation Safety in Nuclear Medicine Procedures.

PubMed

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

2017-03-01

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

Identification of reference genes for RT-qPCR analysis in peach genotypes with contrasting chilling requirements.

PubMed

Marini, N; Bevilacqua, C B; Büttow, M V; Raseira, M C B; Bonow, S

2017-05-25

Selecting and validating reference genes are the first steps in studying gene expression by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR). The present study aimed to evaluate the stability of five reference genes for the purpose of normalization when studying gene expression in various cultivars of Prunus persica with different chilling requirements. Flower bud tissues of nine peach genotypes from Embrapa's peach breeding program with different chilling requirements were used, and five candidate reference genes based on the RT-qPCR that were useful for studying the relative quantitative gene expression and stability were evaluated using geNorm, NormFinder, and bestKeeper software packages. The results indicated that among the genes tested, the most stable genes to be used as reference genes are Act and UBQ10. This study is the first survey of the stability of reference genes in peaches under chilling stress and provides guidelines for more accurate RT-qPCR results.

Recommendation for the review of biological reference intervals in medical laboratories.

PubMed

Henny, Joseph; Vassault, Anne; Boursier, Guilaine; Vukasovic, Ines; Mesko Brguljan, Pika; Lohmander, Maria; Ghita, Irina; Andreu, Francisco A Bernabeu; Kroupis, Christos; Sprongl, Ludek; Thelen, Marc H M; Vanstapel, Florent J L A; Vodnik, Tatjana; Huisman, Willem; Vaubourdolle, Michel

2016-12-01

This document is based on the original recommendation of the Expert Panel on the Theory of Reference Values of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), updated guidelines were recently published under the auspices of the IFCC and the Clinical and Laboratory Standards Institute (CLSI). This document summarizes proposals for recommendations on: (i) The terminology, which is often confusing, noticeably concerning the terms of reference limits and decision limits. (ii) The method for the determination of reference limits according to the original procedure and the conditions, which should be used. (iii) A simple procedure allowing the medical laboratories to fulfill the requirements of the regulation and standards. The updated document proposes to verify that published reference limits are applicable to the laboratory involved. Finally, the strengths and limits of the revised recommendations (especially the selection of the reference population, the maintenance of the analytical quality, the choice of the statistical method used…) will be briefly discussed.

Guidelines for Assessment of Gait and Reference Values for Spatiotemporal Gait Parameters in Older Adults: The Biomathics and Canadian Gait Consortiums Initiative

PubMed Central

Beauchet, Olivier; Allali, Gilles; Sekhon, Harmehr; Verghese, Joe; Guilain, Sylvie; Steinmetz, Jean-Paul; Kressig, Reto W.; Barden, John M.; Szturm, Tony; Launay, Cyrille P.; Grenier, Sébastien; Bherer, Louis; Liu-Ambrose, Teresa; Chester, Vicky L.; Callisaya, Michele L.; Srikanth, Velandai; Léonard, Guillaume; De Cock, Anne-Marie; Sawa, Ryuichi; Duque, Gustavo; Camicioli, Richard; Helbostad, Jorunn L.

2017-01-01

Background: Gait disorders, a highly prevalent condition in older adults, are associated with several adverse health consequences. Gait analysis allows qualitative and quantitative assessments of gait that improves the understanding of mechanisms of gait disorders and the choice of interventions. This manuscript aims (1) to give consensus guidance for clinical and spatiotemporal gait analysis based on the recorded footfalls in older adults aged 65 years and over, and (2) to provide reference values for spatiotemporal gait parameters based on the recorded footfalls in healthy older adults free of cognitive impairment and multi-morbidities. Methods: International experts working in a network of two different consortiums (i.e., Biomathics and Canadian Gait Consortium) participated in this initiative. First, they identified items of standardized information following the usual procedure of formulation of consensus findings. Second, they merged databases including spatiotemporal gait assessments with GAITRite® system and clinical information from the “Gait, cOgnitiOn & Decline” (GOOD) initiative and the Generation 100 (Gen 100) study. Only healthy—free of cognitive impairment and multi-morbidities (i.e., ≤ 3 therapeutics taken daily)—participants aged 65 and older were selected. Age, sex, body mass index, mean values, and coefficients of variation (CoV) of gait parameters were used for the analyses. Results: Standardized systematic assessment of three categories of items, which were demographics and clinical information, and gait characteristics (clinical and spatiotemporal gait analysis based on the recorded footfalls), were selected for the proposed guidelines. Two complementary sets of items were distinguished: a minimal data set and a full data set. In addition, a total of 954 participants (mean age 72.8 ± 4.8 years, 45.8% women) were recruited to establish the reference values. Performance of spatiotemporal gait parameters based on the recorded footfalls declined with increasing age (mean values and CoV) and demonstrated sex differences (mean values). Conclusions: Based on an international multicenter collaboration, we propose consensus guidelines for gait assessment and spatiotemporal gait analysis based on the recorded footfalls, and reference values for healthy older adults. PMID:28824393

Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis.

PubMed

Kreiner, D Scott; Baisden, Jamie; Mazanec, Daniel J; Patel, Rakesh D; Bess, Robert S; Burton, Douglas; Chutkan, Norman B; Cohen, Bernard A; Crawford, Charles H; Ghiselli, Gary; Hanna, Amgad S; Hwang, Steven W; Kilincer, Cumhur; Myers, Mark E; Park, Paul; Rosolowski, Karie A; Sharma, Anil K; Taleghani, Christopher K; Trammell, Terry R; Vo, Andrew N; Williams, Keith D

2016-12-01

The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adult Isthmic Spondylolisthesis features evidence-based recommendations for diagnosing and treating adult patients with isthmic spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic isthmic spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2013. NASS' guideline on this topic is the only guideline on adult isthmic spondylolisthesis accepted in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse. The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with isthmic spondylolisthesis. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. This is a guideline summary review. This guideline is the product of the Adult Isthmic Spondylolisthesis Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questionsto address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guidelines were submitted to an internal peer review process and ultimately approved by the NASS Board of Directors. Upon publication, the Adult Isthmic Spondylolisthesis guideline was accepted into the National Guideline Clearinghouse and will be updated approximately every 5 years. Thirty-one clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with isthmic spondylolisthesis. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx and will remain updated on a timely schedule. Copyright © 2016 Elsevier Inc. All rights reserved.

Reporting guidelines for implementation and operational research.

PubMed

Hales, Simon; Lesher-Trevino, Ana; Ford, Nathan; Maher, Dermot; Ramsay, Andrew; Tran, Nhan

2016-01-01

In public health, implementation research is done to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required.

Well-differentiated neuroendocrine tumor of the stomach

PubMed Central

Gumuscu, Burak; Norwood, Kevin; Parker, George A.; Bridges, C. Lee; Rountree, Carl B.

2016-01-01

Abstract Introduction: A 13-year-old African–American female presented to her primary care physician's office with fatigue, syncope, and hematemesis. After initial evaluation, the patient was referred to pediatric gastroenterology clinic for further evaluation. Main concerns, important findings: An upper gastrointestinal endoscopy was performed to evaluate the source of her bleeding. Endoscopy revealed a 3-cm mass in the lesser curvature of the stomach, and a biopsy of the mass revealed a concern for carcinoid (neuroendocrine) features. Diagnosis: She underwent an open gastrectomy. Post-surgical pathology reports confirmed a well-differentiated neuroendocrine tumor of the stomach. Conclusion: Neuroendocrine tumors of the stomach in children are rare and we presently do not have pediatric-specific diagnostic and treatment guidelines. Although adult-based The North American Neuroendocrine Tumor Society (NANETS) guidelines are helpful, they are clearly not geared toward pediatric patients. To establish pediatric guidelines and to assess effectiveness of treatments, multicenter data collection is essential. In the long run, accumulation of clinically useful treatment information and long-term follow-up guidelines should enable clinicians to improve standard of care given to children with neuroendocrine tumors. PMID:27442656

Orbital infections: a complete cycle 7-year audit and a management guideline.

PubMed

Atfeh, Mihiar Sami; Singh, Kathryn; Khalil, Hisham Saleh

2018-06-04

Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long-term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre. (1) A retrospective 5-year audit cycle on patients with orbital infections. (2) A review of available evidence on the management of orbital infections. (3) A new local multidisciplinary guideline on the management of orbital infections. (4) A retrospective 2-year second audit cycle to assess the clinical outcomes. Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline. However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.

[Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].

PubMed

Birkner, B

2000-09-01

The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.

No. 208-Guidelines for the Management of Herpes Simplex Virus in Pregnancy.

PubMed

Money, Deborah M; Steben, Marc

2017-08-01

To provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. More effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. Medline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. VALIDATION: These guidelines have been reviewed and approved by the Infectious Diseases Committee of the SOGC. The Society of Obstetricians and Gynaecologists of Canada. Copyright © 2017. Published by Elsevier Inc.

Nuclear safety policy working group recommendations on nuclear propulsion safety for the space exploration initiative

NASA Technical Reports Server (NTRS)

Marshall, Albert C.; Lee, James H.; Mcculloch, William H.; Sawyer, J. Charles, Jr.; Bari, Robert A.; Cullingford, Hatice S.; Hardy, Alva C.; Niederauer, George F.; Remp, Kerry; Rice, John W.

1993-01-01

An interagency Nuclear Safety Working Group (NSPWG) was chartered to recommend nuclear safety policy, requirements, and guidelines for the Space Exploration Initiative (SEI) nuclear propulsion program. These recommendations, which are contained in this report, should facilitate the implementation of mission planning and conceptual design studies. The NSPWG has recommended a top-level policy to provide the guiding principles for the development and implementation of the SEI nuclear propulsion safety program. In addition, the NSPWG has reviewed safety issues for nuclear propulsion and recommended top-level safety requirements and guidelines to address these issues. These recommendations should be useful for the development of the program's top-level requirements for safety functions (referred to as Safety Functional Requirements). The safety requirements and guidelines address the following topics: reactor start-up, inadvertent criticality, radiological release and exposure, disposal, entry, safeguards, risk/reliability, operational safety, ground testing, and other considerations.

[Measurement of the air kerma using dosimeters embedded in an acrylic phantom in interventional radiology.].

PubMed

Kawabe, Atsushi; Shibuya, Koichi; Takeda, Yoshihiro

2006-01-01

Interventional radiology procedure guidelines and a measurement manual (IVR guidelines) have been published for the maintenance of interventional equipment with an objective of avoiding serious radiation-induced skin injuries. In the IVR guidelines, the positioning of a dosimeter at the interventional reference point is determined, whereas placement of a phantom is not specified. Therefore, the phantom is placed at any convenient location between the dosimeter and image intensifier. The space around the dosimeter reduces detection of scattered radiation. In this study, dosimeters (consisting of a parallel plate ionization chamber, glass dosimeter and OSL dosimeter) were embedded in the phantom surface to detected scattered radiation accurately. As a result, when dosimeters were embedded in the phantom surface, the air kerma was increased compared with that when dosimeters were placed on the phantom. This suggested that embedded dosimeters were able to detect scattered radiation from the phantom.

Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia.

PubMed

Lavoie, Kim L; Rash, Joshua A; Campbell, Tavis S

2017-01-06

Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.

Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project

PubMed Central

Batalden, Paul; Stevens, David; Ogrinc, Greg; Mooney, Susan

2008-01-01

In 2005 we published draft guidelines for reporting studies of quality improvement interventions as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as SQUIRE (Standards for QUality Improvement Reporting Excellence). We describe the consensus process, which included informal feedback, formal written commentaries, input from publication guideline developers, review of the literature on the epistemology of improvement and on methods for evaluating complex social programs, and a meeting of stakeholders for critical review of the guidelines’ content and wording, followed by commentary on sequential versions from an expert consultant group. Finally, we examine major differences between SQUIRE and the initial draft, and consider limitations of and unresolved questions about SQUIRE; we also describe ancillary supporting documents and alternative versions under development, and plans for dissemination, testing, and further development of SQUIRE. PMID:18830766

[Software for illustrating a cost-quality balance carried out by clinical laboratory practice].

PubMed

Nishibori, Masahiro; Asayama, Hitoshi; Kimura, Satoshi; Takagi, Yasushi; Hagihara, Michio; Fujiwara, Mutsunori; Yoneyama, Akiko; Watanabe, Takashi

2010-09-01

We have no proper reference indicating the quality of clinical laboratory practice, which should clearly illustrates that better medical tests require more expenses. Japanese Society of Laboratory Medicine was concerned about recent difficult medical economy and issued a committee report proposing a guideline to evaluate the good laboratory practice. According to the guideline, we developed software that illustrate a cost-quality balance carried out by clinical laboratory practice. We encountered a number of controversial problems, for example, how to measure and weight each quality-related factor, how to calculate costs of a laboratory test and how to consider characteristics of a clinical laboratory. Consequently we finished only prototype software within the given period and the budget. In this paper, software implementation of the guideline and the above-mentioned problems are summarized. Aiming to stimulate these discussions, the operative software will be put on the Society's homepage for trial

Guidelines for the management of herpes simplex virus in pregnancy.

PubMed

Money, Deborah; Steben, Marc

2008-06-01

To provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. More effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. Medline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.

Text recycling: acceptable or misconduct?

PubMed

Harriman, Stephanie; Patel, Jigisha

2014-08-16

Text recycling, also referred to as self-plagiarism, is the reproduction of an author's own text from a previous publication in a new publication. Opinions on the acceptability of this practice vary, with some viewing it as acceptable and efficient, and others as misleading and unacceptable. In light of the lack of consensus, journal editors often have difficulty deciding how to act upon the discovery of text recycling. In response to these difficulties, we have created a set of guidelines for journal editors on how to deal with text recycling. In this editorial, we discuss some of the challenges of developing these guidelines, and how authors can avoid undisclosed text recycling.

Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions.

PubMed

Gambito, Ephraim D V; Gonzalez-Suarez, Consuelo B; Grimmer, Karen A; Valdecañas, Carolina M; Dizon, Janine Margarita R; Beredo, Ma Eulalia J; Zamora, Marcelle Theresa G

2015-11-04

Clinical practice guidelines need to be regularly updated with current literature in order to remain relevant. This paper reports on the approach taken by the Philippine Academy of Rehabilitation Medicine (PARM). This dovetails with its writing guide, which underpinned its foundational work in contextualizing guidelines for stroke and low back pain (LBP) in 2011. Working groups of Filipino rehabilitation physicians and allied health practitioners met to reconsider and modify, where indicated, the 'typical' Filipino patient care pathways established in the foundation guidelines. New clinical guidelines on stroke and low back pain which had been published internationally in the last 3 years were identified using a search of electronic databases. The methodological quality of each guideline was assessed using the iCAHE Guideline Quality Checklist, and only those guidelines which provided full text references, evidence hierarchy and quality appraisal of the included literature, were included in the PARM update. Each of the PARM-endorsed recommendations was then reviewed, in light of new literature presented in the included clinical guidelines. A novel standard updating approach was developed based on the criteria reported by Johnston et al. (Int J Technol Assess Health Care 19(4):646-655, 2003) and then modified to incorporate wording from the foundational PARM writing guide. The new updating tool was debated, pilot-tested and agreed upon by the PARM working groups, before being applied to the guideline updating process. Ten new guidelines on stroke and eleven for low back pain were identified. Guideline quality scores were moderate to good, however not all guidelines comprehensively linked the evidence body underpinning recommendations with the literature. Consequently only five stroke and four low back pain guidelines were included. The modified PARM updating guide was applied by all working groups to ensure standardization of the wording of updated recommendations and the underpinning evidence bases. The updating tool provides a simple, standard and novel approach that incorporates evidence hierarchy and quality, and wordings of recommendations. It could be used efficiently by other guideline updaters particularly in developing countries, where resources for guideline development and updates are limited. When many people are involved in guideline writing, there is always the possibility of 'slippage' in use of wording and interpretation of evidence. The PARM updating tool provides a mechanism for maintaining a standard process for guideline updating processes that can be followed by clinicians with basic training in evidence-based practice principles.

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).

PubMed

Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C

2018-03-01

Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia.

Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines.

PubMed

von Knobelsdorff-Brenkenhoff, Florian; Pilz, Guenter; Schulz-Menger, Jeanette

2017-09-25

Whereas evidence supporting the diagnostic value of cardiovascular magnetic resonance (CMR) has increased, there exists significant worldwide variability in the clinical utilization of CMR. A recent study demonstrated that CMR is represented in the majority of European Society for Cardiology (ESC) guidelines, with a large number of specific recommendations in particular regarding coronary artery disease. To further investigate the gap between the evidence and clinical use of CMR, this study analyzed the role of CMR in the guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA). Twenty-four AHA/ACC original guidelines, updates and new editions, published between 2006 and 2017, were screened for the terms "magnetic", "MRI", "CMR", "MR" and "imaging". Non-cardiovascular MR examinations were excluded. All CMR-related paragraphs and specific recommendations for CMR including the level of evidence (A, B, C) and the class of recommendation (I, IIa, IIb, III) were extracted. Twelve of the 24 guidelines (50.0%) contain specific recommendations regarding CMR. Four guidelines (16.7%) mention CMR in the text only, and 8 (33.3%) do not mention CMR. The 12 guidelines with recommendations for CMR contain in total 65 specific recommendations (31 class-I, 23 class-IIa, 6 class-IIb, 5 class-III). Most recommendations have evidence level C (44/65; 67.7%), followed by level B (21/65; 32.3%). There are no level A recommendations. 22/65 recommendations refer to vascular imaging, 17 to congenital heart disease, 8 to cardiomyopathies, 8 to myocardial stress testing, 5 to left and right ventricular function, 3 to viability, and 2 to valvular heart disease. CMR is represented in two thirds of the AHA/ACC guidelines, which contain a number of specific recommendations for the use of CMR. In a simplified comparison with the ESC guidelines, CMR is less represented in the AHA/ACC guidelines in particular in the field of coronary artery disease.

Evaluation of four commercial biuret reagent kits of serum total protein by the American Association for Clinical Chemistry reference measurement procedure.

PubMed

He, Meilin; Zhang, Jie

2011-06-01

In China, the traceability of clinical chemistry methods is still immature. Therefore, it is necessary to establish a reference measurement procedure and evaluate commercial reagent kits using such established procedures. We reproduced the reference measurement procedure for serum total protein, as recommended by the American Association for Clinical Chemistry (AACC). We evaluated the performance by Clinical Laboratory Standard Institute (CLSI) guidelines EP15-A and EP6-A. Subsequently, four commercial reagent kits were evaluated by the reproduced reference procedure following CLSI guideline EP9-A2. The performance of the reproduced reference procedure was as follows: CVs ranged from 0.47% to 0.85% at medical decision levels (X(c)) of 45 g/L, 60 g/L and 80 g/L. Linearity was Y=1.0022X-0.2121 (r=0.9999), and recovery ranged from 100.2% to 102.4%. The External Quality Assessment Scheme for Reference Laboratories in Laboratory Medicine (RELA) was applied, and the result was within the limit of equivalence. The linear relationships of four commercial reagent kits, Merit Choice, KHB, Leadman, and Olympus, were, respectively: Y=0.9922X+0.5776 (r=0.9961); Y=0.9936X+0.4316 (r=0.9992); Y=0.9949X+0.9129 (r=0.9987) and Y=0.9923X+0.8876 (r=0.9989). KHB showed slight negative bias, and the mean±SD was -0.03±0.60 g/L. Merit Choice, Leadman, and Olympus all showed positive bias, and the mean±SDs were 0.02±0.63 g/L, 0.55±0.77 g/L and 0.34±0.71 g/L, respectively. The correlation and bias of four commercial reagent kits for serum total protein were found to be acceptable. Thus, these reagent kits can be used reliably in China.

Specific guidelines for assessing and improving the methodological quality of economic evaluations of newborn screening

PubMed Central

2012-01-01

Background Economic evaluation of newborn screening poses specific methodological challenges. Amongst others, these challenges refer to the use of quality adjusted life years (QALYs) in newborns, and which costs and outcomes need to be considered in a full evaluation of newborn screening programmes. Because of the increasing scale and scope of such programmes, a better understanding of the methods of high-quality economic evaluations may be crucial for both producers/authors and consumers/reviewers of newborn screening-related economic evaluations. The aim of this study was therefore to develop specific guidelines designed to assess and improve the methodological quality of economic evaluations in newborn screening. Methods To develop the guidelines, existing guidelines for assessing the quality of economic evaluations were identified through a literature search, and were reviewed and consolidated using a deductive iterative approach. In a subsequent test phase, these guidelines were applied to various economic evaluations which acted as case studies. Results The guidelines for assessing and improving the methodological quality of economic evaluations in newborn screening are organized into 11 categories: “bibliographic details”, “study question and design”, “modelling”, “health outcomes”, “costs”, “discounting”, “presentation of results”, “sensitivity analyses”, “discussion”, “conclusions”, and “commentary”. Conclusions The application of the guidelines highlights important issues regarding newborn screening-related economic evaluations, and underscores the need for such issues to be afforded greater consideration in future economic evaluations. The variety in methodological quality detected by this study reveals the need for specific guidelines on the appropriate methods for conducting sound economic evaluations in newborn screening. PMID:22947299

Intention of physicians to implement guidelines for screening and treatment of latent tuberculosis infection in HIV-infected patients in The Netherlands: a mixed-method design.

PubMed

Evenblij, Kirsten; Verbon, Annelies; van Leth, Frank

2016-09-01

All newly diagnosed HIV-infected patients in the Netherlands should be screened for latent tuberculosis infection (LTBI) and offered preventive therapy if infected without evidence of active tuberculosis. This guideline, endorsed by the national professional body of HIV physicians is in line with international recommendations, and based on the increased risk of progression from LTBI to active tuberculosis in HIV-infected patients. The objective of the study is to assess the intention of HIV physicians to implement this national guideline. A mixed method design triangulating results from two surveys among all (n = 80) HIV physicians in The Netherlands and qualitative interviews among 11 Dutch HIV physicians performed in 2014. The majority of physicians used a risk-stratification approach based on individual a priori risk of tuberculosis to identify HIV-infected patients for LTBI screening, rather than screening all new HIV-infected patients. The intended and actual provision of preventive treatment was low, due to expressed doubts on the accuracy of diagnostic tools for LTBI. Interviewees reported that the guidelines did not match their clinical experience and lacked evidence for the recommendations. Screening for and treatment of LTBI was approached at a patient-level only. None of the interviewees referred to potential public health implications of the guidelines. Intended implementation of the national HIV-TB guidelines in the Netherlands is poor, due to a disconnect between clinical practice and evidence-based recommendations in the guideline. There is an urgent need to reconcile the views of HIV-physicians, public health experts, and guideline committee members, regarding the best strategy to address HIV-TB co-infection in the Netherlands.

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

PubMed Central

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

2015-01-01

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

How equity is addressed in clinical practice guidelines: a content analysis

PubMed Central

Shi, Chunhu; Tian, Jinhui; Wang, Quan; Petkovic, Jennifer; Ren, Dan; Yang, Kehu; Yang, Yang

2014-01-01

Objectives Considering equity into guidelines presents methodological challenges. This study aims to qualitatively synthesise the methods for incorporating equity in clinical practice guidelines (CPGs). Setting Content analysis of methodological publications. Eligibility criteria for selecting studies Methodological publications were included if they provided checklists/frameworks on when, how and to what extent equity should be incorporated in CPGs. Data sources We electronically searched MEDLINE, retrieved references, and browsed guideline development organisation websites from inception to January 2013. After study selection by two authors, general characteristics and checklists items/framework components from included studies were extracted. Based on the questions or items from checklists/frameworks (unit of analysis), content analysis was conducted to identify themes and questions/items were grouped into these themes. Primary outcomes The primary outcomes were methodological themes and processes on how to address equity issues in guideline development. Results 8 studies with 10 publications were included from 3405 citations. In total, a list of 87 questions/items was generated from 17 checklists/frameworks. After content analysis, questions were grouped into eight themes (‘scoping questions’, ‘searching relevant evidence’, ‘appraising evidence and recommendations’, ‘formulating recommendations’, ‘monitoring implementation’, ‘providing a flow chart to include equity in CPGs’, and ‘others: reporting of guidelines and comments from stakeholders’ for CPG developers and ‘assessing the quality of CPGs’ for CPG users). Four included studies covered more than five of these themes. We also summarised the process of guideline development based on the themes mentioned above. Conclusions For disadvantaged population-specific CPGs, eight important methodological issues identified in this review should be considered when including equity in CPGs under the guidance of a scientific guideline development manual. PMID:25479795

Smoking cessation treatment practices: recommendations for improved adoption on cardiology wards.

PubMed

Berndt, Nadine C; Bolman, Catherine; de Vries, Hein; Segaar, Dewi; van Boven, Irene; Lechner, Lilian

2013-01-01

Smoking cessation treatment practices described by the 5 A's (ask, advise, assess, assist, arrange) are not well applied at cardiology wards because of various reasons, such as a lack of time and appropriate skills of the nursing staff. Therefore, a simplified guideline proposing an ask-advise-refer (AAR) strategy was introduced in Dutch cardiac wards. This study aimed to identify factors that determine the intentions of cardiac ward heads in adopting the simplified AAR guideline, as ward heads are key decision makers in the adoption of new guidelines. Ward heads' perceptions of current smoking cessation practices at the cardiac ward were also investigated. A cross-sectional survey with written questionnaires was conducted among heads of cardiology wards throughout the Netherlands, of whom 117 (64%) responded. According to the heads of cardiac wards, smoking cessation practices by cardiologists and nurses were mostly limited to brief practices that are easy to conduct. Only a minority offered intensive counseling or arranged follow-up contact. Heads with strong intentions of adopting the AAR guideline differed significantly on motivational and organizational attributes and perceived more smoking cessation assistance by other health professionals than did heads with weak intentions of adopting. Positive attitudes, social support toward adoption, and perception of much assistance at the ward were significantly associated with increased intentions to adopt the AAR guideline. Brief smoking cessation practices are adequately performed at cardiac wards, but the most effective practices, offering assistance and arranging for follow-up, are less than optimal. The AAR guideline offers a more feasible approach for busy cardiology wards. To ensure successful adoption of this guideline, the heads of cardiac wards should be convinced of its advantages and be encouraged by a supportive work environment. Policies may also facilitate the adoption of the AAR guideline.

IAP Guidelines on Rickettsial Diseases in Children.

PubMed

Rathi, Narendra; Kulkarni, Atul; Yewale, Vijay

2017-03-15

To formulate practice guidelines on rickettsial diseases in children for pediatricians across India. Rickettsial diseases are increasingly being reported from various parts of India. Due to low index of suspicion, nonspecific clinical features in early course of disease, and absence of easily available, sensitive and specific diagnostic tests, these infections are difficult to diagnose. With timely diagnosis, therapy is easy, affordable and often successful. On the other hand, in endemic areas, where healthcare workers have high index of suspicion for these infections, there is rampant and irrational use of doxycycline as a therapeutic trial in patients of undifferentiated fevers. Thus, there is a need to formulate practice guidelines regarding rickettsial diseases in children in Indian context. A committee was formed for preparing guidelines on rickettsial diseases in children in June 2016. A meeting of consultative committee was held in IAP office, Mumbai and scientific content was discussed. Methodology and results were scrutinized by all members and consensus was reached. Textbook references and published guidelines were also used in few instances to make recommendations. Various Indian and international publications pertinent to present study were collated and guidelines were approved by all committee members. Future updates in these guidelines will be dictated by new scientific data in the field of rickettsial diseases in children. Indian tick typhus and scrub typhus are commonly seen rickettsial diseases in India. It is recommended that practicing pediatricians should be well conversant with compatible clinical scenario, suggestive epidemiological features, differential diagnoses and suggestive laboratory features to make diagnosis and avoid over diagnosis of these infections, as suggested in these guidelines. Doxycycline is the drug of choice and treatment should begin promptly without waiting for confirmatory laboratory results.

Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines.

PubMed

Scott, Jared; Howard, Benjamin; Sinnett, Philip; Schiesel, Michael; Baker, Jana; Henderson, Patrick; Vassar, Matt

2017-12-01

The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs. We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA. We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines. Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

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

2015-06-03

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

MRAC Revisited: Guaranteed Performance with Reference Model Modification

NASA Technical Reports Server (NTRS)

Stepanyan, Vahram; Krishnakumar, Kalmaje

2010-01-01

This paper presents modification of the conventional model reference adaptive control (MRAC) architecture in order to achieve guaranteed transient performance both in the output and input signals of an uncertain system. The proposed modification is based on the tracking error feedback to the reference model. It is shown that approach guarantees tracking of a given command and the ideal control signal (one that would be designed if the system were known) not only asymptotically but also in transient by a proper selection of the error feedback gain. The method prevents generation of high frequency oscillations that are unavoidable in conventional MRAC systems for large adaptation rates. The provided design guideline makes it possible to track a reference command of any magnitude form any initial position without re-tuning. The benefits of the method are demonstrated in simulations.

Japan Society of Gynecologic Oncology guidelines 2013 for the treatment of uterine body neoplasms.

PubMed

Ebina, Yasuhiko; Katabuchi, Hidetaka; Mikami, Mikio; Nagase, Satoru; Yaegashi, Nobuo; Udagawa, Yasuhiro; Kato, Hidenori; Kubushiro, Kaneyuki; Takamatsu, Kiyoshi; Ino, Kazuhiko; Yoshikawa, Hiroyuki

2016-06-01

The third version of the Japan Society of Gynecologic Oncology guidelines for the treatment of uterine body neoplasms was published in 2013. The guidelines comprise nine chapters and nine algorithms. Each chapter includes a clinical question, recommendations, background, objectives, explanations, and references. This revision was intended to collect up-to-date international evidence. The highlights of this revision are to (1) newly specify costs and conflicts of interest; (2) describe the clinical significance of pelvic lymph node dissection and para-aortic lymphadenectomy, including variant histologic types; (3) describe more clearly the indications for laparoscopic surgery as the standard treatment; (4) provide guidelines for post-treatment hormone replacement therapy; (5) clearly differentiate treatment of advanced or recurrent cancer between the initial treatment and the treatment carried out after the primary operation; (6) collectively describe fertility-sparing therapy for both atypical endometrial hyperplasia and endometrioid adenocarcinoma (corresponding to G1) and newly describe relapse therapy after fertility-preserving treatment; and (7) newly describe the treatment of trophoblastic disease. Overall, the objective of these guidelines is to clearly delineate the standard of care for uterine body neoplasms in Japan with the goal of ensuring a high standard of care for all Japanese women diagnosed with uterine body neoplasms.