Designing HIV Testing Algorithms Based on 2015 WHO Guidelines Using Data from Six Sites in Sub-Saharan Africa

PubMed Central

Kosack, Cara S.; Shanks, Leslie; Beelaert, Greet; Benson, Tumwesigye; Savane, Aboubacar; Ng'ang'a, Anne; Bita, André; Zahinda, Jean-Paul B. N.; Fransen, Katrien

2017-01-01

ABSTRACT Our objective was to evaluate the performance of HIV testing algorithms based on WHO recommendations, using data from specimens collected at six HIV testing and counseling sites in sub-Saharan Africa (Conakry, Guinea; Kitgum and Arua, Uganda; Homa Bay, Kenya; Douala, Cameroon; Baraka, Democratic Republic of Congo). A total of 2,780 samples, including 1,306 HIV-positive samples, were included in the analysis. HIV testing algorithms were designed using Determine as a first test. Second and third rapid diagnostic tests (RDTs) were selected based on site-specific performance, adhering where possible to the WHO-recommended minimum requirements of ≥99% sensitivity and specificity. The threshold for specificity was reduced to 98% or 96% if necessary. We also simulated algorithms consisting of one RDT followed by a simple confirmatory assay. The positive predictive values (PPV) of the simulated algorithms ranged from 75.8% to 100% using strategies recommended for high-prevalence settings, 98.7% to 100% using strategies recommended for low-prevalence settings, and 98.1% to 100% using a rapid test followed by a simple confirmatory assay. Although we were able to design algorithms that met the recommended PPV of ≥99% in five of six sites using the applicable high-prevalence strategy, options were often very limited due to suboptimal performance of individual RDTs and to shared falsely reactive results. These results underscore the impact of the sequence of HIV tests and of shared false-reactivity data on algorithm performance. Where it is not possible to identify tests that meet WHO-recommended specifications, the low-prevalence strategy may be more suitable. PMID:28747371

Vision Zero San Francisco truck side guard initiative : technical assessment and recommendations

DOT National Transportation Integrated Search

2016-05-01

This report summarizes Volpes research and recommendations supporting San Francisco Municipal Transportation Agency (SFMTA) efforts to improve pedestrian and bicyclist safety through truck-based strategies. Specifically, this initial report focuse...

Guidelines for the Pharmacotherapy of Schizophrenia in Adults.

PubMed

Remington, Gary; Addington, Donald; Honer, William; Ismail, Zahinoor; Raedler, Thomas; Teehan, Michael

2017-09-01

The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia.

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

PubMed Central

Sanello, Ashley; Mulkerin, William; Sporer, Karl A.; Brown, John F.; Koenig, Kristi L.; Rudnick, Eric M.; Salvucci, Angelo A.; Gilbert, Gregory H.

2018-01-01

Introduction In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Results Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Conclusion Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols. PMID:29760852

Presence and Accuracy of Drug Dosage Recommendations for Continuous Renal Replacement Therapy in Tertiary Drug Information References

PubMed Central

Gorman, Sean K; Slavik, Richard S; Lam, Stefanie

2012-01-01

Background: Clinicians commonly rely on tertiary drug information references to guide drug dosages for patients who are receiving continuous renal replacement therapy (CRRT). It is unknown whether the dosage recommendations in these frequently used references reflect the most current evidence. Objective: To determine the presence and accuracy of drug dosage recommendations for patients undergoing CRRT in 4 drug information references. Methods: Medications commonly prescribed during CRRT were identified from an institutional medication inventory database, and evidence-based dosage recommendations for this setting were developed from the primary and secondary literature. The American Hospital Formulary System—Drug Information (AHFS–DI), Micromedex 2.0 (specifically the DRUGDEX and Martindale databases), and the 5th edition of Drug Prescribing in Renal Failure (DPRF5) were assessed for the presence of drug dosage recommendations in the CRRT setting. The dosage recommendations in these tertiary references were compared with the recommendations derived from the primary and secondary literature to determine concordance. Results: Evidence-based drug dosage recommendations were developed for 33 medications administered in patients undergoing CRRT. The AHFS–DI provided no dosage recommendations specific to CRRT, whereas the DPRF5 provided recommendations for 27 (82%) of the medications and the Micromedex 2.0 application for 20 (61%) (13 [39%] in the DRUGDEX database and 16 [48%] in the Martindale database, with 9 medications covered by both). The dosage recommendations were in concordance with evidence-based recommendations for 12 (92%) of the 13 medications in the DRUGDEX database, 26 (96%) of the 27 in the DPRF5, and all 16 (100%) of those in the Martindale database. Conclusions: One prominent tertiary drug information resource provided no drug dosage recommendations for patients undergoing CRRT. However, 2 of the databases in an Internet-based medical information application and the latest edition of a renal specialty drug information resource provided recommendations for a majority of the medications investigated. Most dosage recommendations were similar to those derived from the primary and secondary literature. The most recent edition of the DPRF is the preferred source of information when prescribing dosage regimens for patients receiving CRRT. PMID:22783029

Adult Attitudes Toward the Military: Poll Two

DTIC Science & Technology

2002-04-01

military service, specifically, and (2) develop research-based communications strategies and recommendations for each market . The Defense Manpower...military, their recommendations to youth regarding post-high school options, and research-based message strategies that would resonate with each market ...of Defense’s recruitment advertising and market research programs. • The Research Methodology section provides details on the design of the

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

PubMed

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

2015-03-01

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

Exercise recommendations for childhood cancer survivors exposed to cardiotoxic therapies: an institutional clinical practice initiative.

PubMed

Okada, Maki; Meeske, Kathleen A; Menteer, Jondavid; Freyer, David R

2012-01-01

Childhood cancer survivors who have received treatment with anthracyclines are at risk for developing cardiomyopathy in dose-dependent fashion. Historically, restrictions on certain types of physical activity that were intended to preserve cardiac function have been recommended, based on a mixture of evidence-based and consensus-based recommendations. In the LIFE Cancer Survivorship & Transition Program at Children's Hospital Los Angeles, the authors reevaluated their recommendations for exercise in survivors who were exposed to anthracyclines, with or without irradiation in proximity to the myocardium. The primary goal was to develop consistent, specific, practical, safe, and (where possible) evidence-based recommendations for at-risk survivors in the program. To accomplish this, the authors referred to current exercise guidelines for childhood cancer survivors, consulted recent literature for relevant populations, and obtained input from the program's pediatric cardiology consultant. The resulting risk-based exercise recommendations are designed to complement current published guidelines, maximize safe exercise, and help childhood cancer survivors return to a normal life that emphasizes overall wellness and physical activity. This article describes a single institution's experience in modifying exercise recommendations for at-risk childhood survivors and includes the methods, findings, and current institutional practice recommendations along with sample education materials.

Developing a semantic web model for medical differential diagnosis recommendation.

PubMed

Mohammed, Osama; Benlamri, Rachid

2014-10-01

In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features. We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: the evidence-based recommender component and the proximity-based recommender component. Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets. This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results.

A trust-based recommendation method using network diffusion processes

NASA Astrophysics Data System (ADS)

Chen, Ling-Jiao; Gao, Jian

2018-09-01

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

Objective consensus from decision trees.

PubMed

Putora, Paul Martin; Panje, Cedric M; Papachristofilou, Alexandros; Dal Pra, Alan; Hundsberger, Thomas; Plasswilm, Ludwig

2014-12-05

Consensus-based approaches provide an alternative to evidence-based decision making, especially in situations where high-level evidence is limited. Our aim was to demonstrate a novel source of information, objective consensus based on recommendations in decision tree format from multiple sources. Based on nine sample recommendations in decision tree format a representative analysis was performed. The most common (mode) recommendations for each eventuality (each permutation of parameters) were determined. The same procedure was applied to real clinical recommendations for primary radiotherapy for prostate cancer. Data was collected from 16 radiation oncology centres, converted into decision tree format and analyzed in order to determine the objective consensus. Based on information from multiple sources in decision tree format, treatment recommendations can be assessed for every parameter combination. An objective consensus can be determined by means of mode recommendations without compromise or confrontation among the parties. In the clinical example involving prostate cancer therapy, three parameters were used with two cut-off values each (Gleason score, PSA, T-stage) resulting in a total of 27 possible combinations per decision tree. Despite significant variations among the recommendations, a mode recommendation could be found for specific combinations of parameters. Recommendations represented as decision trees can serve as a basis for objective consensus among multiple parties.

Learning material recommendation based on case-based reasoning similarity scores

NASA Astrophysics Data System (ADS)

Masood, Mona; Mokmin, Nur Azlina Mohamed

2017-10-01

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

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

PubMed

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

2017-01-01

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

Guidelines for the Pharmacotherapy of Schizophrenia in Adults

PubMed Central

Addington, Donald; Honer, William; Ismail, Zahinoor; Raedler, Thomas; Teehan, Michael

2017-01-01

Objective: The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. Method: Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. Results: Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. Conclusions: In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia. PMID:28703015

PubMed Central

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

2018-01-01

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

ACR Appropriateness Criteria® Breast Cancer Screening.

PubMed

Mainiero, Martha B; Moy, Linda; Baron, Paul; Didwania, Aarati D; diFlorio, Roberta M; Green, Edward D; Heller, Samantha L; Holbrook, Anna I; Lee, Su-Ju; Lewin, Alana A; Lourenco, Ana P; Nance, Kara J; Niell, Bethany L; Slanetz, Priscilla J; Stuckey, Ashley R; Vincoff, Nina S; Weinstein, Susan P; Yepes, Monica M; Newell, Mary S

2017-11-01

Breast cancer screening recommendations are based on risk factors. For average-risk women, screening mammography and/or digital breast tomosynthesis is recommended beginning at age 40. Ultrasound (US) may be useful as an adjunct to mammography for incremental cancer detection in women with dense breasts, but the balance between increased cancer detection and the increased risk of a false-positive examination should be considered in the decision. For intermediate-risk women, US or MRI may be indicated as an adjunct to mammography depending upon specific risk factors. For women at high risk due to prior mantle radiation between the ages of 10 to 30, mammography is recommended starting 8 years after radiation therapy but not before age 25. For women with a genetic predisposition, annual screening mammography is recommended beginning 10 years earlier than the affected relative at the time of diagnosis but not before age 30. Annual screening MRI is recommended in high-risk women as an adjunct to mammography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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

PubMed

Kjeken, Ingvild

2011-12-01

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

Guidelines for the Primary Prevention of Stroke

PubMed Central

Meschia, James F.; Bushnell, Cheryl; Boden-Albala, Bernadette; Braun, Lynne T.; Bravata, Dawn M.; Chaturvedi, Seemant; Creager, Mark A.; Eckel, Robert H.; Elkind, Mitchell S.V.; Fornage, Myriam; Goldstein, Larry B.; Greenberg, Steven M.; Horvath, Susanna E.; Iadecola, Costantino; Jauch, Edward C.; Moore, Wesley S.; Wilson, John A.

2016-01-01

The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale. PMID:25355838

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians.

PubMed

Qaseem, Amir; Wilt, Timothy J; Rich, Robert; Humphrey, Linda L; Frost, Jennifer; Forciea, Mary Ann

2017-03-21

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older. This guideline is based on a systematic review of published randomized, controlled trials for primary outcomes and observational studies for harms only (identified through EMBASE, the Cochrane Database of Systematic Reviews, MEDLINE, and ClinicalTrials.gov), from database inception through January 2015. The MEDLINE search was updated through September 2016. Evaluated outcomes included all-cause mortality, morbidity and mortality related to stroke, major cardiac events (fatal and nonfatal myocardial infarction and sudden cardiac death), and harms. This guideline grades the evidence and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. The target audience for this guideline includes all clinicians, and the target patient population includes all adults aged 60 years or older with hypertension. ACP and AAFP recommend that clinicians initiate treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. (Grade: strong recommendation, high-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient. ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for recurrent stroke. (Grade: weak recommendation, moderate-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient. ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Grade: weak recommendation, low-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.

PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain.

PubMed

Neugebauer, E A M; Wilkinson, R C; Kehlet, H; Schug, S A

2007-07-01

Many patients still suffer severe acute pain in the postoperative period. Although guidelines for treating acute pain are widely published and promoted, most do not consider procedure-specific differences in pain experienced or in techniques that may be most effective and appropriate for different surgical settings. The procedure-specific postoperative pain management (PROSPECT) Working Group provides procedure-specific recommendations for postoperative pain management together with supporting evidence from systematic literature reviews and related procedures at http://www.postoppain.org The methodology for PROSPECT reviews was developed and refined by discussion of the Working Group, and it adapts existing methods for formulation of consensus recommendations to the specific requirements of PROSPECT. To formulate PROSPECT recommendations, we use a methodology that takes into account study quality and source and level of evidence, and we use recognized methods for achieving group consensus, thus reducing potential bias. The new methodology is first applied in full for the 2006 update of the PROSPECT review of postoperative pain management for laparoscopic cholecystectomy. Transparency in PROSPECT processes allows the users to be fully aware of any limitations of the evidence and recommendations, thereby allowing for appropriate decisions in their own practice setting.

Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review.

PubMed

Nguyen, Christelle; Lefèvre-Colau, Marie-Martine; Poiraudeau, Serge; Rannou, François

2016-06-01

Rehabilitation is widely recommended in national and international guidelines for managing osteoarthritis (OA) in primary care settings. According to the 2014 OA Research Society International (OARSI) recommendations, rehabilitation is even considered the core treatment of OA and is recommended for all patients. Rehabilitation for OA widely includes land- and water-based exercise, strength training, weight management, self-management and education, biomechanical interventions, and physically active lifestyle. We performed a critical narrative review of the efficacy and safety of rehabilitation for managing OA and discuss evidence-based international recommendations. The process of article selection was unsystematic. Articles were selected based on authors' expertise, self-knowledge, and reflective practice. For the purpose of the review, we focused on land- and water-based exercise and strength training for knee, hip and hand OA. Other aspects of rehabilitation in OA are treated elsewhere in this special issue. Exercise therapy is widely recommended for managing knee, hip and hand OA. However, the level of evidence varies according to OA location. Overall, consistent evidence suggests that exercise therapy and specific strengthening exercise or strength training for the lower limb reduce pain and improve physical function in knee OA. Evidence for other OA sites are less consistent. Therefore, because of the lack of specific studies, recommendations for hip and hand OA are mainly derived from studies of knee OA. In addition, no recommendations have been established regarding the exercise regimen. The efficacy and safety of exercise therapy and strength training need to be further evaluated in randomized controlled trials of patients with hip and hand OA. The optimal delivery of exercise programs also has to be more clearly defined. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Rotorcraft aviation icing research requirements: Research review and recommendations

NASA Technical Reports Server (NTRS)

Peterson, A. A.; Dadone, L.; Bevan, A.

1981-01-01

The status of rotorcraft icing evaluation techniques and ice protection technology was assessed. Recommendations are made for near and long term icing programs that describe the needs of industry. These recommended programs are based on a consensus of the major U.S. helicopter companies. Specific activities currently planned or underway by NASA, FAA and DOD are reviewed to determine relevance to the overall research requirements. New programs, taking advantage of current activities, are recommended to meet the long term needs for rotorcraft icing certification.

The strategic defense of physician autonomy: State public health agencies as countervailing powers.

PubMed

Senier, Laura; Lee, Rachael; Nicoll, Lauren

2017-08-01

Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy. This paper draws on case studies from two US states-Michigan and Connecticut-to better understand the specific role of state public health agencies, and especially whether their activities to encourage adherence to evidence-based recommendations bolster or subvert the interests of other parties in the healthcare arena. We find that lacking authority to compel provider to follow evidence-based recommendations, they improvised ways to foster compliance voluntarily, for example, by emphasizing the role of the physician as gatekeeper, thus affirming the importance of physician autonomy and clinical judgment. Both states also used public health surveillance data to make rare diseases visible and illustrate gaps between recommendations and practice. Finally, they both showed that following evidence-based recommendations could align the professional and market interests of healthcare stakeholders. Both states employed similar strategies with similar effects, despite substantial differences in the regulatory climate and organizational capacity. Taken as a whole, their activities orchestrated a countervailing response that checked the profit-seeking motives of commercial laboratories. Our findings demonstrate that rather than eroding physician autonomy, state action to monitor healthcare quality and encourage adherence to evidence-based recommendations can actually reinforce physician authority. Copyright © 2017 Elsevier Ltd. All rights reserved.

British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update).

PubMed

McKenzie, Y A; Thompson, J; Gulia, P; Lomer, M C E

2016-10-01

Probiotics are often taken by individuals with irritable bowel syndrome (IBS). Which products are effective is unclear, despite an increasing research base. This project will systematically review which strain- and dose- specific probiotics can be recommended to adults with IBS to improve symptoms and quality of life (QoL). It is part of a broader systematic review to update British Dietetic Association guidelines for the dietary management of IBS in adults. CINAHL, Cochrane, Embase, Medline, Scopus and Web of Science were searched for systematic reviews (SRs) of randomised controlled trial (RCT)s recruiting adults with IBS comparing probiotic intervention with placebo. AMSTAR, risk of bias and diet bias tools were used to appraise methodological quality. Symptom and QoL data were appraised to develop probiotic-specific evidence statements on clinically meaningful and marginal outcomes in various settings, graded clinical practice recommendations and practical considerations. Nine systematic reviews and 35 RCTs were included (3406 participants) using 29 dose-specific probiotic formulations. None of the RCTs were at low risk of bias. Twelve out of 29 probiotics (41%) showed no symptom or QoL benefits. Evidence indicated that no strain or dose specific probiotic was consistently effective to improve any IBS symptoms or QoL. Two general clinical practice recommendations were made. Symptom outcomes for dose-specific probiotics were heterogeneous. Specific probiotic recommendations for IBS management in adults were not possible at this time. More data from high-quality RCTs treating specific symptom profiles are needed to support probiotic therapy in the management of IBS. © 2016 The British Dietetic Association Ltd.

A Competitiveness Strategy for America. Reports of the Subcouncils. Second Report to the President & Congress.

ERIC Educational Resources Information Center

Competitiveness Policy Council, Washington, DC.

This publication contains detailed reports from the eight subcouncils established by the Competitiveness Policy Council to develop specific policy recommendations in eight areas. "Building a Standards-Based School System" (Education Subcouncil) recommends redirecting the education system toward achieving the National Education Goals,…

Physiotherapy for functional motor disorders: a consensus recommendation

PubMed Central

Nielsen, Glenn; Stone, Jon; Matthews, Audrey; Brown, Melanie; Sparkes, Chris; Farmer, Ross; Masterton, Lindsay; Duncan, Linsey; Winters, Alisa; Daniell, Laura; Lumsden, Carrie; Carson, Alan; David, Anthony S; Edwards, Mark

2015-01-01

Background Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment. Methods A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience. Results We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms. Conclusions Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package. PMID:25433033

Brief report: Service implementation and maternal distress surrounding evaluation recommendations for young children diagnosed with autism

PubMed Central

Warren, Zachary; Vehorn, Alison; Dohrmann, Elizabeth; Newsom, Cassandra; Taylor, Julie Lounds

2014-01-01

There is limited evidence surrounding the ability of families of children with autism spectrum disorders to access and implement recommended interventions following diagnosis. The distress a family may encounter with regard to inability to access recommended services is also poorly understood. In this study, we present preliminary data regarding implementation of clinical recommendations following autism spectrum disorder diagnosis as well as associations of implementation with maternal functioning. In total, 75 mothers of young children diagnosed with autism spectrum disorder through a university-based preschool autism clinic returned surveys regarding access to recommended services as well as maternal mental health and distress. Results indicate that while families were able to implement numerous recommendations, specific categories of intervention were less likely to be received. Challenges implementing recommended services were not related to increased maternal distress. These results suggest that despite potential barriers toward accessing some specific recommended services following diagnosis of autism spectrum disorder, many families may be quite successful in implementing many other core recommended services and that failure to access such services may not necessarily negatively impact maternal mental health and distress. PMID:23045221

Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines

PubMed Central

Lugtenberg, Marjolein; Burgers, Jako S.; Clancy, Carolyn; Westert, Gert P.; Schneider, Eric C.

2011-01-01

Background Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions. PMID:22028802

NHF-McMaster Guideline on Care Models for Haemophilia Management.

PubMed

Pai, M; Key, N S; Skinner, M; Curtis, R; Feinstein, M; Kessler, C; Lane, S J; Makris, M; Riker, E; Santesso, N; Soucie, J M; Yeung, C H T; Iorio, A; Schünemann, H J

2016-07-01

This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplement and based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation approach). Direct evidence from published literature and the haemophilia community, as well as indirect evidence from other chronic diseases, were reviewed, synthesized and applied to create evidence-based recommendations. The Guideline panel suggests that the integrated care model be used over non-integrated care models for PWH (conditional recommendation, moderate certainty in the evidence). For PWH with inhibitors and those at high risk for inhibitor development, the same recommendation was graded as strong, with moderate certainty in the evidence. The panel suggests that a haematologist, a specialized haemophilia nurse, a physical therapist, a social worker and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components (conditional recommendation, very low certainty in the evidence). Based on available evidence, the integrated model of care in its current structure, is suggested for optimal care of PWH. There is a need for further appropriately designed studies that address unanswered questions about specific outcomes and the optimal structure of the integrated care delivery model in haemophilia. © 2016 John Wiley & Sons Ltd.

Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure

PubMed Central

Brochard, Laurent; Elliott, Mark W.; Hess, Dean; Hill, Nicholas S.; Navalesi, Paolo; Antonelli, Massimo; Brozek, Jan; Conti, Giorgio; Ferrer, Miquel; Guntupalli, Kalpalatha; Jaber, Samir; Keenan, Sean; Mancebo, Jordi; Mehta, Sangeeta; Raoof, Suhail

2017-01-01

Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature. The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material. This guideline committee developed recommendations for 11 actionable questions in a PICO (population–intervention–comparison–outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation. This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders. PMID:28860265

A survey of particle contamination in electronic devices

NASA Technical Reports Server (NTRS)

Adolphsen, J. W.; Kagdis, W. A.; Timmins, A. R.

1976-01-01

The experiences are given of a number of National Aeronautics and Space Administration (NASA) and Space and Missile System Organization (SAMSO) contractors with particle contamination, and the methods used for its prevention and detection, evaluates the bases for the different schemes, assesses their effectiveness, and identifies the problems associated with each. It recommends specific short-range tests or approaches appropriate to individual part-type categories and recommends that specific tasks be initiated to refine techniques and to resolve technical and application facets of promising solutions.

A First Step towards a Clinical Decision Support System for Post-traumatic Stress Disorders.

PubMed

Ma, Sisi; Galatzer-Levy, Isaac R; Wang, Xuya; Fenyö, David; Shalev, Arieh Y

2016-01-01

PTSD is distressful and debilitating, following a non-remitting course in about 10% to 20% of trauma survivors. Numerous risk indicators of PTSD have been identified, but individual level prediction remains elusive. As an effort to bridge the gap between scientific discovery and practical application, we designed and implemented a clinical decision support pipeline to provide clinically relevant recommendation for trauma survivors. To meet the specific challenge of early prediction, this work uses data obtained within ten days of a traumatic event. The pipeline creates personalized predictive model for each individual, and computes quality metrics for each predictive model. Clinical recommendations are made based on both the prediction of the model and its quality, thus avoiding making potentially detrimental recommendations based on insufficient information or suboptimal model. The current pipeline outperforms the acute stress disorder, a commonly used clinical risk factor for PTSD development, both in terms of sensitivity and specificity.

[Guidelines in RA treatment: concepts on safety and recommendations using anti-TNF-alpha inhibitors. Grupo de Estudio de Nuevas Terapias de Enfermedades reumáticas (GENTE)].

PubMed

Díaz-Jouanen, Efraín; Abud-Mendoza, Carlos; Garza-Elizondo, Mario Alberto; Medrano-Ramírez, Gabriel; Burgos-Vargas, Rubén; Orozco-Alcalá, José Javier; Pacheco-Tena, César Francisco; Pineda, Carlos; Pozos-Espíndola, Juan Carlos; Ramos-Niembro, Francisco; Robles-San-Román, Manuel; Santana-Sahagún, Jesús Ernesto

2009-01-01

Recommendations for the use of Disease-Modifying Antirheumatic Drugs (DMARD) with both conventional and biological agents in Rheumatoid Arthritis (RA) must be based on their safety profile, adverse effects, risks, and advantages. With the purpose of presenting the most updated information about the safety of tumor necrosis factor alpha (TNFalpha) antagonists, in this article we summarize the literature published during the last three years about this sort of biological agents in specific clinical situations, such as risk of developing infections, cancer, cardiovascular diseases, and autoimmunity; as well as their administration to patients who will undergo surgical procedures, pregnant and/or breast-feeding women, and patients who need immunizations. Likewise, in this analysis we offer specific recommendations, based on evidence, for the best anti-TNF-alfa management.

Work-life integration in neuropsychology: a review of the existing literature and preliminary recommendations.

PubMed

Feigon, Maia; Block, Cady; Guidotti Breting, Leslie; Boxley, Laura; Dawson, Erica; Cobia, Derin

2018-02-01

The purpose of the current review paper is to identify and describe challenges to work-life integration in neuropsychology, and from this review extrapolate an initial set of recommendations and present a set of scenarios in which the recommendations might apply in the hopes of improving quality of life for current and prospective neuropsychologists. Specific areas of focus include diversity, early and mid-career transitions, and potential barriers to advancement in specific practice settings. A broad review was conducted of extant literature on work-life integration. There is scant scientific literature in this area that is specific to neuropsychologists, or even psychology as a whole. Subsequently, the majority of this review was collected from more developed literatures in business and medical fields. The authors then provided recommendations based on experiences in their respective careers. Attempts were made to promote generalizability of recommendations for neuropsychologists in different settings. Evidence supports a potentially adverse impact on quality of life and overall life satisfaction when work and personal lives conflict. This manuscript identifies some of the potential risks when work and life responsibilities are not well integrated. It is anticipated this will serve as a catalyst for future studies on work-life integration in the field of neuropsychology, specifically.

Cultural Competence of Parenting Education Programs Used by Latino Families: A Review

ERIC Educational Resources Information Center

Vesely, Colleen K.; Ewaida, Marriam; Anderson, Elaine A.

2014-01-01

The cultural competence of 13 parenting education programs for Latino families with young children was examined in this study. Based on our analyses, we make several recommendations for improving the cultural competence and effectiveness of parenting education programs for Latino families with young children. Specifically, we recommend the…

Estimating sensitivity and specificity for technology assessment based on observer studies.

PubMed

Nishikawa, Robert M; Pesce, Lorenzo L

2013-07-01

The goal of this study was to determine the accuracy and precision of using scores from a receiver operating characteristic rating scale to estimate sensitivity and specificity. We used data collected in a previous study that measured the improvements in radiologists' ability to classify mammographic microcalcification clusters as benign or malignant with and without the use of a computer-aided diagnosis scheme. Sensitivity and specificity were estimated from the rating data from a question that directly asked the radiologists their biopsy recommendations, which was used as the "truth," because it is the actual recall decision, thus it is their subjective truth. By thresholding the rating data, sensitivity and specificity were estimated for different threshold values. Because of interreader and intrareader variability, estimated sensitivity and specificity values for individual readers could be as much as 100% in error when using rating data compared to using the biopsy recommendation data. When pooled together, the estimates using thresholding the rating data were in good agreement with sensitivity and specificity estimated from the recommendation data. However, the statistical power of the rating data estimates was lower. By simply asking the observer his or her explicit recommendation (eg, biopsy or no biopsy), sensitivity and specificity can be measured directly, giving a more accurate description of empirical variability and the power of the study can be maximized. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Recommendations for field measurements of aircraft noise

NASA Technical Reports Server (NTRS)

Marsh, A. H.

1982-01-01

Specific recommendations for environmental test criteria, data acquisition procedures, and instrument performance requirements for measurement of noise levels produced by aircraft in flight are provided. Recommendations are also given for measurement of associated airplane and engine parameters and atmospheric conditions. Recommendations are based on capabilities which were available commercially in 1981; they are applicable to field tests of aircraft flying subsonically past microphones located near the surface of the ground either directly under or to the side of a flight path. Aircraft types covered by the recommendations include fixed-wing airplanes powered by turbojet or turbofan engines or by propellers. The recommended field-measurement procedures are consistent with assumed requirements for data processing and analysis.

Summary of the Statement on International Travellers Who Intend to Visit Friends and Relatives

PubMed Central

Brophy, J

2015-01-01

Background Travellers intending to visit friends and relatives (VFRs) are a specific group of travellers who have been identified as having an increased risk of travel-related morbidity. Objective To provide recommendations for risk reduction in international VFRs. Methods Recommendations regarding VFRs were developed based on available travel medicine literature and CATMAT expert opinion. Specific travel-related risks, including infectious disease epidemiology and burden in this population, were reviewed and recommendations were provided to attempt to mitigate these risks. Previous CATMAT statements related to VFRs were referred to and reiterated. Recommendations Rates of travel-related illness in VFRs tend to be higher for many conditions. Disease-specific risk factors and recommendations are discussed throughout this Statement. CATMAT recommends that VFRs’ vaccinations be up-to-date and they be counselled on the importance of various risk reduction activities such as the use of malaria prophylaxis, safe sex practices and injury prevention. Pre- and/or post-travel tuberculosis testing is indicated in certain situations. Conclusion The pre-travel health assessment is an important opportunity to address with VFRs issues regarding health beliefs, health behaviours, current health status and the possibility of pre-existing conditions. Discussions addressing the importance of adherence to health advice and potential challenges to achieving adherence may be necessary. PMID:29769941

Nationwide survey on the 2005 Guidelines for the Management of Community-Acquired Adult Pneumonia: validation of differentiation between bacterial pneumonia and atypical pneumonia.

PubMed

Watanabe, Akira; Goto, Hajime; Kohno, Shigeru; Matsushima, Toshiharu; Abe, Shosaku; Aoki, Nobuki; Shimokata, Kaoru; Mikasa, Keiichi; Niki, Yoshihito

2012-03-01

The Japanese Respiratory Society Guidelines for the Management of Community-Acquired Pneumonia (CAP) in Adults (JRS 2005) was published as a revision of the Basic Concept for the Management of CAP in Adults (JRS 2000). To evaluate the JRS 2005 criteria for differentiating between disease types and assessing the status of antimicrobial agent use in initial treatment, we conducted a prospective survey. The survey was conducted from July 2006 to March 2007 as a nationwide joint study by 200 institutions. The study subjects included patients aged ≥16 years of age who had CAP, and patients who met the inclusion criteria were consecutively enrolled. Disease type differentiation based on JRS 2005 and JRS 2000 was conducted. Disease type diagnosis was also performed based on test results. The sensitivity and specificity of disease type differentiation were calculated. The antimicrobial agents used in the initial treatment were classified as recommended or non-recommended based on JRS 2005. The validity of non-recommended antimicrobial agent use was investigated. A total of 1875 patients were analyzed. Differentiation of atypical pneumonia using the JRS 2005 criteria had higher sensitivity and lower specificity than differentiation using the JRS 2000 criteria. The antimicrobial agents recommended by JRS 2005 were used as initial treatment in a low number of cases. The efficacy of the recommended antimicrobial agents was similar to that of the non-recommended agents. JRS 2005 is advantageous in terms of reducing the number of items used in disease type differentiation. The recommended antimicrobial agents used for the initial treatment are believed to be appropriate. Copyright © 2012 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

An effective trust-based recommendation method using a novel graph clustering algorithm

NASA Astrophysics Data System (ADS)

Moradi, Parham; Ahmadian, Sajad; Akhlaghian, Fardin

2015-10-01

Recommender systems are programs that aim to provide personalized recommendations to users for specific items (e.g. music, books) in online sharing communities or on e-commerce sites. Collaborative filtering methods are important and widely accepted types of recommender systems that generate recommendations based on the ratings of like-minded users. On the other hand, these systems confront several inherent issues such as data sparsity and cold start problems, caused by fewer ratings against the unknowns that need to be predicted. Incorporating trust information into the collaborative filtering systems is an attractive approach to resolve these problems. In this paper, we present a model-based collaborative filtering method by applying a novel graph clustering algorithm and also considering trust statements. In the proposed method first of all, the problem space is represented as a graph and then a sparsest subgraph finding algorithm is applied on the graph to find the initial cluster centers. Then, the proposed graph clustering algorithm is performed to obtain the appropriate users/items clusters. Finally, the identified clusters are used as a set of neighbors to recommend unseen items to the current active user. Experimental results based on three real-world datasets demonstrate that the proposed method outperforms several state-of-the-art recommender system methods.

A Recommender System for an IPTV Service Provider: a Real Large-Scale Production Environment

NASA Astrophysics Data System (ADS)

Bambini, Riccardo; Cremonesi, Paolo; Turrin, Roberto

In this chapter we describe the integration of a recommender system into the production environment of Fastweb, one of the largest European IP Television (IPTV) providers. The recommender system implements both collaborative and content-based techniques, suitable tailored to the specific requirements of an IPTV architecture, such as the limited screen definition, the reduced navigation capabilities, and the strict time constraints. The algorithms are extensively analyzed by means of off-line and on-line tests, showing the effectiveness of the recommender systems: up to 30% of the recommendations are followed by a purchase, with an estimated lift factor (increase in sales) of 15%.

Maternal dietary advice as an artifact of time and culture: post-World War II Queensland, Australia.

PubMed

Thorley, Virginia

2002-03-01

Dietary advice to breastfeeding mothers in post-World War II Queensland, 1945-1965, was not evidence-based, but based on cultural beliefs. Diet-based recommendations for boosting the breastmilk yield included increased intake of milk and protein foods, food supplements, especially chocolate-flavoured supplements, and tablets. Although community beliefs about foods to be avoided during lactation were reflected in informal advice, foods such as green leafy vegetables were specifically recommended by the print materials of the period as part of a healthy diet during breastfeeding.

NASA software specification and evaluation system design, part 2

NASA Technical Reports Server (NTRS)

1976-01-01

A survey and analysis of the existing methods, tools and techniques employed in the development of software are presented along with recommendations for the construction of reliable software. Functional designs for software specification language, and the data base verifier are presented.

Standardization of formulations for the acute amino acid depletion and loading tests.

PubMed

Badawy, Abdulla A-B; Dougherty, Donald M

2015-04-01

The acute tryptophan depletion and loading and the acute tyrosine plus phenylalanine depletion tests are powerful tools for studying the roles of cerebral monoamines in behaviour and symptoms related to various disorders. The tests use either amino acid mixtures or proteins. Current amino acid mixtures lack specificity in humans, but not in rodents, because of the faster disposal of branched-chain amino acids (BCAAs) by the latter. The high content of BCAA (30-60%) is responsible for the poor specificity in humans and we recommend, in a 50g dose, a control formulation with a lowered BCAA content (18%) as a common control for the above tests. With protein-based formulations, α-lactalbumin is specific for acute tryptophan loading, whereas gelatine is only partially effective for acute tryptophan depletion. We recommend the use of the whey protein fraction glycomacropeptide as an alternative protein. Its BCAA content is ideal for specificity and the absence of tryptophan, tyrosine and phenylalanine render it suitable as a template for seven formulations (separate and combined depletion or loading and a truly balanced control). We invite the research community to participate in standardization of the depletion and loading methodologies by using our recommended amino acid formulation and developing those based on glycomacropeptide. © The Author(s) 2015.

Standardization of formulations for the acute amino acid depletion and loading test

PubMed Central

Badawy, Abdulla A-B; Dougherty, Donald M

2017-01-01

The acute tryptophan (Trp) depletion (ATD) and loading (ATL) and the acute tyrosine (Tyr) plus phenylalanine (Phe) depletion (ATPD) tests are powerful tools for studying the roles of cerebral monoamines in behaviour and symptoms related to various disorders. The tests use either amino acid mixtures or proteins. Current amino acid mixtures lack specificity in humans, but not in rodents, because of the faster disposal of branched-chain amino acids (BCAA) by the latter. The high content of BCAA (30-60%) is responsible for the poor specificity in humans and we recommend, in a 50g dose, the control formulation of Young et al. (1985) with a lowered BCAA content (18%) and minor modifications as a common control for the above tests. With protein-based formulations, α-lactalbumin is specific for ATL, whereas gelatine is only partially effective for ATD. We recommend the use of the whey protein fraction glycomacropeptide (GMP) as an alternative protein. Its BCAA content is ideal for specificity and the absence of Trp, Tyr and Phe render it suitable as a template for 7 formulations (separate and combined depletion or loading and a truly balanced control). We invite the research community to participate in standardization of the depletion and loading methodologies by using our recommended amino acid formulation and developing those based on GMP. PMID:25586395

Hantavirus infection--southwestern United States: interim recommendations for risk reduction. Centers for Disease Control and Prevention.

PubMed

Childs, J E; Kaufmann, A F; Peters, C J; Ehrenberg, R L

1993-07-30

This report provides interim recommendations for prevention and control of hantavirus infections associated with rodents in the southwestern United States. It is based on principles of rodent and infection control and contains specific recommendations for reducing rodent shelter and food sources in and around the home, recommendations for eliminating rodents inside the home and preventing them from entering the home, precautions for preventing hantavirus infection while rodent-contaminated areas are being cleaned up, prevention measures for persons who have occupational exposure to wild rodents, and precautions for campers and hikers.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

PubMed

Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

2016-02-01

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

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

PubMed

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

2013-09-01

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

Antipsychotic-induced hyperprolactinemia: synthesis of world-wide guidelines and integrated recommendations for assessment, management and future research.

PubMed

Grigg, Jasmin; Worsley, Roisin; Thew, Caroline; Gurvich, Caroline; Thomas, Natalie; Kulkarni, Jayashri

2017-11-01

Hyperprolactinemia is a highly prevalent adverse effect of many antipsychotic agents, with potentially serious health consequences. Several guidelines have been developed for the management of this condition; yet, their concordance has not been evaluated. The objectives of this paper were (1) to review current clinical guidelines; (2) to review key systematic evidence for management; and (3) based on our findings, to develop an integrated management recommendation specific to male and female patients who are otherwise clinically stabilised on antipsychotics. We performed searches of Medline and EMBASE, supplemented with guideline-specific database and general web searches, to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia, produced/updated 01/01/2010-15/09/2016. A separate systematic search was performed to identify emerging management approaches described in reviews and meta-analyses published ≥ 2010. There is some consensus among guidelines relating to baseline PRL screening (8/12 guidelines), screening for differential diagnosis (7/12) and discontinuing/switching PRL-raising agent (7/12). Guidelines otherwise diverge substantially regarding most aspects of screening, monitoring and management (e.g. treatment with dopamine agonists). There is an omission of clear sex-specific recommendations. Systematic literature on management approaches is promising; more research is needed. An integrated management recommendation is presented to guide sex-specific clinical response to antipsychotic-induced hyperprolactinemia. Key aspects include asymptomatic hyperprolactinemia monitoring and fertility considerations with PRL normalisation. Further empirical work is key to shaping robust guidelines for antipsychotic-induced hyperprolactinemia. The integrated management recommendation can assist clinician and patient decision-making, with the goal of balancing effective psychiatric treatment while minimising PRL-related adverse health effects in male and female patients.

Do we need personalized recommendations for infants at risk of developing disease?

PubMed

Hernell, Olle; West, Christina

2008-01-01

Current nutrition recommendations, directed towards populations, are based on estimated average nutrient requirements for a target population and intend to meet the needs of most individuals within that population. They also aim at preventing common diseases such as obesity, diabetes and cardiovascular disease. For infants with specific genetic polymorphisms, e.g. some inborn errors of metabolism, adherence to current recommendations will cause disease symptoms and they need personalized nutrition recommendations. Some other monogenic polymorphisms, e.g. adult hypolactasia, are common but with varying prevalence between ethnic groups and within populations. Ages at onset as well as the degree of the resulting lactose intolerance also vary, making population-based as well as personalized recommendations difficult. The tolerable intake is best set by each individual based on symptoms. For polygenetic diseases such as celiac disease, type-1 diabetes and allergic disease, current knowledge is insufficient to suggest personalized recommendations aiming at primary prevention for all high-risk infants, although it may be justified to provide such recommendations on an individual level should the parents ask for them. New technologies such as nutrigenetics and nutrigenomics are promising tools with which current nutrition recommendations can possibly be refined and the potential of individualized nutrition be explored. It seems likely that in the future it will be possible to offer more subgroups within a population personalized recommendations.

Solving the stability-accuracy-diversity dilemma of recommender systems

NASA Astrophysics Data System (ADS)

Hou, Lei; Liu, Kecheng; Liu, Jianguo; Zhang, Runtong

2017-02-01

Recommender systems are of great significance in predicting the potential interesting items based on the target user's historical selections. However, the recommendation list for a specific user has been found changing vastly when the system changes, due to the unstable quantification of item similarities, which is defined as the recommendation stability problem. To improve the similarity stability and recommendation stability is crucial for the user experience enhancement and the better understanding of user interests. While the stability as well as accuracy of recommendation could be guaranteed by recommending only popular items, studies have been addressing the necessity of diversity which requires the system to recommend unpopular items. By ranking the similarities in terms of stability and considering only the most stable ones, we present a top- n-stability method based on the Heat Conduction algorithm (denoted as TNS-HC henceforth) for solving the stability-accuracy-diversity dilemma. Experiments on four benchmark data sets indicate that the TNS-HC algorithm could significantly improve the recommendation stability and accuracy simultaneously and still retain the high-diversity nature of the Heat Conduction algorithm. Furthermore, we compare the performance of the TNS-HC algorithm with a number of benchmark recommendation algorithms. The result suggests that the TNS-HC algorithm is more efficient in solving the stability-accuracy-diversity triple dilemma of recommender systems.

A narrative review of evidence-based recommendations for the physical examination of the lumbar spine, sacroiliac and hip joint complex.

PubMed

Wong, C K; Johnson, E K

2012-09-01

Non-specific low back pain is a frequent complaint in primary care, but the differential diagnosis for low back pain can be complex. Despite advances in diagnostic imaging, a specific pathoanatomical source of low back pain can remain elusive in up to 85% of individuals. Best practice guidelines recommend that clinicians conduct a focused physical examination to help to identify patients with non-specific low back pain and an evidence-based course of clinical management. The use of sensitive and specific clinical methods to assess the lumbar spine, sacroiliac and hip joints is critical for effective physical examination. Psychosocial factors also play an important role in the evaluation of individuals with low back pain, but are not included in this narrative review of physical examination methods. Physical examination of the lumbar spine, sacroiliac and hip joints is presented, organized around patient position for efficient and effective clinical assessment. Copyright © 2012 John Wiley & Sons, Ltd.

Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children?

PubMed

Matricciani, Lisa; Blunden, Sarah; Rigney, Gabrielle; Williams, Marie T; Olds, Tim S

2013-04-01

It is widely recognized that sleep is important for children's health and well-being and that short sleep duration is associated with a wide range of negative health outcomes. Recently, there has been much interest in whether or not there are sufficient data to support the specific recommendations made for how much sleep children need. In this article we explore concepts related to children's sleep need, discuss the theory, rationale, and empirical evidence for contemporary sleep recommendations, and outline future research directions for sleep recommendations. If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.

Training and Practices of Cannabis Dispensary Staff.

PubMed

Haug, Nancy A; Kieschnick, Dustin; Sottile, James E; Babson, Kimberly A; Vandrey, Ryan; Bonn-Miller, Marcel O

2016-01-01

Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient demand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms. Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of cannabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed the training and practices of cannabis dispensary staff. Materials and Methods: Medical and nonmedical dispensary staff ( n =55) were recruited via e-mail and social media to complete an online survey assessing their demographic characteristics, dispensary features, patient characteristics, formal training, and cannabis recommendation practices. Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia, nightmares, and Tourette's syndrome. They were more likely to recommend Indica and hybrid plants for post-traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of cannabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn's disease, hepatitis C, and PTSD/trauma, while patients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for arthritis and Alzheimer's disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms. Conclusions: Although many dispensary staff are making recommendations consistent with current evidence, some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient's condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions.

Training and Practices of Cannabis Dispensary Staff

PubMed Central

Haug, Nancy A.; Kieschnick, Dustin; Sottile, James E.; Babson, Kimberly A.; Vandrey, Ryan; Bonn-Miller, Marcel O.

2016-01-01

Abstract Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient demand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms. Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of cannabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed the training and practices of cannabis dispensary staff. Materials and Methods: Medical and nonmedical dispensary staff (n=55) were recruited via e-mail and social media to complete an online survey assessing their demographic characteristics, dispensary features, patient characteristics, formal training, and cannabis recommendation practices. Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia, nightmares, and Tourette's syndrome. They were more likely to recommend Indica and hybrid plants for post-traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of cannabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn's disease, hepatitis C, and PTSD/trauma, while patients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for arthritis and Alzheimer's disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms. Conclusions: Although many dispensary staff are making recommendations consistent with current evidence, some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient's condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions. PMID:28861496

75 FR 33311 - Guidance for Industry on Bioequivalence Recommendations for Specific Products; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... available recommendations on how to design product- specific bioequivalence (BE) studies to support... meaningful opportunity for the public to consider and comment on product-specific BE study recommendations... available recommendations on how to design product-specific BE studies to support ANDAs. Under this process...

Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations

PubMed Central

Sommers, Juultje; Engelbert, Raoul HH; Dettling-Ihnenfeldt, Daniela; Gosselink, Rik; Spronk, Peter E; Nollet, Frans; van der Schaaf, Marike

2015-01-01

Objective: To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units. Methods: We used the EBRO method, as recommended by the ‘Dutch Evidence Based Guideline Development Platform’ to develop an ‘evidence statement for physiotherapy in the intensive care unit’. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts. Results: Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment. Conclusions: These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014. PMID:25681407

Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations.

PubMed

Sommers, Juultje; Engelbert, Raoul H H; Dettling-Ihnenfeldt, Daniela; Gosselink, Rik; Spronk, Peter E; Nollet, Frans; van der Schaaf, Marike

2015-11-01

To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units. We used the EBRO method, as recommended by the 'Dutch Evidence Based Guideline Development Platform' to develop an 'evidence statement for physiotherapy in the intensive care unit'. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts. Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment. These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014. © The Author(s) 2015.

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

PubMed

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

2007-11-01

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

Functional Analysis and Preliminary Specifications for a Single Integrated Central Computer System for Secondary Schools and Junior Colleges. Interim Report.

ERIC Educational Resources Information Center

1968

The present report proposes a central computing facility and presents the preliminary specifications for such a system. It is based, in part, on the results of earlier studies by two previous contractors on behalf of the U.S. Office of Education. The recommendations are based upon the present contractors considered evaluation of the earlier…

Synthesis: Deriving a Core Set of Recommendations to Optimize Diabetes Care on a Global Scale.

PubMed

Mechanick, Jeffrey I; Leroith, Derek

2015-01-01

Diabetes afflicts 382 million people worldwide, with increasing prevalence rates and adverse effects on health, well-being, and society in general. There are many drivers for the complex presentation of diabetes, including environmental and genetic/epigenetic factors. The aim was to synthesize a core set of recommendations from information from 14 countries that can be used to optimize diabetes care on a global scale. Information from 14 papers in this special issue of Annals of Global Health was reviewed, analyzed, and sorted to synthesize recommendations. PubMed was searched for relevant studies on diabetes and global health. Key findings are as follows: (1) Population-based transitions distinguish region-specific diabetes care; (2) biological drivers for diabetes differ among various populations and need to be clarified scientifically; (3) principal resource availability determines quality-of-care metrics; and (4) governmental involvement, independent of economic barriers, improves the contextualization of diabetes care. Core recommendations are as follows: (1) Each nation should assess region-specific epidemiology, the scientific evidence base, and population-based transitions to establish risk-stratified guidelines for diagnosis and therapeutic interventions; (2) each nation should establish a public health imperative to provide tools and funding to successfully implement these guidelines; and (3) each nation should commit to education and research to optimize recommendations for a durable effect. Systematic acquisition of information about diabetes care can be analyzed, extrapolated, and then used to provide a core set of actionable recommendations that may be further studied and implemented to improve diabetes care on a global scale. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Information filtering via preferential diffusion.

PubMed

Lü, Linyuan; Liu, Weiping

2011-06-01

Recommender systems have shown great potential in addressing the information overload problem, namely helping users in finding interesting and relevant objects within a huge information space. Some physical dynamics, including the heat conduction process and mass or energy diffusion on networks, have recently found applications in personalized recommendation. Most of the previous studies focus overwhelmingly on recommendation accuracy as the only important factor, while overlooking the significance of diversity and novelty that indeed provide the vitality of the system. In this paper, we propose a recommendation algorithm based on the preferential diffusion process on a user-object bipartite network. Numerical analyses on two benchmark data sets, MovieLens and Netflix, indicate that our method outperforms the state-of-the-art methods. Specifically, it can not only provide more accurate recommendations, but also generate more diverse and novel recommendations by accurately recommending unpopular objects.

Information filtering via preferential diffusion

NASA Astrophysics Data System (ADS)

Lü, Linyuan; Liu, Weiping

2011-06-01

Recommender systems have shown great potential in addressing the information overload problem, namely helping users in finding interesting and relevant objects within a huge information space. Some physical dynamics, including the heat conduction process and mass or energy diffusion on networks, have recently found applications in personalized recommendation. Most of the previous studies focus overwhelmingly on recommendation accuracy as the only important factor, while overlooking the significance of diversity and novelty that indeed provide the vitality of the system. In this paper, we propose a recommendation algorithm based on the preferential diffusion process on a user-object bipartite network. Numerical analyses on two benchmark data sets, MovieLens and Netflix, indicate that our method outperforms the state-of-the-art methods. Specifically, it can not only provide more accurate recommendations, but also generate more diverse and novel recommendations by accurately recommending unpopular objects.

Hybrid recommendation methods in complex networks.

PubMed

Fiasconaro, A; Tumminello, M; Nicosia, V; Latora, V; Mantegna, R N

2015-07-01

We propose two recommendation methods, based on the appropriate normalization of already existing similarity measures, and on the convex combination of the recommendation scores derived from similarity between users and between objects. We validate the proposed measures on three data sets, and we compare the performance of our methods to other recommendation systems recently proposed in the literature. We show that the proposed similarity measures allow us to attain an improvement of performances of up to 20% with respect to existing nonparametric methods, and that the accuracy of a recommendation can vary widely from one specific bipartite network to another, which suggests that a careful choice of the most suitable method is highly relevant for an effective recommendation on a given system. Finally, we study how an increasing presence of random links in the network affects the recommendation scores, finding that one of the two recommendation algorithms introduced here can systematically outperform the others in noisy data sets.

Treatment of encopresis and chronic constipation in young children: clinical results from interactive parent-child guidance.

PubMed

Reid, Helen; Bahar, Ron J

2006-03-01

To describe the source of and treatment for encopresis in a series of 40 children under age 9 years. Referral for psychological based treatment followed upon limited success of standard gastroenterologic intervention. The treatment provided is defined as interactive parent-child family guidance. This includes a variety of specific psychologically based recommendations offered to parents, and, when indicated, direct interventions with the symptomatic child. These are different from various forms of behavioral corrective reward-punishment interventions frequently recommended for young children with encopresis. The pediatric and the psychological literature offer few reports of successful treatment of young children with this syndrome. Also, there are few specific descriptions of psychologically based interventions. The results reported here are of the successful treatment of 38 of 40 cases referred specifically for psychologically based intervention following the prior limited success of standard gastroenterologic treatment. The interactive parent-child family guidance intervention described in this report, differentiated from typical behavior therapies, is a notably successful mode of psychologically based therapy for these children. It offers an important alternative to standard pediatric gastroenterological treatment for encopresis, as well as to reward-punishment oriented behavioral therapies.

Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations.

PubMed

von Bültzingslöwen, Inger; Sollecito, Thomas P; Fox, Philip C; Daniels, Troy; Jonsson, Roland; Lockhart, Peter B; Wray, David; Brennan, Michael T; Carrozzo, Marco; Gandera, Beatrice; Fujibayashi, Takashi; Navazesh, Mahvash; Rhodus, Nelson L; Schiødt, Morten

2007-03-01

The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia. Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005. Several systemic diseases were identified. From studies published 2002 to 2005, 15 were identified as high-quality studies and were used to support management recommendations: pilocarpine and cevimeline are recommended for treating hyposalivation and xerostomia in primary and secondary Sjögren's syndrome (SS). IFN-alpha lozenges may enhance saliva flow in primary SS patients. Anti-TNF-alpha agents, such as infliximab or etanercept, are not recommended to treat hyposalivation in SS. Dehydroepiandrosterone is not recommended to relieve hyposalivation or xerostomia in primary SS. There was not enough evidence to support any recommendations for the use of local stimulants, lubricants, and protectants for hyposalivation/xerostomia. However, professional judgment and patient preferences may support the use of a specific product for an individual patient. These evidence-based management recommendations should guide the clinician's management decisions for patients with salivary dysfunction related to systemic disease. Future treatment strategies may include new formulations of existing drugs, e.g., local application of pilocarpine. Recent discoveries on gene expression and a better understanding of the etiopathogenesis of SS may open new treatment options in the future.

Guidelines for the diagnosis, prevention and management of osteoporosis.

PubMed

Rossini, M; Adami, S; Bertoldo, F; Diacinti, D; Gatti, D; Giannini, S; Giusti, A; Malavolta, N; Minisola, S; Osella, G; Pedrazzoni, M; Sinigaglia, L; Viapiana, O; Isaia, G C

2016-06-23

Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management.

Human Papillomavirus Vaccine Uptake in Adolescent Boys: An Evidence Review.

PubMed

Voss, Danielle S; Wofford, Linda G

2016-10-01

Despite evidence-based guidelines recommending routine vaccination against human papillomavirus (HPV) for adolescent boys, ages 11-12 years, vaccine uptake among this population remains low. To examine reasons for low HPV quadrivalent vaccine uptake and methods available to increase vaccine uptake among adolescent males, ages 11-12 years. Of 341 identified studies, 30 were included from three databases. The 30 studies were grouped into six categories: population-specific, problem-specific, educational interventions, theory-specific, political implications, and foundational guidelines and Websites. Among eight studies, low vaccine uptake was attributed to lack of parental, adolescent, and physician knowledge of HPV4 vaccine availability and recommendations. HPV4 vaccine educational interventions for parents and adolescents were the most effective for promoting vaccine uptake. Theory applications and gain-framed messages were shown to be effective for assessing HPV vaccine attitudes and perceptions. Political implication studies reveal the need for political and financial measures to encourage HPV vaccine acceptability among the population. To promote HPV vaccine uptake among adolescent males, providers must remain current with HPV vaccine recommendations and offer parental and adolescent HPV education focusing on benefits of vaccine acceptance and risks of vaccine refusal. The results of this review inform our understanding of effective educational strategies to positively impact HPV vaccine uptake in adolescent males. Based on this review, clinicians can employ several evidence-based educational strategies to facilitate HPV vaccine uptake. © 2016 Sigma Theta Tau International.

Distribution automation and control support; Analysis and interpretation of DAC working group results for use in project planning

NASA Technical Reports Server (NTRS)

Klock, P.; Evans, D.

1979-01-01

The Executive Summary and Proceedings of the Working Group Meeting was analyzed to identify specific projects appropriate for Distribution Automation and Control DAC RD&D. Specific projects that should be undertaken in the DAC RD&D program were recommended. The projects are presented under broad categories of work selected based on ESC's interpretation of the results of the Working Group Meeting. Some of the projects are noted as utility industry projects. The ESC recommendations regarding program management are presented. Utility versus Government management responsibilities are noted.

Proposing application of results in sport and exercise research reports.

PubMed

Knudson, Duane; Elliott, Bruce; Hamill, Joseph

2014-09-01

The application of sport and exercise research findings to practice requires careful interpretation and integration of evidence. This paper reviews principles of evidence-based practice and the application of research in sports and exercise, in order to provide recommendations on developing appropriate application sections in research reports for sport and exercise journals. The strength of recommendations for application fall into one of four levels, with potential applications qualified as strong, limited, preliminary, or hypothesized. Specific limitations that should be discussed in framing recommendations for practice are also noted for each of these levels that should be useful for authors, and for practitioners and clinicians in interpreting these recommendations.

Design implications for task-specific search utilities for retrieval and re-engineering of code

NASA Astrophysics Data System (ADS)

Iqbal, Rahat; Grzywaczewski, Adam; Halloran, John; Doctor, Faiyaz; Iqbal, Kashif

2017-05-01

The importance of information retrieval systems is unquestionable in the modern society and both individuals as well as enterprises recognise the benefits of being able to find information effectively. Current code-focused information retrieval systems such as Google Code Search, Codeplex or Koders produce results based on specific keywords. However, these systems do not take into account developers' context such as development language, technology framework, goal of the project, project complexity and developer's domain expertise. They also impose additional cognitive burden on users in switching between different interfaces and clicking through to find the relevant code. Hence, they are not used by software developers. In this paper, we discuss how software engineers interact with information and general-purpose information retrieval systems (e.g. Google, Yahoo!) and investigate to what extent domain-specific search and recommendation utilities can be developed in order to support their work-related activities. In order to investigate this, we conducted a user study and found that software engineers followed many identifiable and repeatable work tasks and behaviours. These behaviours can be used to develop implicit relevance feedback-based systems based on the observed retention actions. Moreover, we discuss the implications for the development of task-specific search and collaborative recommendation utilities embedded with the Google standard search engine and Microsoft IntelliSense for retrieval and re-engineering of code. Based on implicit relevance feedback, we have implemented a prototype of the proposed collaborative recommendation system, which was evaluated in a controlled environment simulating the real-world situation of professional software engineers. The evaluation has achieved promising initial results on the precision and recall performance of the system.

Virtually impossible: limiting Australian children and adolescents daily screen based media use.

PubMed

Houghton, Stephen; Hunter, Simon C; Rosenberg, Michael; Wood, Lisa; Zadow, Corinne; Martin, Karen; Shilton, Trevor

2015-01-22

Paediatric recommendations to limit children's and adolescents' screen based media use (SBMU) to less than two hours per day appear to have gone unheeded. Given the associated adverse physical and mental health outcomes of SBMU it is understandable that concern is growing worldwide. However, because the majority of studies measuring SBMU have focused on TV viewing, computer use, video game playing, or a combination of these the true extent of total SBMU (including non-sedentary hand held devices) and time spent on specific screen activities remains relatively unknown. This study assesses the amount of time Australian children and adolescents spend on all types of screens and specific screen activities. We administered an online instrument specifically developed to gather data on all types of SBMU and SBMU activities to 2,620 (1373 males and 1247 females) 8 to 16 year olds from 25 Australian government and non-government primary and secondary schools. We found that 45% of 8 year olds to 80% of 16 year olds exceeded the recommended < 2 hours per day for SBMU. A series of hierarchical linear models demonstrated different relationships between the degree to which total SBMU and SBMU on specific activities (TV viewing, Gaming, Social Networking, and Web Use) exceeded the < 2 hours recommendation in relation to sex and age. Current paediatric recommendations pertaining to SBMU may no longer be tenable because screen based media are central in the everyday lives of children and adolescents. In any reappraisal of SBMU exposure times, researchers, educators and health professionals need to take cognizance of the extent to which SBMU differs across specific screen activity, sex, and age.

[Dual Antiplatelet Therapy in the Perioperative Period - To Continue or Discontinue Treatment?

PubMed

Koscielny, Jürgen; von Heymann, Christian; Zeymer, Uwe; Cremer, Jochen; Spannagl, Michael; Labenz, Joachim; Giannitsis, Evangelos; Goss, Franz

2017-08-01

Background  For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Often, uncertainty exists with respect to surgical or diagnostic procedures in these high-risk patients: can the DAPT be continued without interruption? If not, what is the recommended withdrawal strategy? What should be considered for the perioperative management? Methods  An interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology developed recommendations relevant to daily clinical practice based on the current scientific evidence. Results  These recommendations include instructions for evaluating the patient- and procedure-specific risks of bleeding and ischaemia, general recommendations regarding the DAPT withdrawal strategy, and specific guidance for frequent surgical or diagnostic procedures. Discussion  This article aims to facilitate the management of patients with DAPT for all medical disciplines involved, thereby ensuring optimal care of patients during the perioperative period. © Georg Thieme Verlag KG Stuttgart · New York.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

PubMed

Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

2016-01-01

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. © 2016 S. Karger AG, Basel and The Endocrine Society.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

PubMed Central

Munns, Craig F.; Shaw, Nick; Kiely, Mairead; Specker, Bonny L.; Thacher, Tom D.; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M. Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A.; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M.; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary

2016-01-01

Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. PMID:26745253

Coronary heart disease in women: highlights of the past 2 years--stepping stones, milestones and obstructing boulders.

PubMed

Wenger, Nanette K

2006-04-01

Emerging data continue to highlight important sex-based differences in coronary heart disease (CHD) prevention and diagnostic testing, in the management of acute coronary syndromes and in the outcomes of CHD therapies. Evidence-based guidelines have been developed that offer specific recommendations for clinicians and information for women. These guidelines are buttressed by results that have become available from randomized, controlled clinical trials in women, and data from CHD registries and clinical trials involving both sexes but including adequate numbers of women to enable the reporting of sex-specific results. Underuse of guideline-based preventive and therapeutic strategies for women probably contributes to their less favorable CHD outcomes. Adherence to recommendations offers the promise of improving the heart health of women. In this article, I summarize new information to guide the preventive, diagnostic and therapeutic management of CHD in women.

Prophylaxis and treatment of seasickness

NASA Technical Reports Server (NTRS)

Yefremenko, M.

1980-01-01

Depending upon the dominant type of symptoms, seasickness is divided into three forms: nervous, gastro-intestinal, and cardiovascular. Various medications are recommended appropriate to these forms. The first goal is normalization of impaired system functions as well as metabolism and the electrolyte and acid-base condition of the organism. Dietary recommendations are made and specific suggestions on the use of physical exercise, including prophylatic vestibular training exercises.

Recommended Values of Meteorological Factors to Be Considered in the Design of Aircraft Ice-Prevention Equipment

NASA Technical Reports Server (NTRS)

Jones, Alun R; Lewis, William

1949-01-01

Meteorological conditions conducive to aircraft icing are arranged in four classifications: three are associated with cloud structure and the fourth with freezing rain. The range of possible meteorological factors for each classification is discussed and specific values recommended for consideration in the design of ice-prevention equipment for aircraft are selected and tabulated. The values selected are based upon a study of the available observational data and theoretical considerations where observations are lacking. Recommendations for future research in the field are presented.

Full-depth reclamation : new test procedures and recommended updates to specifications.

DOT National Transportation Integrated Search

2012-07-01

Rehabilitating an old pavement by pulverizing and stabilizing the existing pavement is a process referred to : as Full Depth Reclamation (FDR). The stabilized layer becomes either the base or sub-base of the new : pavement structure. This process has...

The evolution of standards for naturally occurring fluorides: an example of scientific due process.

PubMed Central

Clark, N; Corbin, S

1983-01-01

In three quarters of a century of observation and research, the effects of fluoride on dental caries and on general bodily health have been well documented. An expanding data base has allowed a firming up of the guidance and standards for appropriate and safe levels of naturally occurring fluorides for human consumption. Over time, through specific recommendations, the maximum fluoride concentrations deemed appropriate have been altered, but by a process of considered adjustment. Although the Public Health Service has been responsible for the formalization of many of the recommended standards, those recommendations have been based on research from many fronts. In the most recent reconsideration of the standards for natural fluoride, the most exhaustive and thoroughly documented review to date was done, incorporating review by representatives from State, Federal, and private programs. Although the specific example of the development of standards for natural fluoride is used, it should be illustrative of similar processes that are constantly underway in regard to substances and factors with a potential impact on the public's health. Expansion of the data base through research and scientific inquiry will lay the foundation for future reconsideration of the standards for naturally occurring fluorides. PMID:6828638

Self-reported adherence to the physical activity recommendation and determinants of misperception in older adults.

PubMed

Visser, Marjolein; Brychta, Robert J; Chen, Kong Y; Koster, Annemarie

2014-04-01

We aimed to compare self-reported adherence to the physical activity recommendation with accelerometry in older adults and to identify determinants of misperception. The sample included 138 adults age 65-75 yr old participating in the Longitudinal Aging Study Amsterdam. Participants completed a lifestyle questionnaire and wore an accelerometer for one week. More than half (56.8%) of the participants reported to adhere to the physical activity recommendation (in 5-min bouts), however, based on accelerometry, this percentage was only 24.6%. Of those who reported to adhere, 65.3% did not do so based on accelerometry. The misperceivers were older (p < .009), more often female (p = .007), had a poorer walking performance (p = .02), reported a lower social support (p = .04), and tended to have a lower self-efficacy (p = .09) compared with those who correctly perceived their adherence to the recommendation. These results suggest that misperception of adherence to the physical activity recommendation is highly prevalent among specific subgroups of older adults.

Opportunities for State-Level Action to Reduce Firearm Violence: Proceeding From the Evidence

PubMed Central

Braga, Anthony A.

2011-01-01

Firearm violence remains an important problem, and a large body of evidence shows that guns used in crime follow generally predictable paths from manufacturer to criminal end user. Policy initiatives based on that evidence have been shown to be effective. A recently published study conducted by a leading policy organization presents new evidence and makes specific recommendations for action by state-level policymakers. Unfortunately, the study's analysis is overly simplified, and the recommendations are therefore misleading. We suggest alternatives that are evidence based. PMID:21778510

Metadata Standard and Data Exchange Specifications to Describe, Model, and Integrate Complex and Diverse High-Throughput Screening Data from the Library of Integrated Network-based Cellular Signatures (LINCS).

PubMed

Vempati, Uma D; Chung, Caty; Mader, Chris; Koleti, Amar; Datar, Nakul; Vidović, Dušica; Wrobel, David; Erickson, Sean; Muhlich, Jeremy L; Berriz, Gabriel; Benes, Cyril H; Subramanian, Aravind; Pillai, Ajay; Shamu, Caroline E; Schürer, Stephan C

2014-06-01

The National Institutes of Health Library of Integrated Network-based Cellular Signatures (LINCS) program is generating extensive multidimensional data sets, including biochemical, genome-wide transcriptional, and phenotypic cellular response signatures to a variety of small-molecule and genetic perturbations with the goal of creating a sustainable, widely applicable, and readily accessible systems biology knowledge resource. Integration and analysis of diverse LINCS data sets depend on the availability of sufficient metadata to describe the assays and screening results and on their syntactic, structural, and semantic consistency. Here we report metadata specifications for the most important molecular and cellular components and recommend them for adoption beyond the LINCS project. We focus on the minimum required information to model LINCS assays and results based on a number of use cases, and we recommend controlled terminologies and ontologies to annotate assays with syntactic consistency and semantic integrity. We also report specifications for a simple annotation format (SAF) to describe assays and screening results based on our metadata specifications with explicit controlled vocabularies. SAF specifically serves to programmatically access and exchange LINCS data as a prerequisite for a distributed information management infrastructure. We applied the metadata specifications to annotate large numbers of LINCS cell lines, proteins, and small molecules. The resources generated and presented here are freely available. © 2014 Society for Laboratory Automation and Screening.

Surveillance Recommendations for Children with Overgrowth Syndromes and Predisposition to Wilms Tumors and Hepatoblastoma.

PubMed

Kalish, Jennifer M; Doros, Leslie; Helman, Lee J; Hennekam, Raoul C; Kuiper, Roland P; Maas, Saskia M; Maher, Eamonn R; Nichols, Kim E; Plon, Sharon E; Porter, Christopher C; Rednam, Surya; Schultz, Kris Ann P; States, Lisa J; Tomlinson, Gail E; Zelley, Kristin; Druley, Todd E

2017-07-01

A number of genetic syndromes have been linked to increased risk for Wilms tumor (WT), hepatoblastoma (HB), and other embryonal tumors. Here, we outline these rare syndromes with at least a 1% risk to develop these tumors and recommend uniform tumor screening recommendations for North America. Specifically, for syndromes with increased risk for WT, we recommend renal ultrasounds every 3 months from birth (or the time of diagnosis) through the seventh birthday. For HB, we recommend screening with full abdominal ultrasound and alpha-fetoprotein serum measurements every 3 months from birth (or the time of diagnosis) through the fourth birthday. We recommend that when possible, these patients be evaluated and monitored by cancer predisposition specialists. At this time, these recommendations are not based on the differential risk between different genetic or epigenetic causes for each syndrome, which some European centers have implemented. This differentiated approach largely represents distinct practice environments between the United States and Europe, and these guidelines are designed to be a broad framework within which physicians and families can work together to implement specific screening. Further study is expected to lead to modifications of these recommendations. Clin Cancer Res; 23(13); e115-e22. ©2017 AACR See all articles in the online-only CCR Pediatric Oncology Series . ©2017 American Association for Cancer Research.

Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Birth Weight: A Cohort Study in China.

PubMed

Yang, Shaoping; Peng, Anna; Wei, Sheng; Wu, Jing; Zhao, Jinzhu; Zhang, Yiming; Wang, Jing; Lu, Yuan; Yu, Yuzhen; Zhang, Bin

2015-01-01

To assess whether pre-pregnancy body mass index (BMI) modify the relationship between gestational weight gain (GWG) and child birth weight (specifically, presence or absence of low birth weight (LBW) or presence of absence of macrosomia), and estimates of the relative risk of macrosomia and LBW based on pre-pregnancy BMI were controlled in Wuhan, China. From June 30, 2011 to June 30, 2013. All data was collected and available from the perinatal health care system. Logistic regression models were used to estimate the independent association among pregnancy weight gain, LBW, normal birth weight, and macrosomia within different pre-pregnancy BMI groups. We built different logistic models for the 2009 Institute of Medicine (IOM) Guidelines and Chinese-recommended GWG which was made from this sample. The Chinese-recommended GWG was derived from the quartile values (25th-75th percentiles) of weight gain at the time of delivery in the subjects which comprised our sample. For LBW children, using the recommended weight gain of the IOM and Chinese women as a reference, the OR for a pregnancy weight gain below recommendations resulted in a positive relationship for lean and normal weight women, but not for overweight and obese women. For macrosomia, considering the IOM's recommended weight gain as a reference, the OR magnitude for pregnancy weight gain above recommendations resulted in a positive correlation for all women. The OR for a pregnancy weight gain below recommendations resulted in a negative relationship for normal BMI and lean women, but not for overweight and obese women based on the IOM recommendations, significant based on the recommended pregnancy weight gain for Chinese women. Of normal weight children, 56.6% were above the GWG based on IOM recommendations, but 26.97% of normal weight children were above the GWG based on Chinese recommendations. A GWG above IOM recommendations might not be helpful for Chinese women. We need unified criteria to classify adult BMI and to expand the sample size to improve representation and to elucidate the relationship between GWG and related outcomes for developing a Chinese GWG recommendation.

Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Birth Weight: A Cohort Study in China

PubMed Central

Wei, Sheng; Wu, Jing; Zhao, Jinzhu; Zhang, Yiming; Wang, Jing; Lu, Yuan; Yu, Yuzhen; Zhang, Bin

2015-01-01

Objective To assess whether pre-pregnancy body mass index (BMI) modify the relationship between gestational weight gain (GWG) and child birth weight (specifically, presence or absence of low birth weight (LBW) or presence of absence of macrosomia), and estimates of the relative risk of macrosomia and LBW based on pre-pregnancy BMI were controlled in Wuhan, China. Methods From June 30, 2011 to June 30, 2013. All data was collected and available from the perinatal health care system. Logistic regression models were used to estimate the independent association among pregnancy weight gain, LBW, normal birth weight, and macrosomia within different pre-pregnancy BMI groups. We built different logistic models for the 2009 Institute of Medicine (IOM) Guidelines and Chinese-recommended GWG which was made from this sample. The Chinese-recommended GWG was derived from the quartile values (25th-75th percentiles) of weight gain at the time of delivery in the subjects which comprised our sample. Results For LBW children, using the recommended weight gain of the IOM and Chinese women as a reference, the OR for a pregnancy weight gain below recommendations resulted in a positive relationship for lean and normal weight women, but not for overweight and obese women. For macrosomia, considering the IOM’s recommended weight gain as a reference, the OR magnitude for pregnancy weight gain above recommendations resulted in a positive correlation for all women. The OR for a pregnancy weight gain below recommendations resulted in a negative relationship for normal BMI and lean women, but not for overweight and obese women based on the IOM recommendations, significant based on the recommended pregnancy weight gain for Chinese women. Of normal weight children, 56.6% were above the GWG based on IOM recommendations, but 26.97% of normal weight children were above the GWG based on Chinese recommendations. Conclusions A GWG above IOM recommendations might not be helpful for Chinese women. We need unified criteria to classify adult BMI and to expand the sample size to improve representation and to elucidate the relationship between GWG and related outcomes for developing a Chinese GWG recommendation. PMID:26115015

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

PubMed

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

2014-12-01

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

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

PubMed

Pellar, Russell Edward; Pope, Janet Elizabeth

2017-06-01

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

Recommended procedures for measuring aircraft noise and associated parameters

NASA Technical Reports Server (NTRS)

Marsh, A. H.

1977-01-01

Procedures are recommended for obtaining experimental values of aircraft flyover noise levels (and associated parameters). Specific recommendations are made for test criteria, instrumentation performance requirements, data-acquisition procedures, and test operations. The recommendations are based on state-of-the-art measurement capabilities available in 1976 and are consistent with the measurement objectives of the NASA Aircraft Noise Prediction Program. The recommendations are applicable to measurements of the noise produced by an airplane flying subsonically over (or past) microphones located near the surface of the ground. Aircraft types covered by the recommendations are fixed-wing airplanes powered by turbojet or turbofan engines and using conventional aerodynamic means for takeoff and landing. Various assumptions with respect to subsequent data processing and analysis were made (and are described) and the recommended measurement procedures are compatible with the assumptions. Some areas where additional research is needed relative to aircraft flyover noise measurement techniques are also discussed.

Evidence-informed recommendations for constructing and disseminating messages supplementing the new Canadian Physical Activity Guidelines

PubMed Central

2013-01-01

Background Few validated guidelines exist for developing messages in health promotion practice. In clinical practice, the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) Instrument is the international gold standard for guideline assessment, development, and reporting. In a case study format, this paper describes the application of the AGREE II principles to guide the development of health promotion guidelines for constructing messages to supplement the new Canadian Physical Activity Guidelines (CPAG) released in 2011. Methods The AGREE II items were modified to suit the objectives of developing messages that (1) clarify key components of the new CPAG and (2) motivate Canadians to meet the CPAG. The adapted AGREE II Instrument was used as a systematic guide for the recommendation development process. Over a two-day meeting, five workgroups (one for each CPAG – child, youth, adult, older adult – and one overarching group) of five to six experts (including behavior change, messaging, and exercise physiology researchers, key stakeholders, and end users) reviewed and discussed evidence for creating and targeting messages to supplement the new CPAG. Recommendations were summarized and reviewed by workgroup experts. The recommendations were pilot tested among end users and then finalized by the workgroup. Results The AGREE II was a useful tool in guiding the development of evidence-based specific recommendations for constructing and disseminating messages that supplement and increase awareness of the new CPAG (child, youth, adults, and older adults). The process also led to the development of sample messages and provision of a rationale alongside the recommendations. Conclusions To our knowledge, these are the first set of evidence-informed recommendations for constructing and disseminating messages supplementing physical activity guidelines. This project also represents the first application of international standards for guideline development (i.e., AGREE II) to the creation of practical recommendations specifically aimed to inform health promotion and public health practice. The messaging recommendations have the potential to increase the public health impact of evidence-based guidelines. PMID:23634998

Teen Pregnancy Prevention Program Recommendations from Urban and Reservation Northern Plains American Indian Community Members.

PubMed

McMahon, Tracey R; Hanson, Jessica D; Griese, Emily R; Kenyon, DenYelle Baete

2015-07-03

Despite declines over the past few decades, the United States has one of the highest rates of teen pregnancy compared to other industrialized nations. American Indian youth have experienced higher rates of teen pregnancy compared to the overall population for decades. Although it's known that community and cultural adaptation enhance program effectiveness, few teen pregnancy prevention programs have published on recommendations for adapting these programs to address the specific needs of Northern Plains American Indian youth. We employed a mixed-methods analysis of 24 focus groups and 20 interviews with a combined total of 185 urban and reservation-based American Indian youth and elders, local health care providers, and local school personnel to detail recommendations for the cultural adaptation, content, and implementation of a teen pregnancy prevention program specific to this population. Gender differences and urban /reservation site differences in the types of recommendations offered and the potential reasons for these differences are discussed.

Reduction in Thyroid Nodule Biopsies and Improved Accuracy with American College of Radiology Thyroid Imaging Reporting and Data System.

PubMed

Hoang, Jenny K; Middleton, William D; Farjat, Alfredo E; Langer, Jill E; Reading, Carl C; Teefey, Sharlene A; Abinanti, Nicole; Boschini, Fernando J; Bronner, Abraham J; Dahiya, Nirvikar; Hertzberg, Barbara S; Newman, Justin R; Scanga, Daniel; Vogler, Robert C; Tessler, Franklin N

2018-04-01

Purpose To compare the biopsy rate and diagnostic accuracy before and after applying the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) criteria for thyroid nodule evaluation. Materials and Methods In this retrospective study, eight radiologists with 3-32 years experience in thyroid ultrasonography (US) reviewed US features of 100 thyroid nodules that were cytologically proven, pathologically proven, or both in December 2016. The radiologists evaluated nodule features in five US categories and provided biopsy recommendations based on their own practice patterns without knowledge of ACR TI-RADS criteria. Another three expert radiologists served as the reference standard readers for the imaging findings. ACR TI-RADS criteria were retrospectively applied to the features assigned by the eight radiologists to produce biopsy recommendations. Comparison was made for biopsy rate, sensitivity, specificity, and accuracy. Results Fifteen of the 100 nodules (15%) were malignant. The mean number of nodules recommended for biopsy by the eight radiologists was 80 ± 16 (standard deviation) (range, 38-95 nodules) based on their own practice patterns and 57 ± 11 (range, 37-73 nodules) with retrospective application of ACR TI-RADS criteria. Without ACR TI-RADS criteria, readers had an overall sensitivity, specificity, and accuracy of 95% (95% confidence interval [CI]: 83%, 99%), 20% (95% CI: 16%, 25%), and 28% (95% CI: 21%, 37%), respectively. After applying ACR TI-RADS criteria, overall sensitivity, specificity, and accuracy were 92% (95% CI: 68%, 98%), 44% (95% CI: 33%, 56%), and 52% (95% CI: 40%, 63%), respectively. Although fewer malignancies were recommended for biopsy with ACR TI-RADS criteria, the majority met the criteria for follow-up US, with only three of 120 (2.5%) malignancy encounters requiring no follow-up or biopsy. Expert consensus recommended biopsy in 55 of 100 nodules with ACR TI-RADS criteria. Their sensitivity, specificity, and accuracy were 87% (95% CI: 48%, 98%), 51% (95% CI: 40%, 62%), and 56% (95% CI: 46%, 66%), respectively. Conclusion ACR TI-RADS criteria offer a meaningful reduction in the number of thyroid nodules recommended for biopsy and significantly improve the accuracy of recommendations for nodule management. © RSNA, 2018 Online supplemental material is available for this article.

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

PubMed

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

2000-01-01

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

Preparing for an epidemic: cancer care in an aging population.

PubMed

Shih, Ya-Chen Tina; Hurria, Arti

2014-01-01

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

Recommendations to enhance constructivist-based learning in Interprofessional Education using video-based self-assessment

PubMed Central

Dahmen, Uta; Schulze, Christine; Schindler, Claudia; Wick, Katharina; Schwartze, Dominique; Veit, Andrea; Smolenski, Ulrich

2016-01-01

Introduction: Interprofessional collaboration is crucial to the optimization of patient care. Aim: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment. Methodology: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants). Results: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording. Conclusion: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core. PMID:27280144

European recommendations for primary prevention of congenital anomalies: a joined effort of EUROCAT and EUROPLAN projects to facilitate inclusion of this topic in the National Rare Disease Plans.

PubMed

Taruscio, Domenica; Arriola, Larraitz; Baldi, Francesca; Barisic, Ingeborg; Bermejo-Sánchez, Eva; Bianchi, Fabrizio; Calzolari, Elisa; Carbone, Pietro; Curran, Rhonda; Garne, Ester; Gatt, Miriam; Latos-Bieleńska, Anna; Khoshnood, Babak; Irgens, Lorentz; Mantovani, Alberto; Martínez-Frías, Maria Luisa; Neville, Amanda; Rißmann, Anke; Ruggeri, Stefania; Wellesley, Diana; Dolk, Helen

2014-01-01

Congenital anomalies (CA) are the paradigm example of rare diseases liable to primary prevention actions due to the multifactorial etiology of many of them, involving a number of environmental factors together with genetic predispositions. Yet despite the preventive potential, lack of attention to an integrated preventive strategy has led to the prevalence of CA remaining relatively stable in recent decades. The 2 European projects, EUROCAT and EUROPLAN, have joined efforts to provide the first science-based and comprehensive set of recommendations for the primary prevention of CA in the European Union. The resulting EUROCAT-EUROPLAN 'Recommendations on Policies to Be Considered for the Primary Prevention of Congenital Anomalies in National Plans and Strategies on Rare Diseases' were issued in 2012 and endorsed by EUCERD (European Union Committee of Experts on Rare Diseases) in 2013. The recommendations exploit interdisciplinary expertise encompassing drugs, diet, lifestyles, maternal health status, and the environment. The recommendations include evidence-based actions aimed at reducing risk factors and at increasing protective factors and behaviors at both individual and population level. Moreover, consideration is given to topics specifically related to CA (e.g. folate status, teratogens) as well as of broad public health impact (e.g. obesity, smoking) which call for specific attention to their relevance in the pre- and periconceptional period. The recommendations, reported entirely in this paper, are a comprehensive tool to implement primary prevention into national policies on rare diseases in Europe. © 2014 S. Karger AG, Basel.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis.

PubMed

Tuncer, Tiraje; Cay, Fatih Hasan; Altan, Lale; Gurer, Gulcan; Kacar, Cahit; Ozcakir, Suheda; Atik, Sahap; Ayhan, Figen; Durmaz, Berrin; Eskiyurt, Nurten; Genc, Hakan; GokceKutsal, Yesim; Gunaydin, Rezzan; Hepguler, Simin; Hizmetli, Sami; Kaya, Taciser; Kurtais, Yesim; Saridogan, Merih; Sindel, Dilsad; Sutbeyaz, Serap; Sendur, Omer Faruk; Ugurlu, Hatice; Unlu, Zeliha

2018-05-17

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

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

PubMed

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

2017-11-01

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

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.

Comparing the Maryland Comprehensive Cancer Control Plan With Federal Cancer Prevention and Control Recommendations.

PubMed

Fowler, Stephanie L; Platz, Elizabeth A; Diener-West, Marie; Hokenmaier, Sarah; Truss, Meredith; Lewis, Courtney; Kanarek, Norma F

2015-10-01

Since the introduction of the Affordable Care Act (ACA) in 2012, 11 million more Americans now have access to preventive services via health care coverage. Several prevention-related recommendations issued by the US Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), and Advisory Committee on Immunization Practices (ACIP) are covered under the ACA. State cancer plans often provide prevention strategies, but whether these strategies correspond to federal evidence-based recommendations is unclear. The objective of this article is to assess whether federal evidence-based recommendations, including those covered under the ACA, are included in the Maryland Comprehensive Cancer Control Plan (MCCCP). A total of 19 federal recommendations pertaining to cancer prevention and control were identified. Inclusion of federal cancer-related recommendations by USPSTF, CDC, and ACIP in the MCCCP's goals, objectives, and strategies was examined. Nine of the federal recommendations were issued after the MCCCP's publication. MCCCP recommendations corresponded completely with 4 federal recommendations and corresponded only partially with 3. Reasons for partial correspondence included specification of less restrictive at-risk populations or different intervention implementers. Three federal recommendations were not mentioned in the MCCCP's goals, objectives, and strategies. Many cancer-related federal recommendations were released after the MCCCP's publication and therefore do not appear in the most current version. We recommend that the results of this analysis be considered in the update of the MCCCP. Our findings underscore the need for a periodic scan for changes to federal recommendations and for adjusting state policies and programs to correspond with federal recommendations, as appropriate for Marylanders.

Impact of United States Preventive Services Task Force Recommendations on Utilization of Prostate-specific Antigen Screening in Medicare Beneficiaries.

PubMed

Khairnar, Rahul; Mishra, Mark V; Onukwugha, Eberechukwu

2018-02-16

Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population. This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables. The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations. The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.

Cognitive Requirements for Small Unit Leaders in Military Operations in Urban Terrain

DTIC Science & Technology

1998-09-01

operations specifically. A cognitive task analysis , based on in depth interviews with subject matter experts (n=7), was conducted to expose the...process. The findings of the cognitive task analysis guided the development of training recommendations, particularly the need for a scenario based

OARSI guidelines for the non-surgical management of knee osteoarthritis.

PubMed

McAlindon, T E; Bannuru, R R; Sullivan, M C; Arden, N K; Berenbaum, F; Bierma-Zeinstra, S M; Hawker, G A; Henrotin, Y; Hunter, D J; Kawaguchi, H; Kwoh, K; Lohmander, S; Rannou, F; Roos, E M; Underwood, M

2014-03-01

To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide. Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OA literature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores. Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. Treatments appropriate for specific clinical sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin, cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs (NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of uncertain appropriateness for specific clinical sub-phenotypes included acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein, glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal), rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments voted not appropriate included risedronate and electrotherapy (neuromuscular electrical stimulation). These evidence-based consensus recommendations provide guidance to patients and practitioners on treatments applicable to all individuals with knee OA, as well as therapies that can be considered according to individualized patient needs and preferences. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

PubMed

Patel, Minal R; Vichich, Jennifer; Lang, Ian; Lin, Jessica; Zheng, Kai

2017-04-01

The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

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.

Recommendations from Friends Anytime and Anywhere: Toward a Model of Contextual Offer and Consumption Values

PubMed Central

Shen, Xiao-Liang; Wang, Nan

2013-01-01

Abstract The ubiquity and portability of mobile devices provide additional opportunities for information retrieval. People can easily access mobile applications anytime and anywhere when they need to acquire specific context-aware recommendations (contextual offer) from their friends. This study, thus, represents an initial attempt to understand users' acceptance of a mobile-based social reviews platform, where recommendations from friends can be obtained with mobile devices. Based on the consumption value theory, a theoretical model is proposed and empirically examined using survey data from 218 mobile users. The findings demonstrate that contextual offers based on users' profiles, access time, and geographic positions significantly predict their value perceptions (utilitarian, hedonic, and social), which, in turn, affect their intention to use a mobile social reviews platform. This study is also believed to provide some useful insights to both research and practice. PMID:23530548

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

PubMed Central

Ward, Michael M.; Deodhar, Atul; Akl, Elie A.; Lui, Andrew; Ermann, Joerg; Gensler, Lianne S.; Smith, Judith A.; Borenstein, David; Hiratzka, Jayme; Weiss, Pamela F.; Inman, Robert D.; Majithia, Vikas; Haroon, Nigil; Maksymowych, Walter P.; Joyce, Janet; Clark, Bruce M.; Colbert, Robert A.; Figgie, Mark P.; Hallegua, David S.; Prete, Pamela E.; Rosenbaum, James T.; Stebulis, Judith A.; van den Bosch, Filip; Yu, David T. Y.; Miller, Amy S.; Reveille, John D.; Caplan, Liron

2016-01-01

Objective To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. Results In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. Conclusion These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas. PMID:26401991

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

PubMed Central

WARD, MICHAEL M.; DEODHAR, ATUL; AKL, ELIE A.; LUI, ANDREW; ERMANN, JOERG; GENSLER, LIANNE S.; SMITH, JUDITH A.; BORENSTEIN, DAVID; HIRATZKA, JAYME; WEISS, PAMELA F.; INMAN, ROBERT D.; MAJITHIA, VIKAS; HAROON, NIGIL; MAKSYMOWYCH, WALTER P.; JOYCE, JANET; CLARK, BRUCE M.; COLBERT, ROBERT A.; FIGGIE, MARK P.; HALLEGUA, DAVID S.; PRETE, PAMELA E.; ROSENBAUM, JAMES T.; STEBULIS, JUDITH A.; VAN DEN BOSCH, FILIP; YU, DAVID T. Y.; MILLER, AMY S.; REVEILLE, JOHN D.; CAPLAN, LIRON

2016-01-01

Objective To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. Results In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. Conclusion These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas. PMID:26401907

Using Positive Behavior Support to Design Effective Classrooms

ERIC Educational Resources Information Center

Anderson, Cynthia M.; Spaulding, Scott A.

2007-01-01

A number of evidence-based classroom management approaches, procedures, and programs have been developed and presented over the years. In this article the authors synthesize recommendations from various sources, focusing on evidence-based strategies that can be implemented in a systematic manner. They focus specifically on universal strategies,…

3 CFR 13544 - Executive Order 13544 of June 10, 2010. Establishing the National Prevention, Health Promotion...

Code of Federal Regulations, 2011 CFR

2011-01-01

..., proper nutrition, appropriate exercise, mental health, behavioral health, substance-use disorder, and... United States; (d) contains specific science-based initiatives to achieve the measurable goals of the... coordinated with science-based prevention recommendations by the Director of the Centers for Disease Control...

[Polish guidelines for the prevention and treatment of venous thromboembolism: 2009 update].

PubMed

Zawilska, Krystyna; Jaeschke, Roman; Tomkowski, Witold; Mayzner-Zawadzka, Ewa; Nizankowski, Rafał; Olejek, Anita; Pasierski, Tomasz; Torbicki, Adam; Undas, Anetta; Jawień, Arkadiusz; Gajewski, Piotr; Sznajd, Jan; Brozek, Jan

2009-01-01

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We systematically identified all current clinical practice guidelines concerning the prevention and/or treatment of venous thromboembolism and assessed their methodological quality using the AGREE instrument. We chose to update existing Polish guidelines by adapting the most recent high quality guidelines that we identified to Polish cultural and organizational setting rather than develop all recommendations de novo. We based our recommendations primarily on the 8th edition of the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines on Antithrombotic and Thrombolytic Therapy and on the European Society of Cardiology (ESC) Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. To make recommendations regarding specific management issues that had not been addressed in ACCP guidelines, or whenever panel members felt they needed additional information to reach the decision we also consulted guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each recommendation we explicitly assessed its relevance and applicability in the context of health care system in Poland. We adapted recommendations when necessary, explicitly stating the rationale for modification and judgements about the values and preferences we assumed. We developed original recommendations on the use of new oral anticoagulants that have recently become available, following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

PubMed Central

Thompson, Melanie A.; Mugavero, Michael J.; Amico, K. Rivet; Cargill, Victoria A.; Chang, Larry W.; Gross, Robert; Orrell, Catherine; Altice, Frederick L.; Bangsberg, David R.; Bartlett, John G.; Beckwith, Curt G.; Dowshen, Nadia; Gordon, Christopher M.; Horn, Tim; Kumar, Princy; Scott, James D.; Stirratt, Michael J.; Remien, Robert H.; Simoni, Jane M.; Nachega, Jean B.

2014-01-01

Description After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). ART adherence is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV. Methods A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation. Recommendations Recommendations are provided for monitoring of entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided. PMID:22393036

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm.

PubMed

Friedli, Natalie; Stanga, Zeno; Culkin, Alison; Crook, Martin; Laviano, Alessandro; Sobotka, Lubos; Kressig, Reto W; Kondrup, Jens; Mueller, Beat; Schuetz, Philipp

2018-03-01

Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search. Based on a recent qualitative systematic review on the topic, we developed clinically relevant recommendations as well as a treatment and monitoring algorithm for the clinical management of inpatients regarding RFS. With international experts, these recommendations were discussed and agreement with the recommendation was rated. Upon hospital admission, we recommend the use of specific screening criteria (i.e., low body mass index, large unintentional weight loss, little or no nutritional intake, history of alcohol or drug abuse) for risk assessment regarding the occurrence of RFS. According to the patient's individual risk for RFS, a careful start of nutritional therapy with a stepwise increase in energy and fluids goals and supplementation of electrolyte and vitamins, as well as close clinical monitoring, is recommended. We also propose criteria for the diagnosis of imminent and manifest RFS with practical treatment recommendations with adoption of the nutritional therapy. Based on the available evidence, we developed a practical algorithm for risk assessment, treatment, and monitoring of RFS in medical inpatients. In daily routine clinical care, this may help to optimize and standardize the management of this vulnerable patient population. We encourage future quality studies to further refine these recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

Automatic stress-relieving music recommendation system based on photoplethysmography-derived heart rate variability analysis.

PubMed

Shin, Il-Hyung; Cha, Jaepyeong; Cheon, Gyeong Woo; Lee, Choonghee; Lee, Seung Yup; Yoon, Hyung-Jin; Kim, Hee Chan

2014-01-01

This paper presents an automatic stress-relieving music recommendation system (ASMRS) for individual music listeners. The ASMRS uses a portable, wireless photoplethysmography module with a finger-type sensor, and a program that translates heartbeat signals from the sensor to the stress index. The sympathovagal balance index (SVI) was calculated from heart rate variability to assess the user's stress levels while listening to music. Twenty-two healthy volunteers participated in the experiment. The results have shown that the participants' SVI values are highly correlated with their prespecified music preferences. The sensitivity and specificity of the favorable music classification also improved as the number of music repetitions increased to 20 times. Based on the SVI values, the system automatically recommends favorable music lists to relieve stress for individuals.

Meeting the Canadian 24-Hour Movement Guidelines for Children and Youth.

PubMed

Roberts, Karen C; Yao, Xiaoquan; Carson, Valerie; Chaput, Jean-Philippe; Janssen, Ian; Tremblay, Mark S

2017-10-18

The Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep , provide specific recommendations on the amount of time over a typical 24-hour day that children and youth aged 5 to 17 should spend in moderate-to-vigorous physical activity (at least 60 minutes), recreational screen time (no more than 2 hours), and sleep (9 to 11 hours for 5- to 13-year-olds; 8 to 10 hours for 14- to 17-year-olds). Based on combined results of cycles 2 (2009-to-2011) and 3 (2012-to-2013) of the Canadian Health Measures Survey, this analysis examines average daily moderate-to-vigorous physical activity, screen time and sleep duration of 5- to 11-year-olds and 12- to 17-year-olds, and the percentages meeting the 24-Hour Guidelines' recommendations. Findings are presented overall and by age group and sex. Differences in average daily times between groups were tested for statistical significance, as weredifferences between groups in the percentages meeting each recommendation and combination of recommendations. Overall, 17.5% of children and youth met the 24-Hour Guidelines' specific time recommendations. Higher percentages of children than youth (29.6% versus 5.5%) and boys than girls (22.9% versus 11.8%) met the recommendations. About a third (36.3%) met two of the three recommendations. Recommendations for moderate-to-vigorous physical activity, sedentary behaviour, and sleep have higher levels of adherence among children than youth.

Return to Learning After a Concussion and Compliance With Recommendations for Cognitive Rest.

PubMed

Olympia, Robert P; Ritter, Jed T; Brady, Jodi; Bramley, Harry

2016-03-01

To determine the compliance of schools and school nurses in the United States with national recommendations for cognitive rest in students who sustain a concussion. Cross-sectional questionnaire based. Members of the National Association of School Nurses working at the high school level. A questionnaire, developed by the authors and based on recommendations for cognitive rest, was electronically distributed 3 times during the 2012 to 2013 academic year. Self-reported responses were collected regarding demographics and compliance of schools and school nurses with recommendations for the management of the postconcussion student, including the presence of specific guidelines for individualized care and the responsibility of the nurse for the prevention, detection, and management of concussions. Analysis was performed on 1033 completed questionnaires (36% usable response rate). Fifty-three percent of schools have guidelines to assist students when returning to school after a concussion. These guidelines include extension of assignment deadlines (87%), rest periods during the school day (84%), postponement or staggering of tests (75%), reduced workload (73%), and accommodation for light or noise sensitivity (64%). Sixty-six percent of nurses in our sample have had special training in the recognition and management of concussions. Nurses reported involvement in the following roles: identifying suspected concussions (80%), providing emotional support for recovering students dealing with concussion-related depression (59%), and guiding the student's postconcussion graduated academic and activity re-entry process (58%). We detected a wide variability in compliance of schools and school nurses with national recommendations for cognitive rest. Ensuring that schools have policies established for a student's return to learning, having specific guidelines to provide an individualized approach to return to learning based on postconcussion signs/symptoms, training school nurses in the recognition and management of concussions, and involving school nurses in the re-entry process are identified areas for improvement. Schools in the United States should be aware of these recommendations to guide a student's postconcussion graduated academic re-entry process.

The advantages and limitations of guideline adaptation frameworks.

PubMed

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

2018-05-29

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

Sensitivity and specificity of waist circumference as a single screening tool for identification of overweight and obesity among Malaysian adults.

PubMed

Kee, C C; Jamaiyah, H; Geeta, A; Ali, Z Ahmad; Safiza, M N Noor; Suzana, S; Khor, G L; Rahmah, R; Jamalludin, A R; Sumarni, M G; Lim, K H; Faudzi, Y Ahmad; Amal, N M

2011-12-01

Generalised obesity and central obesity are risk factors for Type II diabetes mellitus and cardiovascular diseases. Waist circumference (WC) has been suggested as a single screening tool for identification of overweight or obese subjects in lieu of the body mass index (BMI) for weight management in public health program. Currently, the recommended waist circumference cut-off points of > or = 94cm for men and > or =80cm for women (waist action level 1) and > or = 102cm for men and > or = 88cm for women (waist action level 2) used for identification of overweight and obesity are based on studies in Caucasian populations. The objective of this study was to assess the sensitivity and specificity of the recommended waist action levels, and to determine optimal WC cut-off points for identification of overweight or obesity with central fat distribution based on BMI for Malaysian adults. Data from 32,773 subjects (14,982 men and 17,791 women) aged 18 and above who participated in the Third National Health Morbidity Survey in 2006 were analysed. Sensitivity and specificity of WC at waist action level 1 were 48.3% and 97.5% for men; and 84.2% and 80.6% for women when compared to the cut-off points based on BMI > or = 25kg/m2. At waist action level 2, sensitivity and specificity were 52.4% and 98.0% for men, and 79.2% and 85.4% for women when compared with the cut-off points based on BMI (> or = 30 kg/m2). Receiver operating characteristic analyses showed that the appropriatescreening cut-off points for WC to identify subjects with overweight (> or = 25kg/m2) was 86.0cm (sensitivity=83.6%, specificity=82.5%) for men, and 79.1cm (sensitivity=85.0%, specificity=79.5%) for women. Waist circumference cut-off points to identify obese subjects (BMI > or = 30 kg/m2) was 93.2cm (sensitivity=86.5%, specificity=85.7%) for men and 85.2cm (sensitivity=77.9%, specificity=78.0%) for women. Our findings demonstrated that the current recommended waist circumference cut-off points have low sensitivity for identification of overweight and obesity in men. We suggest that these newly identified cut-off points be considered.

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

PubMed Central

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

2008-01-01

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

Shilling Attacks Detection in Recommender Systems Based on Target Item Analysis

PubMed Central

Zhou, Wei; Wen, Junhao; Koh, Yun Sing; Xiong, Qingyu; Gao, Min; Dobbie, Gillian; Alam, Shafiq

2015-01-01

Recommender systems are highly vulnerable to shilling attacks, both by individuals and groups. Attackers who introduce biased ratings in order to affect recommendations, have been shown to negatively affect collaborative filtering (CF) algorithms. Previous research focuses only on the differences between genuine profiles and attack profiles, ignoring the group characteristics in attack profiles. In this paper, we study the use of statistical metrics to detect rating patterns of attackers and group characteristics in attack profiles. Another question is that most existing detecting methods are model specific. Two metrics, Rating Deviation from Mean Agreement (RDMA) and Degree of Similarity with Top Neighbors (DegSim), are used for analyzing rating patterns between malicious profiles and genuine profiles in attack models. Building upon this, we also propose and evaluate a detection structure called RD-TIA for detecting shilling attacks in recommender systems using a statistical approach. In order to detect more complicated attack models, we propose a novel metric called DegSim’ based on DegSim. The experimental results show that our detection model based on target item analysis is an effective approach for detecting shilling attacks. PMID:26222882

Identification of abnormal accident patterns at intersections

DOT National Transportation Integrated Search

1999-08-01

This report presents the findings and recommendations based on the Identification of Abnormal Accident Patterns at Intersections. This project used a statistically valid sampling method to determine whether a specific intersection has an abnormally h...

Evaluation of signal timing and coordination procedures.

DOT National Transportation Integrated Search

1985-01-01

Based on a review of available literature, recommended procedures for timing the various types of signals are provided. Specifically, procedures are included for both pretimed and vehicle-actuated controllers located at isolated intersections and at ...

76 FR 4121 - Advisory Committee on Interdisciplinary, Community-Based Linkages; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-24

... Education, Professional Development and Lifelong Learning for the 21st Century Health Care Workforce. The... with experts, and discussion sessions specific to the development of recommendations to be addressed in...

Ground-based facilities for simulation of microgravity: organism-specific recommendations for their use, and recommended terminology.

PubMed

Herranz, Raul; Anken, Ralf; Boonstra, Johannes; Braun, Markus; Christianen, Peter C M; de Geest, Maarten; Hauslage, Jens; Hilbig, Reinhard; Hill, Richard J A; Lebert, Michael; Medina, F Javier; Vagt, Nicole; Ullrich, Oliver; van Loon, Jack J W A; Hemmersbach, Ruth

2013-01-01

Research in microgravity is indispensable to disclose the impact of gravity on biological processes and organisms. However, research in the near-Earth orbit is severely constrained by the limited number of flight opportunities. Ground-based simulators of microgravity are valuable tools for preparing spaceflight experiments, but they also facilitate stand-alone studies and thus provide additional and cost-efficient platforms for gravitational research. The various microgravity simulators that are frequently used by gravitational biologists are based on different physical principles. This comparative study gives an overview of the most frequently used microgravity simulators and demonstrates their individual capacities and limitations. The range of applicability of the various ground-based microgravity simulators for biological specimens was carefully evaluated by using organisms that have been studied extensively under the conditions of real microgravity in space. In addition, current heterogeneous terminology is discussed critically, and recommendations are given for appropriate selection of adequate simulators and consistent use of nomenclature.

Evidence-based recommendations to improve reproductive healthcare for incarcerated women.

PubMed

Knittel, Andrea; Ti, Angeline; Schear, Sarah; Comfort, Megan

2017-09-11

Purpose The purpose of this paper is to describe standards for evidence-based reproductive healthcare for incarcerated women. Design/methodology/approach The literature on reproductive healthcare in the US criminal justice system and recommendations from professional organizations were reviewed and critical areas of concern were identified. Within these areas, studies and expert opinion were synthesized and policy recommendations were formulated through an iterative process of group discussion and document revision. This brief specifically addresses women's incarceration in the USA, but the recommendations are grounded in a human rights framework with global relevance. Findings Women who are incarcerated have health needs that are distinct from those of men, and there is a clear need for gender-responsive reproductive healthcare within the criminal justice system. This brief identifies five core domains of reproductive healthcare: routine screening, menstruation-related concerns, prenatal and postpartum care, contraception and abortion, and sexually transmitted infections. The recommendations emphasize the continuity between the criminal justice system and the community, as well as the dignity and self-determination of incarcerated women. Originality/value This brief provides a unique synthesis of the available evidence with concrete recommendations for improving the reproductive healthcare for incarcerated women.

Comparing the Maryland Comprehensive Cancer Control Plan With Federal Cancer Prevention and Control Recommendations

PubMed Central

Platz, Elizabeth A.; Diener-West, Marie; Hokenmaier, Sarah; Truss, Meredith; Lewis, Courtney; Kanarek, Norma F.

2015-01-01

Introduction Since the introduction of the Affordable Care Act (ACA) in 2012, 11 million more Americans now have access to preventive services via health care coverage. Several prevention-related recommendations issued by the US Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), and Advisory Committee on Immunization Practices (ACIP) are covered under the ACA. State cancer plans often provide prevention strategies, but whether these strategies correspond to federal evidence-based recommendations is unclear. The objective of this article is to assess whether federal evidence-based recommendations, including those covered under the ACA, are included in the Maryland Comprehensive Cancer Control Plan (MCCCP). Methods A total of 19 federal recommendations pertaining to cancer prevention and control were identified. Inclusion of federal cancer-related recommendations by USPSTF, CDC, and ACIP in the MCCCP’s goals, objectives, and strategies was examined. Results Nine of the federal recommendations were issued after the MCCCP’s publication. MCCCP recommendations corresponded completely with 4 federal recommendations and corresponded only partially with 3. Reasons for partial correspondence included specification of less restrictive at-risk populations or different intervention implementers. Three federal recommendations were not mentioned in the MCCCP’s goals, objectives, and strategies. Conclusion Many cancer-related federal recommendations were released after the MCCCP’s publication and therefore do not appear in the most current version. We recommend that the results of this analysis be considered in the update of the MCCCP. Our findings underscore the need for a periodic scan for changes to federal recommendations and for adjusting state policies and programs to correspond with federal recommendations, as appropriate for Marylanders. PMID:26425867

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

NASA Astrophysics Data System (ADS)

Ingram, Rick E.

1992-04-01

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

[Analysis of characteristics shown in self introduction letter and professor's recommendation letter].

PubMed

Kim, Sang Hyun

2013-09-01

The purpose of this study was to investigate applicants' behavioral characteristics based on the evaluation of cognitive, affective and social domain shown in self introduction letter and professor's recommendation letter. Self introduction letters and professor's recommendation letters of 109 applicants students who applied to medical school were collected. Frequency analysis and simple correlation were done in self introduction letter and professor's recommendation letter. Frequency analysis showed affective characteristics were most often mentioned in self introduction letter, and cognitive characteristics were most frequently described in professor's recommendation letter. There was a strong correlation between cognitive domains of self introduction letter and cognitive domain of professor's recommendation letter. There was a strong correlation between affective domain of self introduction letter and cognitive domain professor's recommendation letter. It is very important to make full use of self introduction letter and professor's recommendation letter for selecting medical students. Through the frequency analysis and simple correlation, more specific guidelines need to be suggested in order to secure fairness and objectivity in the evaluation of self-introduction letter and professor's recommendation letter.

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

PubMed

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

2017-04-01

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

Integrating Genomics Into Clinical Pediatric Oncology Using the Molecular Tumor Board at the Memorial Sloan Kettering Cancer Center.

PubMed

Ortiz, Michael V; Kobos, Rachel; Walsh, Michael; Slotkin, Emily K; Roberts, Stephen; Berger, Michael F; Hameed, Meera; Solit, David; Ladanyi, Marc; Shukla, Neerav; Kentsis, Alex

2016-08-01

Pediatric oncologists have begun to leverage tumor genetic profiling to match patients with targeted therapies. At the Memorial Sloan Kettering Cancer Center (MSKCC), we developed the Pediatric Molecular Tumor Board (PMTB) to track, integrate, and interpret clinical genomic profiling and potential targeted therapeutic recommendations. This retrospective case series includes all patients reviewed by the MSKCC PMTB from July 2014 to June 2015. Cases were submitted by treating oncologists and potential treatment recommendations were based upon the modified guidelines of the Oxford Centre for Evidence-Based Medicine. There were 41 presentations of 39 individual patients during the study period. Gliomas, acute myeloid leukemia, and neuroblastoma were the most commonly reviewed cases. Thirty nine (87%) of the 45 molecular sequencing profiles utilized hybrid-capture targeted genome sequencing. In 30 (73%) of the 41 presentations, the PMTB provided therapeutic recommendations, of which 19 (46%) were implemented. Twenty-one (70%) of the recommendations involved targeted therapies. Three (14%) targeted therapy recommendations had published evidence to support the proposed recommendations (evidence levels 1-2), eight (36%) recommendations had preclinical evidence (level 3), and 11 (50%) recommendations were based upon hypothetical biological rationales (level 4). The MSKCC PMTB enabled a clinically relevant interpretation of genomic profiling. Effective use of clinical genomics is anticipated to require new and improved tools to ascribe pathogenic significance and therapeutic actionability. The development of specific rule-driven clinical protocols will be needed for the incorporation and evaluation of genomic and molecular profiling in interventional prospective clinical trials. © 2016 Wiley Periodicals, Inc.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders.

PubMed

Hay, Phillipa; Chinn, David; Forbes, David; Madden, Sloane; Newton, Richard; Sugenor, Lois; Touyz, Stephen; Ward, Warren

2014-11-01

This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014. The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified. In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to guide practice. Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in AN, and research is urgently needed for all aspects of ARFID assessment and management. Associate Professor Susan Byrne, Dr Angelica Claudino, Dr Anthea Fursland, Associate Professor Jennifer Gaudiani, Dr Susan Hart, Ms Gabriella Heruc, Associate Professor Michael Kohn, Dr Rick Kausman, Dr Sarah Maguire, Ms Peta Marks, Professor Janet Treasure and Mr Andrew Wallis. © The Royal Australian and New Zealand College of Psychiatrists 2014.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-04-01

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

Off-label use of vaccines.

PubMed

Neels, Pieter; Southern, James; Abramson, Jon; Duclos, Philippe; Hombach, Joachim; Marti, Melanie; Fitzgerald-Husek, Alanna; Fournier-Caruana, Jacqueline; Hanquet, Germaine

2017-04-25

This article reviews the off-label recommendations and use of vaccines, and focuses on the differences between the labelled instructions on how to use the vaccine as approved by the regulatory authorities (or "label" 1 ), and the recommendations for use issued by public health advisory bodies at national and international levels. Differences between public health recommendations and the product label regarding the vaccine use can lead to confusion at the level of vaccinators and vaccinees and possibly result in lower compliance with national vaccination schedules. In particular, in many countries, the label may contain regulatory restrictions and warnings against vaccination of specific population groups (e.g. pregnant women) due to a lack of evidence of safety from controlled trials at the time of initial licensure of the vaccine, while public health authorities may recommend the same vaccine for that group, based on additional post-marketing data and benefit risk analyses. We provide an overview of the different responsibilities between regulatory authorities and public health advisory bodies, and the rationale for off-label use 2 of vaccines, the challenges involved based on the impact of off-label use in real-life. We propose to reduce off-label use of vaccines by requiring the manufacturer to regularly adapt the label as much as possible to the public health needs as supported by new evidence. This would require manufacturers to collect and report post-marketing data, communicate them to all stakeholders and regulators to extrapolate existing evidence (when acceptable) to other groups or to other brands of a vaccine (class effect 3 ). Regulatory authorities have a key role to play by requesting additional post-marketing data, e.g. in specific target groups. When public health recommendations for vaccine use that are outside labelled indications are considered necessary, good communication between regulatory bodies, public health authorities, companies and health care providers or vaccinators is crucial. Recommendations as well as labels and label changes should be evidence-based. The rationale for the discrepancy and the recommended off-label use of a vaccine should be communicated to providers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Multimedia-based decision support system for hazards recognition and abatement

DOEpatents

Czachowski, John B.; Zoldak, John T.

1998-01-01

A system for monitoring a site includes a portable data collection module used in the field to collect site specific data, and a processor module located at a central location. The data collection module displays choices of categories of findings, and then specific findings within each category. A selected specific finding is then displayed in report form with a citation to the specific code or statutory requirement, as well as a recommended course of action and an abatement date.

Recommendations for Promoting Physical Activity for Children and Adolescents in Germany. A Consensus Statement

PubMed Central

Graf, Christine; Beneke, Ralph; Bloch, Wilhelm; Bucksch, Jens; Dordel, Sigrid; Eiser, Stefanie; Ferrari, Nina; Koch, Benjamin; Krug, Susanne; Lawrenz, Wolfgang; Manz, Kristin; Naul, Roland; Oberhoffer, Renate; Quilling, Eike; Schulz, Henry; Stemper, Theo; Stibbe, Günter; Tokarski, Walter; Völker, Klaus; Woll, Alexander

2014-01-01

Increasing physical activity and reduction of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases in children and adolescents. However, the question of how much physical activity is useful for which target group is still a matter of debate. International guidelines (World Health Organization; European Association for the Study of Obesity), which are mainly based on expert opinions, recommend 60 min of physical activity every day. Age- and sex-specific features and regional differences are not taken into account. Therefore, expert consensus recommendations for promoting physical activity of children and adolescents in Germany were developed with special respect to national data, but also with respect to aspects of specific target groups, e.g., children with a lower socio-economic status (SES) or with migration background. They propose 90 min/day of physical activity, or at least 12,000 steps daily. Additionally, lifestyle factors, especially restriction of media consumption, were integrated. The recommendations provide orientation for parents and caregivers, for institutions such as schools and kindergartens as well as for communities and stakeholders. PMID:24821136

[Patient safety in home care - A review of international recommendations].

PubMed

Czakert, Judith; Lehmann, Yvonne; Ewers, Michael

2018-06-08

In recent years there has been a growing trend towards nursing care at home in general as well as towards intensive home care being provided by specialized home care services in Germany. However, resulting challenges for patient safety have rarely been considered. Against this background we aimed to explore whether international recommendations for patient safety in home care in general and in intensive home care in particular already exist and how they can stimulate further practice development in Germany. A review of online English documents containing recommendations for patient safety in intensive home care was conducted. Available documents were analyzed and compared in terms of their form and content. Overall, a small number of relevant documents could be identified. None of these documents exclusively refer to the intensive home care sector. Despite their differences, however, the analysis of four selected documents showed similarities, e. g., regarding specific topics of patient safety (communication, involvement of patients and their relatives, risk assessment, medication management, qualification). Furthermore, strengths and weaknesses of the documents became apparent: e. g., an explicit understanding of patient safety, a literature-based introduction to safety topics or an adaptation of the recommendations to the specific features of home care were occasionally lacking. This document analysis provides interesting input to the formal and content-related development of specific recommendations and to practice development in Germany to improve patient safety in home care. Copyright © 2018. Published by Elsevier GmbH.

Applying a "Big Data" Literature System to Recommend Antihypertensive Drugs for Hypertension Patients with Diabetes Mellitus.

PubMed

Shu, Jing-Xian; Li, Ying; He, Ting; Chen, Ling; Li, Xue; Zou, Lin-Lin; Yin, Lu; Li, Xiao-Hui; Wang, An-Li; Liu, Xing; Yuan, Hong

2018-01-07

BACKGROUND The explosive increase in medical literature has changed therapeutic strategies, but it is challenging for physicians to keep up-to-date on the medical literature. Scientific literature data mining on a large-scale of can be used to refresh physician knowledge and better improve the quality of disease treatment. MATERIAL AND METHODS This paper reports on a reformulated version of a data mining method called MedRank, which is a network-based algorithm that ranks therapy for a target disease based on the MEDLINE literature database. MedRank algorithm input for this study was a clear definition of the disease model; the algorithm output was the accurate recommendation of antihypertensive drugs. Hypertension with diabetes mellitus was chosen as the input disease model. The ranking output of antihypertensive drugs are based on the Joint National Committee (JNC) guidelines, one through eight, and the publication dates, ≤1977, ≤1980, ≤1984, ≤1988, ≤1993, ≤1997, ≤2003, and ≤2013. The McNemar's test was used to evaluate the efficacy of MedRank based on specific JNC guidelines. RESULTS The ranking order of antihypertensive drugs changed with the date of the published literature, and the MedRank algorithm drug recommendations had excellent consistency with the JNC guidelines in 2013 (P=1.00 from McNemar's test, Kappa=0.78, P=1.00). Moreover, the Kappa index increased over time. Sensitivity was better than specificity for MedRank; in addition, sensitivity was maintained at a high level, and specificity increased from 1997 to 2013. CONCLUSIONS The use of MedRank in ranking medical literature on hypertension with diabetes mellitus in our study suggests possible application in clinical practice; it is a potential method for supporting antihypertensive drug-prescription decisions.

Geotechnical Aspects of Rock Erosion in Emergency Spillway Channels. Report 5 Summary of Results, Conclusions and Recommendations

DTIC Science & Technology

1990-09-01

channel. Erosion susceptibility, similar to spillway evaluation, must emphasize rock-mass rating or classification systems (e.g. rippability ) which, when...recommends site-specific "proof of concept" testing of an Erosion Probability Index (EPI) based on rock-mass rippability rating and lithostratigraphic...and rock-mass parameters that provide key input parameters to Weaver’s (1975) Rippability Rating (RR) scheme (or Bieniawski’s (1974) Rock Mass Rating

Assessment of DoD Enterprise Resource Planning Business Systems

DTIC Science & Technology

2011-02-01

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

The Development of Mobile Application to Introduce Historical Monuments in Manado

NASA Astrophysics Data System (ADS)

Rupilu, Moshe Markhasi; Suyoto; Santoso, Albertus Joko

2018-02-01

Learning the historical value of a monument is important because it preserves cultural and historical values, as well as expanding our personal insight. In Indonesia, particularly in Manado, North Sulawesi, there are many monuments. The monuments are erected for history, religion, culture and past war, however these aren't written in detail in the monuments. To get information on specific monument, manual search was required, i.e. asking related people or sources. Based on the problem, the development of an application which can utilize LBS (Location Based Service) method and some algorithmic methods specifically designed for mobile devices such as Smartphone, was required so that information on every monument in Manado can be displayed in detail using GPS coordinate. The application was developed by KNN method with K-means algorithm and collaborative filtering to recommend monument information to tourist. Tourists will get recommended options filtered by distance. Then, this method was also used to look for the closest monument from user. KNN algorithm determines the closest location by making comparisons according to calculation of longitude and latitude of several monuments tourist wants to visit. With this application, tourists who want to know and find information on monuments in Manado can do them easily and quickly because monument information is recommended directly to user without having to make selection. Moreover, tourist can see recommended monument information and search several monuments in Manado in real time.

Mission-oriented requirements for updating MIL-H-8501. Volume 2: STI background and rationale. [military rotorcraft

NASA Technical Reports Server (NTRS)

Clement, W. F.; Hoh, R. H.; Mitchell, D. G.; Ferguson, S. W., III

1985-01-01

A supplement to the structure of a new flying and ground handling qualities specification for military rotorcraft structure is presented in order to explain the background and rationale for the specification structure, the proposed forms of criteria, and the status of the existing data base. Critical gaps in the data base for the new structure are defined, and recommendations are provided for the research required to address the most important of these gaps.

Treatment Recommendations for Single-Unit Crowns: Findings from The National Dental Practice-Based Research Network

PubMed Central

McCracken, Michael S.; Louis, David R.; Litaker, Mark S.; Minyé, Helena M.; Mungia, Rahma; Gordan, Valeria V.; Marshall, Don G.; Gilbert, Gregg H.

2016-01-01

Background Objectives were to: (1) quantify practitioner variation in likelihood to recommend a crown; and (2) test whether certain dentist, practice, and clinical factors are significantly associated with this likelihood. Methods Dentists in the National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In four clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. These responses were used to calculate a dentist-specific “Crown Factor” (CF; range 0–12). A higher score implies a higher likelihood to recommend a crown. Certain characteristics were tested for statistically significant associations with the CF. Results 1,777 of 2,132 eligible dentists responded (83%). Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, endodontically-treated, or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, Southwest practitioners, and practitioners with a balanced work load were more likely to recommend crowns, as were practitioners who use optical scanners for digital impressions. Conclusions There is substantial variation in the likelihood of recommending a crown. While consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied by type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. Practical Implications Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture -- whether from endodontic treatment, fractured teeth, or large restorations -- prompted many clinicians to recommend crowns. PMID:27492046

Physiotherapy in rheumatoid arthritis: development of a practice guideline.

PubMed

Hurkmans, E J; van der Giesen, F J; Bloo, H; Boonman, D C; van der Esch, M; Fluit, M; Hilberdink, W K; Peter, W F; van der Stegen, H P; Veerman, E A; Verhoef, J; Vermeulen, H M; Hendriks, H M; Schoones, J W; Vliet Vlieland, T P

2011-01-01

To improve the quality of the physiotherapy management in patients with rheumatoid arthritis (RA) a Dutch practice guideline, based on current scientific evidence and best practice, was developed. This guideline comprised all elements of a structured approach (assessment, treatment and evaluation) and was based on the Internatio-nal Classification of Functioning, disability and Health (ICF) and the ICF core sets for RA. A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 10 experts from different professional backgrounds resulting in the final guideline. In total 7 topics were selected. For the initial assessment, three recommendations were made. Based on the ICF core sets for RA a list of health problems relevant for the physiotherapist was made and completed with red flags and points of attention. Concerning treatment, three recommendations were formulated; both exercise therapy and education on physiotherapy were recommended, whereas passive interventions (delivery of heat or cold, mechanical, electric and electromagnetic energy, massage, passive mobilization/manipulation and balneotherapy) were neither recommended nor discouraged. For treatment evaluation at the level of activities and participation, the Health Assessment Questionnaire was recommended. For evaluating specific body structures and functions the handheld dynamometer, 6-minute walk test or Ästrand bicycle test (including Borg-scale for rating the perceived exertion), Escola Paulista de Medicina Range of Motion Scale and a Visual Analog Scale for pain and morning stiffness were recommended. This physiotherapy practice guideline for RA included seven recommendations on the initial assessment, treatment and evaluation, which were all based on the ICF and the ICF Core Set for RA. The implementation of the guideline in clinical practice needs further evaluation.

Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report

PubMed Central

Clavien, Pierre-Alain; Lesurtel, Mickael; Bossuyt, Patrick M M; Gores, Gregory J; Langer, Bernard; Perrier, Arnaud

2012-01-01

Although liver transplantation is a widely accepted treatment for hepatocellular carcinoma (HCC), much controversy remains and there is no generally accepted set of guidelines. An international consensus conference was held on Dec 2–4, 2010, in Zurich, Switzerland, with the aim of reviewing current practice regarding liver transplantation in patients with HCC and to develop internationally accepted statements and guidelines. The format of the conference was based on the Danish model. 19 working groups of experts prepared evidence-based reviews according to the Oxford classification, and drafted recommendations answering 19 specific questions. An independent jury of nine members was appointed to review these submissions and make final recommendations, after debates with the experts and audience at the conference. This report presents the final 37 statements and recommendations, covering assessment of candidates for liver transplantation, criteria for listing in cirrhotic and non-cirrhotic patients, role of tumour downstaging, management of patients on the waiting list, role of living donation, and post-transplant management. PMID:22047762

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

PubMed

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

2015-04-01

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

An Efficient Recommendation Filter Model on Smart Home Big Data Analytics for Enhanced Living Environments.

PubMed

Chen, Hao; Xie, Xiaoyun; Shu, Wanneng; Xiong, Naixue

2016-10-15

With the rapid growth of wireless sensor applications, the user interfaces and configurations of smart homes have become so complicated and inflexible that users usually have to spend a great amount of time studying them and adapting to their expected operation. In order to improve user experience, a weighted hybrid recommender system based on a Kalman Filter model is proposed to predict what users might want to do next, especially when users are located in a smart home with an enhanced living environment. Specifically, a weight hybridization method was introduced, which combines contextual collaborative filter and the contextual content-based recommendations. This method inherits the advantages of the optimum regression and the stability features of the proposed adaptive Kalman Filter model, and it can predict and revise the weight of each system component dynamically. Experimental results show that the hybrid recommender system can optimize the distribution of weights of each component, and achieve more reasonable recall and precision rates.

An Efficient Recommendation Filter Model on Smart Home Big Data Analytics for Enhanced Living Environments

PubMed Central

Chen, Hao; Xie, Xiaoyun; Shu, Wanneng; Xiong, Naixue

2016-01-01

With the rapid growth of wireless sensor applications, the user interfaces and configurations of smart homes have become so complicated and inflexible that users usually have to spend a great amount of time studying them and adapting to their expected operation. In order to improve user experience, a weighted hybrid recommender system based on a Kalman Filter model is proposed to predict what users might want to do next, especially when users are located in a smart home with an enhanced living environment. Specifically, a weight hybridization method was introduced, which combines contextual collaborative filter and the contextual content-based recommendations. This method inherits the advantages of the optimum regression and the stability features of the proposed adaptive Kalman Filter model, and it can predict and revise the weight of each system component dynamically. Experimental results show that the hybrid recommender system can optimize the distribution of weights of each component, and achieve more reasonable recall and precision rates. PMID:27754456

Psychosocial Accommodation to Group Confinement in the Advanced Base Habitat

DTIC Science & Technology

1988-06-01

16 Recommendations................................................ 22 Conflict Management ....................................... 22... Conflict Management . Even these brief tests revealed significant potential for interpersonal conflict. Further, crew members stated that the brevity of the...that specific attention be given to conflict management in the Advanced Base Habitat. This may take the form of selection of crew members who have highly

Involving Stakeholders in Programme Theory Specification: Discussion of a Systematic, Consensus-Based Approach

ERIC Educational Resources Information Center

van Urk, Felix; Grant, Sean; Bonell, Chris

2016-01-01

The use of explicit programme theory to guide evaluation is widely recommended. However, practitioners and other partnering stakeholders often initiate programmes based on implicit theories, leaving researchers to explicate them before commencing evaluation. The current study aimed to apply a systematic method to undertake this process. We…

77 FR 56851 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-14

... Bioequivalence Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY... draft product-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal...

Brief assessment of food insecurity accurately identifies high-risk US adults.

PubMed

Gundersen, Craig; Engelhard, Emily E; Crumbaugh, Amy S; Seligman, Hilary K

2017-06-01

To facilitate the introduction of food insecurity screening into clinical settings, we examined the test performance of two-item screening questions for food insecurity against the US Department of Agriculture's Core Food Security Module. We examined sensitivity, specificity and accuracy of various two-item combinations of questions assessing food insecurity in the general population and high-risk population subgroups. 2013 Current Population Survey December Supplement, a population-based US survey. All survey participants from the general population and high-risk subgroups. The test characteristics of multiple two-item combinations of questions assessing food insecurity had adequate sensitivity (>97 %) and specificity (>70 %) for widespread adoption as clinical screening measures. We recommend two specific items for clinical screening programmes based on their widespread current use and high sensitivity for detecting food insecurity. These items query how often the household 'worried whether food would run out before we got money to buy more' and how often 'the food that we bought just didn't last and we didn't have money to get more'. The recommended items have sensitivity across high-risk population subgroups of ≥97 % and a specificity of ≥74 % for food insecurity.

Preparedness of households and catering establishments for incidents involving radioactive contamination.

PubMed

Enqvist, H

2005-01-01

This short paper describes a number of investigations carried out to ensure preparedness for crises involving radioactivity to catering operations and private households in Finland. The specific recommendations for catering kitchens during crises were published in 1994. A study to determine the level of adherence to these recommendations is summarised here, together with its findings and subsequent recommendations. Another study on the pre-planning of crisis menus is described. New challenges for the catering kitchens are touched upon. A crisis food preparation booklet for households is described and based on consumers' attitudes suggestions are made for how this can be improved in the future.

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

PubMed Central

Arnold, J Malcolm O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O’Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

2007-01-01

Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada. PMID:17245481

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers.

PubMed

Arnold, J Malcom O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O'Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

2007-01-01

Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada.

Mixed methods analysis of eighteen worksite policies, programs, and environments for physical activity.

PubMed

Hipp, J Aaron; Dodson, Elizabeth A; Lee, Jung Ae; Marx, Christine M; Yang, Lin; Tabak, Rachel G; Hoehner, Christine; Marquet, Oriol; Brownson, Ross C

2017-06-14

This study examined whether specific worksite supports for physical activity (PA) were associated with total and domain-specific PA. A cross-sectional, telephone-based study was conducted in four Missouri, USA, metropolitan areas in 2012 and 2013. Outcome variables included total PA and sub-domains (leisure, work, travel) measured using the International Physical Activity Questionnaire. Logistic regression determined odds of meeting PA recommendations, given access to and use of 18 unique PA worksite supports. A subsample of 119 participants also wore hip accelerometry for seven consecutive days and maintained a wear-time diary. Access to worksite supports were associated with odds of meeting objective moderate and vigorous (MV) PA above 150 min per week. Among 2013 survey participants, meeting PA recommendations while performing work-related tasks was significantly associated with several supports (e.g., walking maps, stair prompts), as was meeting recommendations during travel (e.g., flextime for PA, incentives for public transportation, walking/bicycling to work). Access to 11 worksite supports increased odds of meeting PA recommendations through leisure-time PA; five supports were associated with total PA. There were significant differences between access to and use of supports. Using objective MVPA, access to worksite challenges and bike storage were significantly associated with five and three times greater odds of meeting 150 min of MVPA per week, respectively. Worksite wellness plans are increasing across the US and employers are eager for evidence-based supports for increasing PA. This study provides insights into the utility of multiple worksite supports for PA to increase odds that employees meet PA recommendations.

A Machine Learning Recommender System to Tailor Preference Assessments to Enhance Person-Centered Care Among Nursing Home Residents.

PubMed

Gannod, Gerald C; Abbott, Katherine M; Van Haitsma, Kimberly; Martindale, Nathan; Heppner, Alexandra

2018-05-21

Nursing homes (NHs) using the Preferences for Everyday Living Inventory (PELI-NH) to assess important preferences and provide person-centered care find the number of items (72) to be a barrier to using the assessment. Using a sample of n = 255 NH resident responses to the PELI-NH, we used the 16 preference items from the MDS 3.0 Section F to develop a machine learning recommender system to identify additional PELI-NH items that may be important to specific residents. Much like the Netflix recommender system, our system is based on the concept of collaborative filtering whereby insights and predictions (e.g., filters) are created using the interests and preferences of many users. The algorithm identifies multiple sets of "you might also like" patterns called association rules, based upon responses to the 16 MDS preferences that recommends an additional set of preferences with a high likelihood of being important to a specific resident. In the evaluation of the combined apriori and logistic regression approach, we obtained a high recall performance (i.e., the ratio of correctly predicted preferences compared with all predicted preferences and nonpreferences) and high precision (i.e., the ratio of correctly predicted rules with respect to the rules predicted to be true) of 80.2% and 79.2%, respectively. The recommender system successfully provides guidance on how to best tailor the preference items asked of residents and can support preference capture in busy clinical environments, contributing to the feasibility of delivering person-centered care.

78 FR 20925 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-08

... Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal Register of...

77 FR 35688 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal Register of...

77 FR 16842 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-22

... Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal Register of...

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

PubMed

Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C

2017-12-01

Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

Clinical inquiries. What test is the best for diagnosing infectious mononucleosis?

PubMed

Bell, Amy Trelease; Fortune, Barbara; Sheeler, Robert

2006-09-01

Tests for antibodies to Epstein-Barr viral capsid antigen or Epstein-Barr nuclear antigen are the most sensitive, are highly specific, and are also the most expensive for diagnosing infectious mononucleosis (strength of recommendation [SOR]: C, based on validating cohort study). Heterophile antibody tests have similar specificity and are cheaper, but are less sensitive in children or in adults during the early days of the illness (SOR: C, based on validating cohort study). The polymerase chain reaction assay for Epstein-Barr virus DNA is more sensitive than the heterophile antibody test in children, is highly specific, but is also expensive (SOR: C, based on validating cohort study). The percentages of atypical lymphocytes and total lymphocytes on a complete blood count provide another specific and moderately sensitive, yet inexpensive, test (SOR: C, based on validating cohort study).

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

PubMed Central

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

2017-01-01

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

Publishing web-based guidelines using interactive decision models.

PubMed

Sanders, G D; Nease, R F; Owens, D K

2001-05-01

Commonly used methods for guideline development and dissemination do not enable developers to tailor guidelines systematically to specific patient populations and update guidelines easily. We developed a web-based system, ALCHEMIST, that uses decision models and automatically creates evidence-based guidelines that can be disseminated, tailored and updated over the web. Our objective was to demonstrate the use of this system with clinical scenarios that provide challenges for guideline development. We used the ALCHEMIST system to develop guidelines for three clinical scenarios: (1) Chlamydia screening for adolescent women, (2) antiarrhythmic therapy for the prevention of sudden cardiac death; and (3) genetic testing for the BRCA breast-cancer mutation. ALCHEMIST uses information extracted directly from the decision model, combined with the additional information from the author of the decision model, to generate global guidelines. ALCHEMIST generated electronic web-based guidelines for each of the three scenarios. Using ALCHEMIST, we demonstrate that tailoring a guideline for a population at high-risk for Chlamydia changes the recommended policy for control of Chlamydia from contact tracing of reported cases to a population-based screening programme. We used ALCHEMIST to incorporate new evidence about the effectiveness of implantable cardioverter defibrillators (ICD) and demonstrate that the cost-effectiveness of use of ICDs improves from $74 400 per quality-adjusted life year (QALY) gained to $34 500 per QALY gained. Finally, we demonstrate how a clinician could use ALCHEMIST to incorporate a woman's utilities for relevant health states and thereby develop patient-specific recommendations for BRCA testing; the patient-specific recommendation improved quality-adjusted life expectancy by 37 days. The ALCHEMIST system enables guideline developers to publish both a guideline and an interactive decision model on the web. This web-based tool enables guideline developers to tailor guidelines systematically, to update guidelines easily, and to make the underlying evidence and analysis transparent for users.

Recommendations for Self-Report Outcome Measures in Vulvodynia Clinical Trials.

PubMed

Pukall, Caroline F; Bergeron, Sophie; Brown, Candace; Bachmann, Gloria; Wesselmann, Ursula

2017-08-01

Vulvodynia (idiopathic chronic vulvar pain) is a prevalent condition associated with significant and negative impacts in many areas of function. Despite the increased research interest in vulvodynia in recent years, recommendations for outcome measures for use in clinical trials are missing. The purpose of this paper, therefore, was to provide recommendations for outcome measures for vulvodynia clinical trials so that consistent measures are used across trials to facilitate between-study comparisons and the conduct of large multicenter trials, and to improve measurement of the multiple dimensions of vulvodynia. Given that provoked vestibulodynia (PVD)-characterized by provoked pain localized to the vaginal opening-is the most common subtype of vulvodynia and the current main focus of clinical trials, this paper focused on recommended outcome measures in PVD clinical trials. The framework used to guide the selection of outcome measures was based on the one proposed by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The IMMPACT framework provided a well-suited guideline for outcome measure recommendations in PVD clinical trials. However, given the provoked presentation of PVD and the significant impact it has on sexuality, modifications to some of the IMMPACT recommendations were made and specific additional measures were suggested. Measures that are specific to vulvovaginal pain are ideal for adoption in PVD clinical trials, and many such measures currently exist that allow the relevant IMMPACT domains to be captured.

Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

PubMed

Narouze, Samer; Benzon, Honorio T; Provenzano, David A; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R; Rauck, Richard; Huntoon, Marc A

2015-01-01

Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report.

PubMed

Drossman, Douglas A; Tack, Jan; Ford, Alexander C; Szigethy, Eva; Törnblom, Hans; Van Oudenhove, Lukas

2018-03-01

Central neuromodulators (antidepressants, antipsychotics, and other central nervous system-targeted medications) are increasingly used for treatment of functional gastrointestinal disorders (FGIDs), now recognized as disorders of gut-brain interaction. However, the available evidence and guidance for the use of central neuromodulators in these conditions is scanty and incomplete. In this Rome Foundation Working Team report, a multidisciplinary team summarized available research evidence and clinical experience to provide guidance and treatment recommendations. The working team summarized the literature on the pharmacology of central neuromodulators and their effects on gastrointestinal sensorimotor function and conducted an evidence-based review on their use for treating FGID syndromes. Because of the paucity of data for FGIDs, we included data for non-gastrointestinal painful disorders and specific symptoms of pain, nausea, and vomiting. This information was combined into a final document comprising a synthesis of available evidence and recommendations for clinical use guided by the research and clinical experience of the experts on the committee. The evidence-based review on neuromodulators in FGID, restricted by the limited available controlled trials, was integrated with open-label studies and case series, along with the experience of experts to create recommendations using a consensus (Delphi) approach. Due to the diversity of conditions and complexity of treatment options, specific recommendations were generated for different FGIDs. However, some general recommendations include: (1) low to modest dosages of tricyclic antidepressants provide the most convincing evidence of benefit for treating chronic gastrointestinal pain and painful FGIDs and serotonin noradrenergic reuptake inhibitors can also be recommended, though further studies are needed; (2) augmentation, that is, adding a second treatment (adding quetiapine, aripiprazole, buspirone α2δ ligand agents) is recommended when a single medication is unsuccessful or produces side effects at higher dosages; (3) treatment should be continued for 6-12 months to potentially prevent relapse; and (4) implementation of successful treatment requires effective communication skills to improve patient acceptance and adherence, and to optimize the patient-provider relationship. Based on systematic and selectively focused review and the consensus of a multidisciplinary panel, we have provided summary information and guidelines for the use of central neuromodulators in the treatment of chronic gastrointestinal symptoms and FGIDs. Further studies are needed to confirm and refine these recommendations. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Improving Professional Development to Enhance Reading Outcomes for Students in Special Education.

PubMed

Lemons, Christopher J; Otaiba, Stephanie Al; Conway, Sheila J; Mellado De La Cruz, Veronica

2016-12-01

The purpose of this article is to focus specifically on professional development that is needed to ensure that preservice and in-service teachers are prepared to deliver intensive intervention to enhance reading outcomes of students in special education. Our aim is to provide recommendations to ensure that special educators are prepared to design and implement data-based individualization in the area of reading. We highlight what special educators need to know to implement data-based individualization and provide recommendations for improving professional development using findings from federally funded projects. Implications for practice and next steps for research and policy are provided. © 2016 Wiley Periodicals, Inc.

ACR Appropriateness Criteria® Headache-Child.

PubMed

Hayes, Laura L; Palasis, Susan; Bartel, Twyla B; Booth, Timothy N; Iyer, Ramesh S; Jones, Jeremy Y; Kadom, Nadja; Milla, Sarah S; Myseros, John S; Pakalnis, Ann; Partap, Sonia; Robertson, Richard L; Ryan, Maura E; Saigal, Gaurav; Soares, Bruno P; Tekes, Aylin; Karmazyn, Boaz K

2018-05-01

Headaches in children are not uncommon and have various causes. Proper neuroimaging of these children is very specific to the headache type. Care must be taken to choose and perform the most appropriate initial imaging examination in order to maximize the ability to properly determine the cause with minimum risk to the child. This evidence-based report discusses the different headache types in children and provides appropriate guidelines for imaging these children. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

PubMed

Narouze, Samer; Benzon, Honorio T; Provenzano, David; Buvanendran, Asokumar; De Andres, José; Deer, Timothy; Rauck, Richard; Huntoon, Marc A

2018-04-01

The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated periodically with consideration of new evidence.

A Policy Language for Modelling Recommendations

NASA Astrophysics Data System (ADS)

Abou El Kalam, Anas; Balbiani, Philippe

While current and emergent applications become more and more complex, most of existing security policies and models only consider a yes/no response to the access requests. Consequently, modelling, formalizing and implementing permissions, obligations and prohibitions do not cover the richness of all the possible scenarios. In fact, several applications have access rules with the recommendation access modality. In this paper we focus on the problem of formalizing security policies with recommendation needs. The aim is to provide a generic domain-independent formal system for modelling not only permissions, prohibitions and obligations, but also recommendations. In this respect, we present our logic-based language, the semantics, the truth conditions, our axiomatic as well as inference rules. We also give a representative use case with our specification of recommendation requirements. Finally, we explain how our logical framework could be used to query the security policy and to check its consistency.

[French recommendations on control measures to reduce the infectious risk in immunocompromised patients].

PubMed

Zahar, J-R; Jolivet, S; Adam, H; Dananché, C; Lizon, J; Alfandari, S; Boulestreau, H; Baghdadi, N; Bay, J-O; Bénéteau, A-M; Bougnoux, M-E; Brenier-Pinchart, M-P; Dalle, J-H; Fournier, S; Fuzibet, J-G; Kauffmann-Lacroix, C; Le Guinche, I; Lepelletier, D; Loukili, N; Lory, A; Morvan, M; Oumedaly, R; Ribaud, P; Rohrlich, P; Vanhems, P; Aho, S; Vanjak, D; Gangneux, J-P

2017-12-01

The increase use of immunosuppressive treatments in patients with solid cancer and/or inflammatory diseases requires revisiting our practices for the prevention of infectious risk in the care setting. A review of the literature by a multidisciplinary working group at the beginning of 2014 wished to answer the following 4 questions to improve healthcare immunocompromised patients: (I) How can we define immunocompromised patients with high, intermediate and low infectious risk, (II) which air treatment should be recommended for this specific population? (III) What additional precautions should be recommended for immunocompromised patients at risk for infection? (IV) Which global environmental control should be recommended? Based on data from the literature and using the GRADE method, we propose 15 recommendations that could help to reduce the risk of infection in these exposed populations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Quality assurance: recommended guidelines for safe heating by capacitive-type heating technique to treat patients with metallic implants.

PubMed

Kato, Hirokazu; Kondo, Motoharu; Imada, Hajime; Kuroda, Masahiro; Kamimura, Yoshitsugu; Saito, Kazuyuki; Kuroda, Kagayaki; Ito, Koichi; Takahashi, Hideaki; Matsuki, Hidetoshi

2013-05-01

This article is a redissemination of the previous Japanese Quality Assurance Guide guidelines. Specific absorption rate and temperature distribution were investigated with respect to various aspects including metallic implant size and shape, insertion site, insertion direction, blood flow and heating power, and simulated results were compared with adverse reactions of patients treated by radio frequency capacitive-type heating. Recommended guidelines for safe heating methods for patients with metallic implants are presented based on our findings.

[Quality of the pharmacotherapeutic recommendations for the integrated care procedures in Andalusia].

PubMed

Corte, Rosa María Muñoz; Estepa, Raúl García; Ramos, Bernardo Santos; Paloma, Francisco Javier Bautista

2009-01-01

To evaluate the quality of the pharmacotherapeutic recommendations included in the Integrated Care Procedures (PAIs regarding its initials in Spanish) of the Andalusian Ministry of Health, published up to March 2008, through the design and validation of a tool. The assessment tool was designed based on similar instruments, specifically the AGREE. Other criteria included were taken from various literature sources or were devised by ourselves. The tool was validated prior to being used. After applying it to all the PAIs, we examined the degree of compliance with these pharmacotherapeutic criteria, both as a whole and by PAIs subgroups. The developed tool is a questionnaire of 20 items, divided into 4 sections. The first section consists of the essential criteria, and the rest make reference to more specific, non essential criteria: definition of the level of evidence, thoroughness of information and definition of indicators. It was found that 4 of the 60 PAIs do not contain any type of therapeutic recommendation. No PAI fulfils all the items listed in the tool, however, 70 % of them fulfil the essential quality criteria established. There is a great variability in the content of pharmacotherapeutic recommendations for each PAI. Once the validity of the tool has been proved, it could be used to assess the quality of the therapeutic recommendations in clinical practice guidelines.

Rationale for recommending a lower dose of primaquine as a Plasmodium falciparum gametocytocide in populations where G6PD deficiency is common

PubMed Central

2012-01-01

In areas of low malaria transmission, it is currently recommended that a single dose of primaquine (0.75 mg base/kg; 45 mg adult dose) be added to artemisinin combination treatment (ACT) in acute falciparum malaria to block malaria transmission. Review of studies of transmission-blocking activity based on the infectivity of patients or volunteers to anopheline mosquitoes, and of haemolytic toxicity in glucose 6-dehydrogenase (G6PD) deficient subjects, suggests that a lower primaquine dose (0.25 mg base/kg) would be safer and equally effective. This lower dose could be deployed together with ACTs without G6PD testing wherever use of a specific gametocytocide is indicated. PMID:23237606

Rationale for recommending a lower dose of primaquine as a Plasmodium falciparum gametocytocide in populations where G6PD deficiency is common.

PubMed

White, Nicholas J; Qiao, Li Guo; Qi, Gao; Luzzatto, Lucio

2012-12-14

In areas of low malaria transmission, it is currently recommended that a single dose of primaquine (0.75 mg base/kg; 45 mg adult dose) be added to artemisinin combination treatment (ACT) in acute falciparum malaria to block malaria transmission. Review of studies of transmission-blocking activity based on the infectivity of patients or volunteers to anopheline mosquitoes, and of haemolytic toxicity in glucose 6-dehydrogenase (G6PD) deficient subjects, suggests that a lower primaquine dose (0.25 mg base/kg) would be safer and equally effective. This lower dose could be deployed together with ACTs without G6PD testing wherever use of a specific gametocytocide is indicated.

A comparison of the treatment recommendations for neurogenic lower urinary tract dysfunction in the national institute for health and care excellence, European Association of Urology and international consultations on incontinence guidelines.

PubMed

Jaggi, Ashley; Drake, Marcus; Siddiqui, Emad; Fatoye, Francis

2018-04-17

Healthcare guidelines are an important vehicle in establishing up-to-date evidence based medicine (EBM) in clinical practice. Due to varying development processes, clinical guidelines created by different institutions can often contain contrasting recommendations. This can have implications for optimal and standardized patient care across management settings. The similarities and differences of treatment recommendations made in the National Institute for Health and Care Excellence (NICE), The European Association of Urology (EAU), and the International Consultation on Continence (ICI) guidelines for neurogenic lower urinary tract dysfunction (NLUTD) were assessed. The guidelines generally agree on their approach to conservative management, including behavioral therapies, and catheterization techniques. There was discrepancy on the benefit of using an alpha blocker in NLUTD and bladder outlet obstruction (BOO) and administering Botulinum toxin A (Onabotulinum-A) in NLUTD. The highest degree of divergence was seen in recommendations for surgical treatments, where the EAU made gender-specific recommendations, and gave continent urinary diversion higher preference than given in the NICE and ICI guidelines. In the absence of high-quality clinical evidence, many of the recommendations made across all three guidelines are based on expert opinion. NICE, the EAU and ICI have similarities but they place differing emphasis on costs and expert opinion, which translated in notably different recommendations. It is evident that increased research efforts, possibly in the form of prospective registries, pragmatic trials, and resource utilization studies are necessary to improve the underlying evidence base for NLUTD, and subsequently the strength and concordance of recommendations across guidelines. © 2018 Wiley Periodicals, Inc.

Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

PubMed Central

Visser, K; Katchamart, W; Loza, E; Martinez-Lopez, J A; Salliot, C; Trudeau, J; Bombardier, C; Carmona, L; van der Heijde, D; Bijlsma, J W J; Boumpas, D T; Canhao, H; Edwards, C J; Hamuryudan, V; Kvien, T K; Leeb, B F; Martín-Mola, E M; Mielants, H; Müller-Ladner, U; Murphy, G; Østergaard, M; Pereira, I A; Ramos-Remus, C; Valentini, G; Zochling, J; Dougados, M

2009-01-01

Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use. PMID:19033291

ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis.

PubMed

Jacobson, Jon A; Roberts, Catherine C; Bencardino, Jenny T; Appel, Marc; Arnold, Erin; Baccei, Steven J; Cassidy, R Carter; Chang, Eric Y; Fox, Michael G; Greenspan, Bennett S; Gyftopoulos, Soterios; Hochman, Mary G; Mintz, Douglas N; Newman, Joel S; Rosenberg, Zehava S; Shah, Nehal A; Small, Kirstin M; Weissman, Barbara N

2017-05-01

Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. This review first discusses the characteristic osseous and soft tissue abnormalities seen with inflammatory arthritis and how they may be imaged. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity as there is significant overlap of imaging findings among the various types of arthritis. This review provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Applying Web Usage Mining for Personalizing Hyperlinks in Web-Based Adaptive Educational Systems

ERIC Educational Resources Information Center

Romero, Cristobal; Ventura, Sebastian; Zafra, Amelia; de Bra, Paul

2009-01-01

Nowadays, the application of Web mining techniques in e-learning and Web-based adaptive educational systems is increasing exponentially. In this paper, we propose an advanced architecture for a personalization system to facilitate Web mining. A specific Web mining tool is developed and a recommender engine is integrated into the AHA! system in…

Angles-only, ground-based, initial orbit determination

NASA Astrophysics Data System (ADS)

Taff, L. G.; Randall, P. M. S.; Stansfield, S. A.

1984-05-01

Over the past few years, passive, ground-based, angles-only initial orbit determination has had a thorough analytical, numerical, experimental, and creative re-examination. This report presents the numerical culmination of this effort and contains specific recommendations for which of several techniques one should use on the different subsets of high altitude artificial satellites and minor planets.

Multisociety task force recommendations of competencies in Pulmonary and Critical Care Medicine.

PubMed

Buckley, John D; Addrizzo-Harris, Doreen J; Clay, Alison S; Curtis, J Randall; Kotloff, Robert M; Lorin, Scott M; Murin, Susan; Sessler, Curtis N; Rogers, Paul L; Rosen, Mark J; Spevetz, Antoinette; King, Talmadge E; Malhotra, Atul; Parsons, Polly E

2009-08-15

Numerous accrediting organizations are calling for competency-based medical education that would help define specific specialties and serve as a foundation for ongoing assessment throughout a practitioner's career. Pulmonary Medicine and Critical Care Medicine are two distinct subspecialties, yet many individual physicians have expertise in both because of overlapping content. Establishing specific competencies for these subspecialties identifies educational goals for trainees and guides practitioners through their lifelong learning. To define specific competencies for graduates of fellowships in Pulmonary Medicine and Internal Medicine-based Critical Care. A Task Force composed of representatives from key stakeholder societies convened to identify and define specific competencies for both disciplines. Beginning with a detailed list of existing competencies from diverse sources, the Task Force categorized each item into one of six core competency headings. Each individual item was reviewed by committee members individually, in group meetings, and conference calls. Nominal group methods were used for most items to retain the views and opinions of the minority perspective. Controversial items underwent additional whole group discussions with iterative modified-Delphi techniques. Consensus was ultimately determined by a simple majority vote. The Task Force identified and defined 327 specific competencies for Internal Medicine-based Critical Care and 276 for Pulmonary Medicine, each with a designation as either: (1) relevant, but competency is not essential or (2) competency essential to the specialty. Specific competencies in Pulmonary and Critical Care Medicine can be identified and defined using a multisociety collaborative approach. These recommendations serve as a starting point and set the stage for future modification to facilitate maximum quality of care as the specialties evolve.

Attitudes, Patterns of Recommendation, and Communication of Pediatric Providers About Complementary and Alternative Medicine in a Large Metropolitan Children’s Hospital

PubMed Central

Kundu, Anjana; Tassone, Rosalie F.; Jimenez, Nathalia; Seidel, Kristy; Valentine, Jessica K.; Pagel, Paul S.

2014-01-01

The authors conducted an Email survey of their medical staff to explore the attitudes, patterns of recommendation, and communication of pediatric providers about complementary and alternative medicine (CAM) in a large metropolitan children’s hospital. Two thirds of the respondents reported awareness about their patients’ CAM therapy use (65%) and recommended CAM therapy to their patients (67%). Providers who reported personal use of CAM (71%) were more likely to recommend CAM to their patients compared with those who do not (76% vs 45%; P < .05). One half of pediatric providers reported occasional consultation with their patient’s CAM provider, but bidirectional communication was rare (4%). Specific changes in care based on a CAM provider’s recommendations were also unusual (4%). Despite the positive attitudes about and willingness to recommend CAM by pediatric providers, communication between these clinicians and CAM providers may be less than ideal. PMID:21127080

Impact of different recommendations on adequacy rate for sleep duration in children.

PubMed

Bruni, Oliviero; Brambilla, Paolo

2017-01-25

A huge amount of literature in the last decades showed that sleep is essential for children's health and well-being and that short sleep duration is associated with several negative health outcomes. Many developmental phases in infancy and childhood are in strict relationship with an healthy sleep.In the last years some specific recommendations made for how much sleep children need have been published. The empirical evidences for contemporary sleep recommendations has changed and the new recommendations are clearly different from the previous ones and reflect clearly the changes in the sleep need of the children and adolescents in the last decades although seem still to be largely unfitting for preadolescence and adolescence.If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.Sleep recommendations for children play an important role for public policies and interventions, and to advertise parents and children of the negative consequences of sleep deprivation/reduction.

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

DOT National Transportation Integrated Search

2011-12-12

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

Comparative analysis of dietary guidelines in the Spanish-Speaking Caribbean.

PubMed

Fuster, Melissa

2016-03-01

Dietary guidelines are important education and policy tools to address local nutrition concerns. The current paper presents a comparative analysis of nutrition messages from three Spanish-speaking Caribbean countries (Cuba, Puerto Rico and Dominican Republic) to explore how these dietary guidelines address common public health nutrition concerns, contextualized in different changing food environments and food culture similarities. Qualitative, comparative analysis of current dietary guideline documents and key recommendations. Key recommendations were categorized into sixteen themes (two diet-based, ten food-based and four 'other'). Only the Cuban dietary guidelines included diet-based key recommendations. Of the ten food-based key recommendations, only four themes overlapped across the three dietary guidelines (the encouragement of fruits and vegetables, addressing protein sources and fat). Other overlaps were found between dietary guideline pairs, except between Cuba and Puerto Rico. Further analysis revealed differences in levels of specificity and acknowledgement of local dietary patterns and issues, as well as the need to revise the guidelines to account for current scientific advances. The present study underscored the importance of context in the framing of dietary advice and the influence of national socio-economic and political situations on nutrition policy and education efforts. The results contribute to inform efforts to improve nutrition communication in the region and among migrant communities.

The problem resident behavior guide: strategies for remediation.

PubMed

Williamson, Kelly; Quattromani, Erin; Aldeen, Amer

2016-04-01

In 2012, the ACGME supplemented the core competencies with outcomes-based milestones for resident performance within the six competency domains. These milestones address the knowledge, skills, abilities, attitudes, and experiences that a resident is expected to progress through during the course of training. Even prior to the initiation of the milestones, there was a paucity of EM literature addressing the remediation of problem resident behaviors and there remain few readily accessible tools to aid in the implementation of a remediation plan. The goal of the "Problem Resident Behavior Guide" is to provide specific strategies for resident remediation based on deficiencies identified within the framework of the EM milestones. The "Problem Resident Behavior Guide" is a written instructional manual that provides concrete examples of remediation strategies to address specific milestone deficiencies. The more than 200 strategies stem from the experiences of the authors who have professional experience at three different academic hospitals and emergency medicine residency programs, supplemented by recommendations from educational leaders as well as utilization of valuable education adjuncts, such as focused simulation exercises, lecture preparation, and themed ED shifts. Most recommendations require active participation by the resident with guidance by faculty to achieve the remediation expectations. The ACGME outcomes-based milestones aid in the identification of deficiencies with regards to resident performance without providing recommendations on remediation. The Problem Resident Behavior Guide can therefore have a significant impact by filling in this gap.

Cultural theories of nursing responsive to human needs and values.

PubMed

Kikuchi, June F

2005-01-01

To present an alternative to the recent proposal that the extant theories of nursing be replaced with culture-specific theories of nursing in order to have theories of nursing that are culturally responsive. A philosophical analysis of the implications for nursing practice of adopting the proposal serves as the basis for recommending a different philosophically based theoretical solution. Anticipated probable objections to that recommendation are considered. Culture-specific theories of nursing might allow nurses to be culturally sensitive. However, because nurses must be humanly responsive to the needs of people as human beings and not just as cultural beings, cultural theories of nursing should be developed within the precepts of a transcultural theory of nursing grounded in a conception of objective human needs and values.

Ground-Based Facilities for Simulation of Microgravity: Organism-Specific Recommendations for Their Use, and Recommended Terminology

PubMed Central

Anken, Ralf; Boonstra, Johannes; Braun, Markus; Christianen, Peter C.M.; de Geest, Maarten; Hauslage, Jens; Hilbig, Reinhard; Hill, Richard J.A.; Lebert, Michael; Medina, F. Javier; Vagt, Nicole; Ullrich, Oliver

2013-01-01

Abstract Research in microgravity is indispensable to disclose the impact of gravity on biological processes and organisms. However, research in the near-Earth orbit is severely constrained by the limited number of flight opportunities. Ground-based simulators of microgravity are valuable tools for preparing spaceflight experiments, but they also facilitate stand-alone studies and thus provide additional and cost-efficient platforms for gravitational research. The various microgravity simulators that are frequently used by gravitational biologists are based on different physical principles. This comparative study gives an overview of the most frequently used microgravity simulators and demonstrates their individual capacities and limitations. The range of applicability of the various ground-based microgravity simulators for biological specimens was carefully evaluated by using organisms that have been studied extensively under the conditions of real microgravity in space. In addition, current heterogeneous terminology is discussed critically, and recommendations are given for appropriate selection of adequate simulators and consistent use of nomenclature. Key Words: 2-D clinostat—3-D clinostat—Gravity—Magnetic levitation—Random positioning machine—Simulated microgravity—Space biology. Astrobiology 13, 1–17. PMID:23252378

Review of Orbital Propellant Transfer Techniques and the Feasibility of a Thermal Bootstrap Propellant Transfer Concepts

NASA Technical Reports Server (NTRS)

Yoshikawa, H. H.; Madison, I. B.

1971-01-01

This study was performed in support of the NASA Task B-2 Study Plan for Space Basing. The nature of space-based operations implies that orbital transfer of propellant is a prime consideration. The intent of this report is (1) to report on the findings and recommendations of existing literature on space-based propellant transfer techniques, and (2) to determine possible alternatives to the recommended methods. The reviewed literature recommends, in general, the use of conventional liquid transfer techniques (i.e., pumping) in conjunction with an artificially induced gravitational field. An alternate concept that was studied, the Thermal Bootstrap Transfer Process, is based on the compression of a two-phase fluid with subsequent condensation to a liquid (vapor compression/condensation). This concept utilizes the intrinsic energy capacities of the tanks and propellant by exploiting temperature differentials and available energy differences. The results indicate the thermodynamic feasibility of the Thermal Bootstrap Transfer Process for a specific range of tank sizes, temperatures, fill-factors and receiver tank heat transfer coefficients.

Management of a suspicious adnexal mass: a clinical practice guideline

PubMed Central

Dodge, J.E.; Covens, A.L.; Lacchetti, C.; Elit, L.M.; Le, T.; Devries–Aboud, M.; Fung-Kee-Fung, M.

2012-01-01

Questions What is the optimal strategy for preoperative identification of the adnexal mass suspicious for ovarian cancer? What is the most appropriate surgical procedure for a woman who presents with an adnexal mass suspicious for malignancy? Perspectives In Canada in 2010, 2600 new cases of ovarian cancer were estimated to have been diagnosed, and of those patients, 1750 were estimated to have died, making ovarian cancer the 7th most prevalent form of cancer and the 5th leading cause of cancer death in Canadian women. Women with ovarian cancer typically have subtle, nonspecific symptoms such as abdominal pain, bloating, changes in bowel frequency, and urinary or pelvic symptoms, making early detection difficult. Thus, most ovarian cancer cases are diagnosed at an advanced stage, when the cancer has spread outside the pelvis. Because of late diagnosis, the 5-year relative survival ratio for ovarian cancer in Canada is only 40%. Unfortunately, because of the low positive predictive value of potential screening tests (cancer antigen 125 and ultrasonography), there is currently no screening strategy for ovarian cancer. The purpose of this document is to identify evidence that would inform optimal recommended protocols for the identification and surgical management of adnexal masses suspicious for malignancy. Outcomes Outcomes of interest for the identification question included sensitivity and specificity. Outcomes of interest for the surgical question included optimal surgery, overall survival, progression-free or disease-free survival, reduction in the number of surgeries, morbidity, adverse events, and quality of life. Methodology After a systematic review, a practice guideline containing clinical recommendations relevant to patients in Ontario was drafted. The practice guideline was reviewed and approved by the Gynecology Disease Site Group and the Report Approval Panel of the Program in Evidence-based Care. External review by Ontario practitioners was obtained through a survey, the results of which were incorporated into the practice guideline. Practice Guideline These recommendations apply to adult women presenting with a suspicious adnexal mass, either symptomatic or asymptomatic. Identification of an Adnexal Mass Suspicious for Ovarian Cancer Sonography (particularly 3-dimensional sonography), magnetic resonance imaging (mri), and computed tomography (ct) imaging are each recommended for differentiating malignant from benign ovarian masses. However, the working group offers the following further recommendations, based on their expert consensus opinion and a consideration of availability, access, and harm: Where technically feasible, transvaginal sonography should be the modality of first choice in patients with a suspicious isolated ovarian mass.To help clarify malignant potential in patients in whom ultrasonography may be unreliable, mri is the most appropriate test.In cases in which extra-ovarian disease is suspected or needs to be ruled out, ct is the most useful technique.Evaluation of an adnexal mass by Doppler technology alone is not recommended. Doppler technology should be combined with a morphology assessment.Ultrasonography-based morphology scoring systems can be used to differentiate benign from malignant adnexal masses. These scoring systems are based on specific ultrasound parameters, each with several scores base on determined features. All evaluated scoring systems were found to have an acceptable level of sensitivity and specificity; the choice of scoring system may therefore be made based on clinician preference.As a standalone modality, serum cancer antigen 125 is not recommended for distinguishing between benign and malignant adnexal masses.Frozen sections for the intraoperative diagnosis of a suspicious adnexal mass is recommended in settings in which availability and patient preference allow. Surgical Procedures for an Adnexal Mass Suspicious for Malignancy To improve survival, comprehensive surgical staging with lymphadenectomy is recommended for the surgical management of patients with early-stage ovarian cancer. Laparoscopy is a reasonable alternative to laparotomy, provided that appropriate surgery and staging can be done. The choice between laparoscopy and laparotomy should be based on patient and clinician preference. Discussion with a gynecologic oncologist is recommended. Fertility-preserving surgery is an acceptable alternative to more extensive surgery in patients with low-malignant-potential tumours and those with well-differentiated surgical stage i ovarian cancer. Discussion with a gynecologic oncologist is recommended. PMID:22876153

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

PubMed

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

2012-12-01

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

Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

PubMed

Kernan, Walter N; Ovbiagele, Bruce; Black, Henry R; Bravata, Dawn M; Chimowitz, Marc I; Ezekowitz, Michael D; Fang, Margaret C; Fisher, Marc; Furie, Karen L; Heck, Donald V; Johnston, S Claiborne Clay; Kasner, Scott E; Kittner, Steven J; Mitchell, Pamela H; Rich, Michael W; Richardson, DeJuran; Schwamm, Lee H; Wilson, John A

2014-07-01

The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines. © 2014 American Heart Association, Inc.

The Impact of Youth and Family Risk Factors on Service Recommendations and Delivery in a School-Based System of Care

PubMed Central

Whitson, Melissa L.; Connell, Christian M.; Bernard, Stanley; Kaufman, Joy S.

2010-01-01

The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed. PMID:20165927

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2015-01-01

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Data You May Like: A Recommender System for Research Data Discovery

NASA Astrophysics Data System (ADS)

Devaraju, A.; Davy, R.; Hogan, D.

2016-12-01

Various data portals been developed to facilitate access to research datasets from different sources. For example, the Data Publisher for Earth & Environmental Science (PANGAEA), the Registry of Research Data Repositories (re3data.org), and the National Geoscience Data Centre (NGDC). Due to data quantity and heterogeneity, finding relevant datasets on these portals may be difficult and tedious. Keyword searches based on specific metadata elements or multi-key indexes may return irrelevant results. Faceted searches may be unsatisfactory and time consuming, especially when facet values are exhaustive. We need a much more intelligent way to complement existing searching mechanisms in order to enhance user experiences of the data portals. We developed a recommender system that helps users to find the most relevant research datasets on the CSIRO's Data Access Portal (DAP). The system is based on content-based filtering. We computed the similarity of datasets based on data attributes (e.g., descriptions, fields of research, location, contributors, and provenance) and inference from transaction logs (e.g., the relations among datasets and between queries and datasets). We improved the recommendation quality by assigning weights to data similarities. The weight values are drawn from a survey involving data users. The recommender results for a given dataset are accessible programmatically via a web service. Taking both data attributes and user actions into account, the recommender system will make it easier for researchers to find and reuse data offered through the data portal.

Cardiovascular Update: Risk, Guidelines, and Recommendations.

PubMed

Pearson, Tamera

2015-09-01

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. © 2015 The Author(s).

Deep Vein Thrombosis Prophylaxis: State of the Art.

PubMed

Lieberman, Jay R

2018-03-21

The selection of a prophylaxis regimen to prevent symptomatic pulmonary embolism and deep vein thrombosis is a balance between efficacy and safety. The latest American Academy of Orthopaedic Surgeons guideline recommended that either chemoprophylaxis or mechanical prophylaxis be used after total joint arthroplasty but did not recommend specific agents. However, the latest evidence-based American College of Chest Physicians guideline recommended a variety of chemoprophylaxis and mechanical agents for a minimum of 10 to 14 days after total joint arthroplasty. Risk stratification is the key to the selection of the appropriate prophylaxis regimen for the individual patient, but the optimal risk stratification protocol still needs to be developed. Copyright © 2018. Published by Elsevier Inc.

Application of probabilistic analysis/design methods in space programs - The approaches, the status, and the needs

NASA Technical Reports Server (NTRS)

Ryan, Robert S.; Townsend, John S.

1993-01-01

The prospective improvement of probabilistic methods for space program analysis/design entails the further development of theories, codes, and tools which match specific areas of application, the drawing of lessons from previous uses of probability and statistics data bases, the enlargement of data bases (especially in the field of structural failures), and the education of engineers and managers on the advantages of these methods. An evaluation is presently made of the current limitations of probabilistic engineering methods. Recommendations are made for specific applications.

Crew interface specifications development for inflight maintenance and stowage functions

NASA Technical Reports Server (NTRS)

Carl, J. G.

1974-01-01

Findings and data products developed during crew specification study for inflight maintenance and stowage functions are reported. From this information base, a family of data concepts to support crew inflight troubleshooting and corrective maintenance activities was developed and specified. Recommendations are made for the improvement of inflight maintenance planning, preparations and operations in future space flight programs through the establishment of an inflight maintenance organization and specific suggestions for techniques to improve the management of the inflight maintenance function.

Parents’ perceptions of provider communication regarding adolescent vaccines

PubMed Central

Dempsey, Amanda F.; Pyrzanowski, Jennifer; Lockhart, Steven; Campagna, Elizabeth; Barnard, Juliana; O'Leary, Sean T.

2016-01-01

ABSTRACT Strong provider recommendations for adolescent vaccines are critical for achieving high vaccination levels.  However, little is known about parents’ preferred provider communication strategies for adolescent vaccines in general, and for human papillomavirus (HPV) vaccines specifically. We performed a cross-sectional survey of 800 parents of 9-14 year olds in April 2014 to assess current adolescent vaccine communication practices by providers, parents’ preferred HPV vaccine-specific communication strategies, and the association of these two outcomes with experiential, attitudinal and demographic characteristics.  Among the 356 parents in the study (response rate 48%), HPV vaccines were reported as less likely to have been “very strongly” recommended by their adolescent’s provider (39%) than other adolescent-targeted vaccines (45%-59%, <0.05 for all comparisons).  Receiving a very strong recommendation for HPV vaccines was associated with a higher likelihood of vaccine receipt (71% versus 39%, p<0.001), or among those not yet vaccinated, increased likelihood of positive vaccination intentions (82% vs. 60%, p = 0.015).  Nearly all parents (87%) reported that, if available, they would use a website providing personalized HPV vaccine-related materials before their adolescent’s next check-up, and other technology-based communications were also endorsed by the majority of parents.   From these data we conclude that parents received weaker recommendations for HPV vaccines than other adolescent vaccines, and that most parents want additional HPV vaccine-related materials, preferably delivered using a variety of technology-based modalities which is not their providers’ current practice. PMID:27078515

The Acid Rain Debate.

ERIC Educational Resources Information Center

Bybee, Rodger; And Others

1984-01-01

Describes an activity which provides opportunities for role-playing as industrialists, ecologists, and government officials. The activity involves forming an international commission on acid rain, taking testimony, and, based on the testimony, making recommendations to governments on specific ways to solve the problem. Includes suggestions for…

34 CFR 200.47 - SEA responsibilities for supplemental educational services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... high quality, research-based, and specifically designed to increase the academic achievement of... State's approved provider list; (ii) Parent recommendations or results from parent surveys, if any... results from parent surveys regarding the success of the provider's instructional program in increasing...

A service brokering and recommendation mechanism for better selecting cloud services.

PubMed

Gui, Zhipeng; Yang, Chaowei; Xia, Jizhe; Huang, Qunying; Liu, Kai; Li, Zhenlong; Yu, Manzhu; Sun, Min; Zhou, Nanyin; Jin, Baoxuan

2014-01-01

Cloud computing is becoming the new generation computing infrastructure, and many cloud vendors provide different types of cloud services. How to choose the best cloud services for specific applications is very challenging. Addressing this challenge requires balancing multiple factors, such as business demands, technologies, policies and preferences in addition to the computing requirements. This paper recommends a mechanism for selecting the best public cloud service at the levels of Infrastructure as a Service (IaaS) and Platform as a Service (PaaS). A systematic framework and associated workflow include cloud service filtration, solution generation, evaluation, and selection of public cloud services. Specifically, we propose the following: a hierarchical information model for integrating heterogeneous cloud information from different providers and a corresponding cloud information collecting mechanism; a cloud service classification model for categorizing and filtering cloud services and an application requirement schema for providing rules for creating application-specific configuration solutions; and a preference-aware solution evaluation mode for evaluating and recommending solutions according to the preferences of application providers. To test the proposed framework and methodologies, a cloud service advisory tool prototype was developed after which relevant experiments were conducted. The results show that the proposed system collects/updates/records the cloud information from multiple mainstream public cloud services in real-time, generates feasible cloud configuration solutions according to user specifications and acceptable cost predication, assesses solutions from multiple aspects (e.g., computing capability, potential cost and Service Level Agreement, SLA) and offers rational recommendations based on user preferences and practical cloud provisioning; and visually presents and compares solutions through an interactive web Graphical User Interface (GUI).

Preparing for Euro 2012: developing a hazard risk assessment.

PubMed

Wong, Evan G; Razek, Tarek; Luhovy, Artem; Mogilevkina, Irina; Prudnikov, Yuriy; Klimovitskiy, Fedor; Yutovets, Yuriy; Khwaja, Kosar A; Deckelbaum, Dan L

2015-04-01

Risk assessment is a vital step in the disaster-preparedness continuum as it is the foundation of subsequent phases, including mitigation, response, and recovery. To develop a risk assessment tool geared specifically towards the Union of European Football Associations (UEFA) Euro 2012. In partnership with the Donetsk National Medical University, Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk Regional Public Health Administration, and the Ministry of Emergency of Ukraine, a table-based tool was created, which, based on historical evidence, identifies relevant potential threats, evaluates their impacts and likelihoods on graded scales based on previous available data, identifies potential mitigating shortcomings, and recommends further mitigation measures. This risk assessment tool has been applied in the vulnerability-assessment-phase of the UEFA Euro 2012. Twenty-three sub-types of potential hazards were identified and analyzed. Ten specific hazards were recognized as likely to very likely to occur, including natural disasters, bombing and blast events, road traffic collisions, and disorderly conduct. Preventative measures, such as increased stadium security and zero tolerance for impaired driving, were recommended. Mitigating factors were suggested, including clear, incident-specific preparedness plans and enhanced inter-agency communication. This hazard risk assessment tool is a simple aid in vulnerability assessment, essential for disaster preparedness and response, and may be applied broadly to future international events.

Preventive Interventions for the Second Half of Life: A Systematic Review.

PubMed

Hajat, Cother; Selwyn, Adriana; Harris, Mark; Yach, Derek

2018-05-01

Recent improvements in life expectancy globally require intensified focus on noncommunicable diseases and age-related conditions. The purpose of this article is to inform the development of age-specific prevention guidelines for adults aged 50 and above, which are currently lacking. PubMed, Cochrane database, and Google Scholar and explicit outreach to experts in the field. Meta-analyses, intervention-based, and prospective cohort studies that reported all-cause mortality, disease-specific mortality, or morbidity in adults were included. A systematic review was undertaken in 2015 using search terms of a combination of and "intervention," "mortality," "reduction," "improvement," "death," and "morbidity." Interventions were categorized according to the Center for Evidence-Based Medicine Level of Evidence framework. A summary table reports for each intervention the impact, strength of evidence, initiation, duration, and details of the intervention. Age-decade-specific preventive recommendations have been proposed relating to physical activity, diet, tobacco and alcohol use, medication adherence, screening and vaccination, and mental and cognitive health. Clear recommendations have been made according to the existing evidence base, but further research investment is needed to fill the many gaps. Further, personalized approaches to healthy aging complemented by population-wide approaches and broader cross-sector partnerships will help to ensure greater longevity is an opportunity, rather than a burden, for society.

Recommendations for Improving Identification and Quantification in Non-Targeted, GC-MS-Based Metabolomic Profiling of Human Plasma

PubMed Central

Wang, Hanghang; Muehlbauer, Michael J.; O’Neal, Sara K.; Newgard, Christopher B.; Hauser, Elizabeth R.; Shah, Svati H.

2017-01-01

The field of metabolomics as applied to human disease and health is rapidly expanding. In recent efforts of metabolomics research, greater emphasis has been placed on quality control and method validation. In this study, we report an experience with quality control and a practical application of method validation. Specifically, we sought to identify and modify steps in gas chromatography-mass spectrometry (GC-MS)-based, non-targeted metabolomic profiling of human plasma that could influence metabolite identification and quantification. Our experimental design included two studies: (1) a limiting-dilution study, which investigated the effects of dilution on analyte identification and quantification; and (2) a concentration-specific study, which compared the optimal plasma extract volume established in the first study with the volume used in the current institutional protocol. We confirmed that contaminants, concentration, repeatability and intermediate precision are major factors influencing metabolite identification and quantification. In addition, we established methods for improved metabolite identification and quantification, which were summarized to provide recommendations for experimental design of GC-MS-based non-targeted profiling of human plasma. PMID:28841195

Women's experiences of developing musculoskeletal diseases: employment challenges and policy recommendations.

PubMed

Crooks, Valorie A

2007-07-30

To answer three specific questions: (i) How do women experience the workplace after the onset of a musculoskeletal disease; (ii) What employment policy and programme suggestions can they offer for ways to better support chronically ill women in their abilities to maintain workforce participation; and (iii) How are these women's employment policy and programme recommendations informed by their own lived experiences and desires? In-depth interviews were conducted with 18 women who had developed musculoskeletal diseases while involved in the labour market. Data were coded and analysed thematically. Participants identified three common workplace barriers experienced and three types of workplace accommodations commonly requested. They offered four specific employment policy and programme recommendations for ways to better support women who develop musculoskeletal diseases in maintaining labour market participation. It is found that their employment policy and programme recommendations are informed by their own experiences in the workplace and desires for being supported in maintaining involvement in paid labour. Creating employment programmes and policies that support chronically ill women in their attempts to remain involved in the workforce based on how much paid labour they are able to perform and where they are best able to work is of the utmost importance.

Probiotics in dietary guidelines and clinical recommendations outside the European Union

PubMed Central

Ebner, Stephan; Smug, Linda N; Kneifel, Wolfgang; Salminen, Seppo J; Sanders, Mary Ellen

2014-01-01

Fermented foods have been consumed for centuries across many geographical locales and have traditionally been considered healthy foods, partly because of the live microbes contained in them. The concept of “probiotics” further requires that the microbes be defined and their health effects be demonstrated through human intervention studies or other suitable investigations before marketing with corresponding health messages. Here, we review recommendations for fermented foods and probiotics in several countries outside the EU, focusing on food-based dietary guidelines. We emphasize recommendations on yoghurt and probiotics made by expert bodies. We found that dietary guidelines commonly advocate the consumption of yoghurt or similar products, but specific comments on probiotics are rare. Further, we reviewed guidelines from clinical associations. In general, they acknowledge the beneficial effects of probiotics, but often suggest the need for further research. This is true despite good quality evidence supporting the role of probiotics for certain health effects, such as prevention of eczema in infants, management of side effects from antibiotics and alleviation of functional bowel symptoms. Additional research to support future dietary recommendations should focus on determining effect size, identifying responders and non-responders, clarifying strain-specificity of effects and confirming mechanisms. PMID:25473160

Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer

PubMed Central

Balneaves, Lynda G.; Carlson, Linda E.; Cohen, Misha; Deng, Gary; Hershman, Dawn; Mumber, Matthew; Perlmutter, Jane; Seely, Dugald; Sen, Ananda; Zick, Suzanna M.; Tripathy, Debu

2014-01-01

Background The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies. Methods Following the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system. Results The search (January 1, 1990–December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I). Conclusions Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes. PMID:25749602

Barriers and Solutions to Fieldwork Education in Hand Therapy.

PubMed

Short, Nathan; Sample, Shelby; Murphy, Malachi; Austin, Brittany; Glass, Jillian

2017-08-09

Survey. Fieldwork education is a vital component of training the next generation of CHTs. Barriers and solutions to fieldwork rotations in hand therapy are examined, as well as proposed solutions, including recommendations for student preparation. This descriptive study examined barriers for certified hand therapist clinicians to accept students for clinical rotations and clinicians' preferences for student preparation before a rotation in a hand setting. A survey was developed, peer reviewed, and distributed using the electronic mailing list of the Hand Therapy Certification Commission via SurveyMonkey. Aggregate responses were analyzed to identify trends including barriers to student clinical rotations and recommendations for students to prepare for hand rotations. A total of 2080 participants responded to the survey, representing a 37% response rate. Common logistical barriers were identified for accepting students such as limited clinical time and space. Many clinicians (32% agree and 8% strongly agree) also felt that the students lack the clinical knowledge to be successful. Areas of knowledge, skill set, and experience were surveyed for development before a clinical rotation in a hand setting. Most respondents (74%) reported increased likelihood of accepting a student with the recommended preparation. Novel qualitative responses to improve clinical experiences are presented as well. Student preparation before a clinical rotation in a hand setting appears to be a significant barrier based on the survey results. Areas of recommended knowledge, skill set, and experience may serve to guide both formal and informal methods of student preparation before a hand-specific clinical rotation to facilitate knowledge translation from experienced certified hand therapists to the next generation. Although logistical barriers may be difficult to overcome, hand-specific preparation based on clinician' recommendations may facilitate student acceptance and success in hand specialty clinical rotations. N/A. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Patient-reported outcome measures in arthroplasty registries

PubMed Central

Bohm, Eric; Franklin, Patricia; Lyman, Stephen; Denissen, Geke; Dawson, Jill; Dunn, Jennifer; Eresian Chenok, Kate; Dunbar, Michael; Overgaard, Søren; Garellick, Göran; Lübbeke, Anne

2016-01-01

Abstract — The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use are the Short Form health surveys (SF-36 or SF-12) and EuroQol 5-dimension (EQ-5D). The Working Group recommends that registries should choose specific PROMs that have been appropriately developed with good measurement properties for arthroplasty patients. The Working Group recommend the use of a 1-item pain question (“During the past 4 weeks, how would you describe the pain you usually have in your [right/left] [hip/knee]?”; response: none, very mild, mild, moderate, or severe) and a single-item satisfaction outcome (“How satisfied are you with your [right/left] [hip/knee] replacement?”; response: very unsatisfied, dissatisfied, neutral, satisfied, or very satisfied). Survey logistics include patient instructions, paper- and electronic-based data collection, reminders for follow-up, centralized as opposed to hospital-based follow-up, sample size, patient- or joint-specific evaluation, collection intervals, frequency of response, missing values, and factors in establishing a PROMs registry program. The Working Group recommends including age, sex, diagnosis at joint, general health status preoperatively, and joint pain and function score in case-mix adjustment models. Interpretation and statistical analysis should consider the absolute level of pain, function, and general health status as well as improvement, missing data, approaches to analysis and case-mix adjustment, minimal clinically important difference, and minimal detectable change. The Working Group recommends data collection immediately before and 1 year after surgery, a threshold of 60% for acceptable frequency of response, documentation of non-responders, and documentation of incomplete or missing data. PMID:27228230

Physical activity, sedentary behaviour and sleep in COPD guidelines: A systematic review.

PubMed

Lewthwaite, Hayley; Effing, Tanja W; Olds, Timothy; Williams, Marie T

2017-08-01

Physical activity, sedentary and sleep behaviours have strong associations with health. This systematic review aimed to identify how clinical practice guidelines (CPGs) for the management of chronic obstructive pulmonary disease (COPD) report specific recommendations and strategies for these movement behaviours. A systematic search of databases (Medline, Scopus, CiNAHL, EMbase, Clinical Guideline), reference lists and websites identified current versions of CPGs published since 2005. Specific recommendations and strategies concerning physical activity, sedentary behaviour and sleep were extracted verbatim. The proportions of CPGs providing specific recommendations and strategies were reported. From 2370 citations identified, 35 CPGs were eligible for inclusion. Of these, 21 (60%) provided specific recommendations for physical activity, while none provided specific recommendations for sedentary behaviour or sleep. The most commonly suggested strategies to improve movement behaviours were encouragement from a healthcare provider (physical activity n = 20; sedentary behaviour n = 2) and referral for a diagnostic sleep study (sleep n = 4). Since optimal physical activity, sedentary behaviour and sleep durations and patterns are likely to be associated with mitigating the effects of COPD, as well as with general health and well-being, there is a need for further COPD-specific research, consensus and incorporation of recommendations and strategies into CPGs.

Shifting public health practice to advance health equity: recommendations from experts and community leaders.

PubMed

Knight, Erin K

2014-01-01

While the evidence base regarding the social determinants of health and their relationship to health inequities grows, the field of public health is challenged to translate this knowledge into practice changes that advance health equity. Drawing on the knowledge, beliefs, and experiences of public health experts and community leaders working to advance health equity, our objective was to develop and disseminate recommendations for changing public health practice to better address this problem. We conducted semistructured, qualitative telephone interviews (n = 25) with key informants. Interviews were recorded and transcribed, and data were coded and analyzed using both inductive and deductive methods. Member checks were used to enhance quality. A purposeful sample of key informants was selected from content experts and community leaders involved with the development of the Unnatural Causes public impact campaign. Participants represented state and local health departments, community-based organizations, national research/advocacy organizations, and academic institutions across the country. Participants distinguished between social determinants of health and their structural precursors in social and political institutions. They believed that the field of public health has an obligation to address health inequities and shifts in practice are needed that focus more attention on societal factors that underlie such inequities. According to participants, specific practice changes are difficult to identify because actions should be community specific and community driven. Recommended approaches that may be adapted to community-based needs and assets include building nontraditional partnerships, engaging in political advocacy, promoting community leadership, collecting better data on social conditions and institutional factors, and enhancing communication for health equity. Recommended shifts in practice may be facilitated by revisiting our understanding of the 3 core functions of public health-assessment, assurance, and policy development.

Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine: 2015 Update.

PubMed

Neal, Joseph M; Kopp, Sandra L; Pasternak, Jeffrey J; Lanier, William L; Rathmell, James P

2015-01-01

In March 2012, the American Society of Regional Anesthesia and Pain Medicine convened its second Practice Advisory on Neurological Complications in Regional Anesthesia and Pain Medicine. This update is based on the proceedings of that conference and relevant information published since its conclusion. This article updates previously described information on the pathophysiology of spinal cord injury and adds new material on spinal stenosis, blood pressure control during neuraxial blockade, neuraxial injury subsequent to transforaminal procedures, cauda equina syndrome/local anesthetic neurotoxicity/arachnoiditis, and performing regional anesthetic or pain medicine procedures in patients concomitantly receiving general anesthesia or deep sedation. Recommendations are based on extensive review of research on humans or employing animal models, case reports, pathophysiology research, and expert opinion. The pathophysiology of spinal cord injury associated with regional anesthetic techniques is reviewed in depth, including that related to mechanical trauma from direct needle/catheter injury or mass lesions, spinal cord ischemia or vascular injury from direct needle/catheter trauma, and neurotoxicity from local anesthetics, adjuvants, or antiseptics. Specific recommendations are offered that may reduce the likelihood of spinal cord injury associated with regional anesthetic or interventional pain medicine techniques. The practice advisory's recommendations may, in select cases, reduce the likelihood of injury. However, many of the described injuries are neither predictable nor preventable based on our current state of knowledge. Since publication of initial recommendations in 2008, new information has enhanced our understanding of 5 specific entities: spinal stenosis, blood pressure control during neuraxial anesthesia, neuraxial injury subsequent to transforaminal techniques, cauda equina syndrome/local anesthetic neurotoxicity/arachnoiditis, and performing regional anesthetic or pain procedures in patients concomitantly receiving general anesthesia or deep sedation.

Development of food-based complementary feeding recommendations for 9- to 11-month-old peri-urban Indonesian infants using linear programming.

PubMed

Santika, Otte; Fahmida, Umi; Ferguson, Elaine L

2009-01-01

Effective population-specific, food-based complementary feeding recommendations (CFR) are required to combat micronutrient deficiencies. To facilitate their formulation, a modeling approach was recently developed. However, it has not yet been used in practice. This study therefore aimed to use this approach to develop CFR for 9- to 11-mo-old Indonesian infants and to identify nutrients that will likely remain low in their diets. The CFR were developed using a 4-phase approach based on linear and goal programming. Model parameters were defined using dietary data collected in a cross-sectional survey of 9- to 11-mo-old infants (n = 100) living in the Bogor District, West-Java, Indonesia and a market survey of 3 local markets. Results showed theoretical iron requirements could not be achieved using local food sources (highest level achievable, 63% of recommendations) and adequate levels of iron, niacin, zinc, and calcium were difficult to achieve. Fortified foods, meatballs, chicken liver, eggs, tempe-tofu, banana, and spinach were the best local food sources to improve dietary quality. The final CFR were: breast-feed on demand, provide 3 meals/d, of which 1 is a fortified infant cereal; > or = 5 servings/wk of tempe/tofu; > or = 3 servings/wk of animal-source foods, of which 2 servings/wk are chicken liver; vegetables, daily; snacks, 2 times/d, including > or = 2 servings/wk of banana; and > or = 4 servings/wk of fortified-biscuits. Results showed that the approach can be used to objectively formulate population-specific CFR and identify key problem nutrients to strengthen nutrition program planning and policy decisions. Before recommending these CFR, their long-term acceptability, affordability, and effectiveness should be assessed.

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 3: Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement.

PubMed

Flannery, Ann Marie; Duhaime, Ann-Christine; Tamber, Mandeep S; Kemp, Joanna

2014-11-01

This systematic review was undertaken to answer the following question: Do technical adjuvants such as ventricular endoscopic placement, computer-assisted electromagnetic guidance, or ultrasound guidance improve ventricular shunt function and survival? The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of cerebrospinal fluid shunts for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been delineated a priori were then examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. The search yielded 163 abstracts, which were screened for potential relevance to the application of technical adjuvants in shunt placement. Fourteen articles were selected for full-text review. One additional article was selected during a review of literature citations. Eight of these articles were included in the final recommendations concerning the use of endoscopy, ultrasonography, and electromagnetic image guidance during shunt placement, whereas the remaining articles were excluded due to poor evidence or lack of relevance. The evidence included 1 Class I, 1 Class II, and 6 Class III papers. An evidentiary table of relevant articles was created. CONCLUSIONS/RECOMMENDATION: There is insufficient evidence to recommend the use of endoscopic guidance for routine ventricular catheter placement. Level I, high degree of clinical certainty. The routine use of ultrasound-assisted catheter placement is an option. Level III, unclear clinical certainty. The routine use of computer-assisted electromagnetic (EM) navigation is an option. Level III, unclear clinical certainty.

[The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence].

PubMed

Semisa, Domenico; Lasalvia, Antonio; Miceli, Maurizio; Dall'Agnola, Rosa Bruna; Pucci, Cristina; Bissoli, Sarah; Visani, Enrico; Pismataro, Carmine Pasquale; Vanetti, Michele; Pioli, Rosaria; Ruggeri, Mirella; Lora, Antonio

2008-01-01

This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT'S. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: (a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; (b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services. In each of the 19 mental health departments or psychiatric services participating in the Project there were organized "multidisciplinary" focus groups and "specialistic" focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category. Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or the assertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic option for patients with schizophrenia, since in many Italian services, when the use of psychological interventions are needed, the tendency is to prefer interventions based on psychodynamic theories. The SIEP indicators were generally held to be clear and acceptable. In the view of the focus groups, the NICE guidelines are on the whole useful and suitable for orientating the services in the choice of more efficacious practices in the treatment of patients with schizophrenia. Moreover, the results obtained legitimate the use of the set of SIEP indicators for the evaluation of good practices and the quality of care offered by Italian services. Finally, the use of focus groups delines to a different context as well as the verification of the comprehensibility and applicability of SIEP indicators.

Multidrug-resistant bacterial microorganisms (MDRO) in end-of-life care: development of recommendations for hospitalized patients using a mixed-methods approach.

PubMed

Heckel, Maria; Stiel, Stephanie; Herbst, Franziska A; Tiedtke, Johanna M; Sturm, Alexander; Adelhardt, Thomas; Bogdan, Christian; Sieber, Cornel; Schöffski, Oliver; Lang, Frieder R; Ostgathe, Christoph

2018-03-16

Palliative care professionals are frequently confronted with patients colonized or infected with MDRO. One major challenge is how to balance necessary isolation measures and social inclusion as one of the main principles of palliative and end-of-life care. To date, MDRO-specific policies and protocols vary widely between institutions. provide empirical recommendations on how to deal with hospitalized MDRO patients in end-of-life care. Recommendations were developed based on (i) initial results of face-to-face interviews and focus groups, (ii) impartial experts' comments and consensus on the draft via online survey and (iii) a face-to-face meeting with consortium members to finalize recommendations. Findings of 158 interviews and six focus groups (39 participants) with patients, family caregivers, staff members and institutional stakeholders contributed to the recommendations. The assessments of 17 experts were considered. In total, 21 recommendations were approved. The recommended strategy in dealing with MDRO at the end of life allows case-based application of protection and isolation measures. MDRO diagnostics and therapy involve screening at admission. The recommendations suggest consideration of required accommodation facilities, provided material as well as staff and time resources. The recommendations further highlight the importance of providing for strategies enabling the patient's social inclusion and provision of verbal and written information about MDRO for patients and family caregivers, transparent medical documentation, and staff member training. The recommendations summarize the perspectives of individuals and groups affected by MDRO at the end of life and provide practical guidance for clinical routine. Further dissemination and implementation requirements are discussed and should contain the evaluation of the knowledge, views, worries, and anxieties of the target groups.

Implementing portfolio in postgraduate general practice training. Benefits and recommendations.

PubMed

Alotaibi, Fawaz S

2012-10-01

This paper presents a review to explore the literature focusing on portfolio in postgraduate general practice (GP) training, and to examine the impact of implementation of portfolio on learning process, as well as proposing recommendations for its implementation in postgraduate GP training. An electronic search was carried out on several databases for studies addressing portfolio in postgraduate GP training. Six articles were included to address specifically the effectiveness of portfolio in postgraduate GP training. Five of them described successful experiences of portfolio-based learning implementation. Only one article addressed portfolio-based assessment in postgraduate GP training. The existing evidence provides various benefits of professional portfolio-based learning. It does appear to have advantages of stimulating reflective learning, promoting proactive learning, and bridging the hospital experiences of the learners to GP. Moreover, the challenges to implementation of portfolio-based learning are often based on orientation and training of stakeholders.

Teaching Math to Young Children. Educator's Practice Guide. What Works Clearinghouse. NCEE 2014-4005

ERIC Educational Resources Information Center

Frye, Douglas; Baroody, Arthur J.; Burchinal, Margaret; Carver, Sharon M.; Jordan, Nancy C.; McDowell, Judy

2013-01-01

The goal of this practice guide is to offer educators specific, evidence-based recommendations that address the challenge of teaching early math to children ages 3 to 6. The guide provides practical, clear information on critical topics related to teaching early math and is based on the best available evidence as judged by the authors. The guide…

Defining Mathematics Competency in the Service of Cognitively Based Assessment for Grades 6 through 8. Research Report. ETS RR-09-42

ERIC Educational Resources Information Center

Graf, Edith Aurora

2009-01-01

This report makes recommendations for the development of middle-school assessment in mathematics, based on a synthesis of scientific findings in cognitive psychology and mathematics education. The focus is on background research, rather than test specifications or example tasks. Readers interested in early development and pilot efforts associated…

Growth and clinical variables in nitrogen-restricted piglets fed an adjusted essential amino acid mix: Effects using partially intact protein-based diets

USDA-ARS?s Scientific Manuscript database

Current recommendations for protein levels in infant formula ensure that growth matches or exceeds growth of breast-fed infants, but may provide a surplus of amino acids (AA). Recent studies in infants using AA-based formulas support specific adjustment of the essential AA (EAA) composition allowing...

What Would Be the Effect of Referral to High-Volume Hospitals in a Largely Rural State?

ERIC Educational Resources Information Center

Ward, Marcia M.; Jaana, Mirou; Wakefield, Douglas S.; Ohsfeldt, Robert L.; Schneider, John E.; Miller, Thomas; Lei, Yang

2004-01-01

Volume of certain surgical procedures has been linked to patient outcomes. The Leapfrog Group and others have recommended evidence-based referral using specific volume thresholds for nonemergent cases. The literature is limited on the effect of such referral on hospitals, especially in rural areas. To examine the impact of evidence-based referral…

Rice straw-wood particle composite for sound absorbing wooden construction materials.

PubMed

Yang, Han-Seung; Kim, Dae-Jun; Kim, Hyun-Joong

2003-01-01

In this study, rice straw-wood particle composite boards were manufactured as insulation boards using the method used in the wood-based panel industry. The raw material, rice straw, was chosen because of its availability. The manufacturing parameters were: a specific gravity of 0.4, 0.6, and 0.8, and a rice straw content (10/90, 20/80, and 30/70 weight of rice straw/wood particle) of 10, 20, and 30 wt.%. A commercial urea-formaldehyde adhesive was used as the composite binder, to achieve 140-290 psi of bending modulus of rupture (MOR) with 0.4 specific gravity, 700-900 psi of bending MOR with 0.6 specific gravity, and 1400-2900 psi of bending MOR with a 0.8 specific gravity. All of the composite boards were superior to insulation board in strength. Width and length of the rice straw particle did not affect the bending MOR. The composite boards made from a random cutting of rice straw and wood particles were the best and recommended for manufacturing processes. Sound absorption coefficients of the 0.4 and 0.6 specific gravity boards were higher than the other wood-based materials. The recommended properties of the rice straw-wood particle composite boards are described, to absorb noises, preserve the temperature of indoor living spaces, and to be able to partially or completely substitute for wood particleboard and insulation board in wooden constructions.

A multi-label learning based kernel automatic recommendation method for support vector machine.

PubMed

Zhang, Xueying; Song, Qinbao

2015-01-01

Choosing an appropriate kernel is very important and critical when classifying a new problem with Support Vector Machine. So far, more attention has been paid on constructing new kernels and choosing suitable parameter values for a specific kernel function, but less on kernel selection. Furthermore, most of current kernel selection methods focus on seeking a best kernel with the highest classification accuracy via cross-validation, they are time consuming and ignore the differences among the number of support vectors and the CPU time of SVM with different kernels. Considering the tradeoff between classification success ratio and CPU time, there may be multiple kernel functions performing equally well on the same classification problem. Aiming to automatically select those appropriate kernel functions for a given data set, we propose a multi-label learning based kernel recommendation method built on the data characteristics. For each data set, the meta-knowledge data base is first created by extracting the feature vector of data characteristics and identifying the corresponding applicable kernel set. Then the kernel recommendation model is constructed on the generated meta-knowledge data base with the multi-label classification method. Finally, the appropriate kernel functions are recommended to a new data set by the recommendation model according to the characteristics of the new data set. Extensive experiments over 132 UCI benchmark data sets, with five different types of data set characteristics, eleven typical kernels (Linear, Polynomial, Radial Basis Function, Sigmoidal function, Laplace, Multiquadric, Rational Quadratic, Spherical, Spline, Wave and Circular), and five multi-label classification methods demonstrate that, compared with the existing kernel selection methods and the most widely used RBF kernel function, SVM with the kernel function recommended by our proposed method achieved the highest classification performance.

A Multi-Label Learning Based Kernel Automatic Recommendation Method for Support Vector Machine

PubMed Central

Zhang, Xueying; Song, Qinbao

2015-01-01

Choosing an appropriate kernel is very important and critical when classifying a new problem with Support Vector Machine. So far, more attention has been paid on constructing new kernels and choosing suitable parameter values for a specific kernel function, but less on kernel selection. Furthermore, most of current kernel selection methods focus on seeking a best kernel with the highest classification accuracy via cross-validation, they are time consuming and ignore the differences among the number of support vectors and the CPU time of SVM with different kernels. Considering the tradeoff between classification success ratio and CPU time, there may be multiple kernel functions performing equally well on the same classification problem. Aiming to automatically select those appropriate kernel functions for a given data set, we propose a multi-label learning based kernel recommendation method built on the data characteristics. For each data set, the meta-knowledge data base is first created by extracting the feature vector of data characteristics and identifying the corresponding applicable kernel set. Then the kernel recommendation model is constructed on the generated meta-knowledge data base with the multi-label classification method. Finally, the appropriate kernel functions are recommended to a new data set by the recommendation model according to the characteristics of the new data set. Extensive experiments over 132 UCI benchmark data sets, with five different types of data set characteristics, eleven typical kernels (Linear, Polynomial, Radial Basis Function, Sigmoidal function, Laplace, Multiquadric, Rational Quadratic, Spherical, Spline, Wave and Circular), and five multi-label classification methods demonstrate that, compared with the existing kernel selection methods and the most widely used RBF kernel function, SVM with the kernel function recommended by our proposed method achieved the highest classification performance. PMID:25893896

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region.

PubMed

Cameron, Donald; Hock, Quak Seng; Kadim, Musal; Mohan, Neelam; Ryoo, Eell; Sandhu, Bhupinder; Yamashiro, Yuichiro; Jie, Chen; Hoekstra, Hans; Guarino, Alfredo

2017-12-07

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG ( LGG ) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile -induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic ( L reuteri ) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.

EULAR recommendations for conducting clinical studies and/or clinical trials in systemic vasculitis: focus on anti‐neutrophil cytoplasm antibody‐associated vasculitis

PubMed Central

Hellmich, Bernhard; Flossmann, Oliver; Gross, Wolfgang L; Bacon, Paul; Cohen‐Tervaert, Jan Willem; Guillevin, Loic; Jayne, David; Mahr, Alfred; Merkel, Peter A; Raspe, Heiner; Scott, David G I; Witter, James; Yazici, Hasan; Luqmani, Raashid A

2007-01-01

Objectives To develop the European League Against Rheumatism (EULAR) recommendations for conducting clinical studies and/or clinical trials in systemic vasculitis. Methods An expert consensus group was formed consisting of rheumatologists, nephrologists and specialists in internal medicine representing five European countries and the USA, a clinical epidemiologist and representatives from regulatory agencies. Using an evidence‐based and expert opinion‐based approach in accordance with the standardised EULAR operating procedures, the group identified nine topics for a systematic literature search through a modified Delphi technique. On the basis of research questions posed by the group, recommendations were derived for conducting clinical studies and/or clinical trials in systemic vasculitis. Results Based on the results of the literature research, the expert committee concluded that sufficient evidence to formulate guidelines on conducting clinical trials was available only for anti‐neutrophil cytoplasm antibody‐associated vasculitides (AAV). It was therefore decided to focus the recommendations on these diseases. Recommendations for conducting clinical trials in AAV were elaborated and are presented in this summary document. It was decided to consider vasculitis‐specific issues rather than general issues of trial methodology. The recommendations deal with the following areas related to clinical studies of vasculitis: definitions of disease, activity states, outcome measures, eligibility criteria, trial design including relevant end points, and biomarkers. A number of aspects of trial methodology were deemed important for future research. Conclusions On the basis of expert opinion, recommendations for conducting clinical trials in AAV were formulated. Furthermore, the expert committee identified a strong need for well‐designed research in non‐AAV systemic vasculitides. PMID:17170053

A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions.

PubMed

Abidi, Samina

2017-10-26

Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.

PubMed

Thomas, Stephen H; Brown, Kathleen M; Oliver, Zoë J; Spaite, Daniel W; Lawner, Benjamin J; Sahni, Ritu; Weik, Tasmeen S; Falck-Ytter, Yngve; Wright, Joseph L; Lang, Eddy S

2014-01-01

Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council. Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local adaptation. Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.

Test techniques for evaluating flight displays

NASA Technical Reports Server (NTRS)

Haworth, Loran A.; Newman, Richard L.

1993-01-01

The rapid development of graphics technology allows for greater flexibility in aircraft displays, but display evaluation techniques have not kept pace. Historically, display evaluation has been based on subjective opinion and not on the actual aircraft/pilot performance. Existing electronic display specifications and evaluation techniques are reviewed. A display rating technique analogous to handling qualities ratings was developed and is recommended for future evaluations. The choice of evaluation pilots is also discussed and the use of a limited number of trained evaluators is recommended over the use of a large number of operational pilots.

Euthanasia

USGS Publications Warehouse

Franson, J.C.

1999-01-01

Euthanasia means to cause humane death. Some current euthanasia techniques may become unacceptable over time and be replaced by new techniques as more data are gathered and evaluated. The following information and recommendations are based largely on the 1993 report of the American Veterinary Medical Association (AVMA) Panel on Euthanasia. The recommendations in the panel report were intended to serve as guidelines, and they require the use of professional judgement for specific situations. Ultimately, it is the responsibility of those persons carrying out euthanasia to assure that it is done in the most humane manner possible.

Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology.

PubMed

Hastey, Christine J; Boyd, Halsey; Schuetz, Audrey N; Anderson, Karen; Citron, Diane M; Dzink-Fox, Jody; Hackel, Meredith; Hecht, David W; Jacobus, Nilda V; Jenkins, Stephen G; Karlsson, Maria; Knapp, Cynthia C; Koeth, Laura M; Wexler, Hannah; Roe-Carpenter, Darcie E

2016-12-01

Antimicrobial susceptibility testing of anaerobic isolates was conducted at four independent sites from 2010 to 2012 and compared to results from three sites during the period of 2007-2009. This data comparison shows significant changes in antimicrobial resistance in some anaerobic groups. Therefore, we continue to recommend institutions regularly perform susceptibility testing when anaerobes are cultured from pertinent sites. Annual generation of an institutional-specific antibiogram is recommended for tracking of resistance trends over time. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2015-01-01

Military recommendations for dietary protein are based on the recommended dietary allowance (RDA) of 0.8 g of protein per kilogram of body mass (BM) established by the Food and Nutrition Board, Institute of Medicine (IOM) of the National Academies. The RDA is likely adequate for most military personnel, particularly when activity levels are low and energy intake is sufficient to maintain a healthy body weight. However, military recommendations account for periods of increased metabolic demand during training and real-world operations, especially those that produce an energy deficit. Under those conditions, protein requirements are higher (1.5-2.0 g/kg BM) in an attempt to attenuate the unavoidable loss of muscle mass that occurs during prolonged or repeated exposure to energy deficits. Whole foods are recommended as the primary method to consume more protein, although there are likely operational scenarios where whole foods are not available and consuming supplemental protein at effective, not excessive, doses (20-25 g or 0.25-0.3 g/kg BM per meal) is recommended. Despite these evidence-based, condition-specific recommendations, the necessity of protein supplements and the requirements and rationale for consuming higher-protein diets are often misunderstood, resulting in an overconsumption of dietary protein and unsubstantiated health-related concerns. This review will provide the basis of the US military dietary protein requirements and highlight common misconceptions associated with the amount and safety of protein in military diets. 2015.

Laboratory Medicine Best Practice Guideline: Vitamins A, E and the Carotenoids in Blood

PubMed Central

Greaves, Ronda F; Woollard, Gerald A; Hoad, Kirsten E; Walmsley, Trevor A; Johnson, Lambro A; Briscoe, Scott; Koetsier, Sabrina; Harrower, Tamantha; Gill, Janice P

2014-01-01

Despite apparent method similarities between laboratories there appear to be confounding factors inhibiting uniform reporting and standardisation of vitamin assays. The Australasian Association of Clinical Biochemists (AACB) Vitamins Working Party, in conjunction with The Royal College of Pathologists of Australasia Quality Assurance Programs, has formulated a guideline to improve performance, reproducibility and accuracy of fat-soluble vitamin results. The aim of the guideline is to identify critical pre-analytical, analytical and post-analytical components of the analysis of vitamins A, E and carotenoids in blood to promote best practice and harmonisation. This best practice guideline has been developed with reference to the Centers for Disease Control and Prevention (CDC) “Laboratory Medicine Best Practices: Developing an Evidence-Based Review and Evaluation Process”. The CDC document cites an evaluation framework for generating best practice recommendations that are specific to laboratory medicine. These 50 recommendations proposed herein, were generated from a comprehensive literature search and the extensive combined experience of the AACB Vitamins Working Party members. They were formulated based on comparison between an impact assessment rating and strength of evidence and were classified as either: (1) strongly recommend, (2) recommend, (3) no recommendation for or against, or (4) recommend against. These best practice recommendations represent the consensus views, in association with peer reviewed evidence of the AACB Vitamins Working Party, towards best practice for the collection, analysis and interpretation of vitamins A, E and carotenoids in blood. PMID:25210208

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary prevention of osteoarthritis by joint injury prevention in sport and recreation.

PubMed

Emery, C A; Roos, E M; Verhagen, E; Finch, C F; Bennell, K L; Story, B; Spindler, K; Kemp, J; Lohmander, L S

2015-05-01

The risk of post-traumatic osteoarthritis (PTOA) substantially increases following joint injury. Research efforts should focus on investigating the efficacy of preventative strategies in high quality randomized controlled trials (RCT). The objective of these OARSI RCT recommendations is to inform the design, conduct and analytical approaches to RCTs evaluating the preventative effect of joint injury prevention strategies. Recommendations regarding the design, conduct, and reporting of RCTs evaluating injury prevention interventions were established based on the consensus of nine researchers internationally with expertise in epidemiology, injury prevention and/or osteoarthritis (OA). Input and resultant consensus was established through teleconference, face to face and email correspondence over a 1 year period. Recommendations for injury prevention RCTs include context specific considerations regarding the research question, research design, study participants, randomization, baseline characteristics, intervention, outcome measurement, analysis, implementation, cost evaluation, reporting and future considerations including the impact on development of PTOA. Methodological recommendations for injury prevention RCTs are critical to informing evidence-based practice and policy decisions in health care, public health and the community. Recommendations regarding the interpretation and conduct of injury prevention RCTs will inform the highest level of evidence in the field. These recommendations will facilitate between study comparisons to inform best practice in injury prevention that will have the greatest public health impact. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Energy-efficiency program for clothes washers, clothes dryers, and dishwashers

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

Not Available

1977-11-01

The objectives of this study of dishwashers, clothes washers, and clothes dryers are: to evaluate existing energy efficiency test procedures and recommend the use of specific test procedures for each appliance group and to establish the maximum economically and technologically feasible energy-efficiency improvement goals for each appliance group. Specifically, the program requirements were to determine the energy efficiency of the 1972 models, to evaluate the feasibility improvements that could be implemented by 1980 to maximize energy efficiency, and to calculate the percentage efficiency improvement based on the 1972 baseline and the recommended 1980 targets. The test program was conducted usingmore » 5 dishwashers, 4 top-loading clothes washers, one front-loading clothes washer, 4 electric clothes dryers, and 4 gas clothes dryers. (MCW)« less

Symptoms, Diagnosis, and Treatment of Cow's Milk Allergy.

PubMed

Vandenplas, Yvan; Marchand, Johan; Meyns, Lien

2015-01-01

The diagnosis and management of cow's milk allergy (CMA) is a topic of debate because there are no specific symptoms and reliable diagnostic tests. Literature was searched using databases to find original papers and reviews on this topic. A "challenge test" is still recommended as the most specific and sensitive diagnostic test, although a positive challenge test does not proof the involvement of the immune system. Only in the rare case of anaphylaxis, the challenge tests is not recommended. The Cow's Milk Symptom Score (CoMiSS) is an awareness tool for health care professionals to better recognize symptoms caused by the ingestion of cow's milk, but still needs validation. Today, the recommended diagnostic approach consists of an elimination diet with an extensive cow's milk based hydrolysate, followed by a challenge test. Amino acid based formula is reserved for the severe cases. Rice hydrolysates are gaining popularity, because they have been shown to be effective, have a better acceptability, and to be cheaper than the extensive cow's milk based hydrolysates. Soy infant formula may offer an additional alternative option as reviews concluded that about 10-15% of infants allergic to cow's milk will also react to soy. Gastro-intestinal microbiota manipulation may be of additional benefit in the treatment of CMA. The development of rice hydrolysates challenge the use of Today, extensive cow's milk based extensive hydrolysates remain the first option for the majority of patients and amino acid formula for the most severe cases. Rice hydrolysates and soy infant formula are considered as second choice options.

Impact of the United States Preventive Services Task Force 'D' recommendation on prostate cancer screening and staging.

PubMed

Eapen, Renu S; Herlemann, Annika; Washington, Samuel L; Cooperberg, Matthew R

2017-05-01

In 2012, the United States Preventive Services Task Force (USPSTF) issued a grade 'D' recommendation against the use of routine prostate-specific antigen (PSA)-based screening for any men. This recommendation reflects critical misinterpretations of the available evidence base regarding benefits and harms of PSA screening and has influenced the nationwide landscape of prostate cancer screening, diagnosis, and treatment. Following the USPSTF recommendation, a substantial decline in PSA screening was noted for all age groups. Similarly, overall rates of prostate biopsy and prostate cancer incidence have significantly decreased with a shift toward higher grade and stage disease upon diagnosis. Concurrently, the incidence of metastatic prostate cancer has significantly risen in the United States. These trends are concerning particularly for the younger men with occult high-grade disease who are expected to benefit the most from early detection and definitive prostate cancer treatment. These emerging trends in PSA screening and prostate cancer incidence following the USPSTF recommendation may have significant public health implications. Due to the long natural history of the disease, a long-term follow-up is needed to provide a better understanding on the implications of such recommendations on disease progression and mortality rates in prostate cancer patients. The future of US screening policy should reflect a targeted 'smarter' screening strategy rather than dichotomizing the decision between 'screen all' or 'screen none'.

A hybrid personalized data recommendation approach for geoscience data sharing

NASA Astrophysics Data System (ADS)

WANG, M.; Wang, J.

2016-12-01

Recommender systems are effective tools helping Internet users overcome information overloading. The two most widely used recommendation algorithms are collaborating filtering (CF) and content-based filtering (CBF). A number of recommender systems based on those two algorithms were developed for multimedia, online sells, and other domains. Each of the two algorithms has its advantages and shortcomings. Hybrid approaches that combine these two algorithms are better choices in many cases. In geoscience data sharing domain, where the items (datasets) are more informative (in space and time) and domain-specific, no recommender system is specialized for data users. This paper reports a dynamic weighted hybrid recommendation algorithm that combines CF and CBF for geoscience data sharing portal. We first derive users' ratings on items with their historical visiting time by Jenks Natural Break. In the CBF part, we incorporate the space, time, and subject information of geoscience datasets to compute item similarity. Predicted ratings were computed with k-NN method separately using CBF and CF, and then combined with weights. With training dataset we attempted to find the best model describing ideal weights and users' co-rating numbers. A logarithmic function was confirmed to be the best model. The model was then used to tune the weights of CF and CBF on user-item basis with test dataset. Evaluation results show that the dynamic weighted approach outperforms either solo CF or CBF approach in terms of Precision and Recall.

Valid analytical performance specifications for combined analytical bias and imprecision for the use of common reference intervals.

PubMed

Hyltoft Petersen, Per; Lund, Flemming; Fraser, Callum G; Sandberg, Sverre; Sölétormos, György

2018-01-01

Background Many clinical decisions are based on comparison of patient results with reference intervals. Therefore, an estimation of the analytical performance specifications for the quality that would be required to allow sharing common reference intervals is needed. The International Federation of Clinical Chemistry (IFCC) recommended a minimum of 120 reference individuals to establish reference intervals. This number implies a certain level of quality, which could then be used for defining analytical performance specifications as the maximum combination of analytical bias and imprecision required for sharing common reference intervals, the aim of this investigation. Methods Two methods were investigated for defining the maximum combination of analytical bias and imprecision that would give the same quality of common reference intervals as the IFCC recommendation. Method 1 is based on a formula for the combination of analytical bias and imprecision and Method 2 is based on the Microsoft Excel formula NORMINV including the fractional probability of reference individuals outside each limit and the Gaussian variables of mean and standard deviation. The combinations of normalized bias and imprecision are illustrated for both methods. The formulae are identical for Gaussian and log-Gaussian distributions. Results Method 2 gives the correct results with a constant percentage of 4.4% for all combinations of bias and imprecision. Conclusion The Microsoft Excel formula NORMINV is useful for the estimation of analytical performance specifications for both Gaussian and log-Gaussian distributions of reference intervals.

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.

Practice Parameter: Evaluation of the child with microcephaly (an evidence-based review)

PubMed Central

Ashwal, Stephen; Michelson, David; Plawner, Lauren; Dobyns, William B.

2009-01-01

Objective: To make evidence-based recommendations concerning the evaluation of the child with microcephaly. Methods: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a 4-tiered scheme of evidence classification. Results: Microcephaly is an important neurologic sign but there is nonuniformity in its definition and evaluation. Microcephaly may result from any insult that disturbs early brain growth and can be seen in association with hundreds of genetic syndromes. Annually, approximately 25,000 infants in the United States will be diagnosed with microcephaly (head circumference <−2 SD). Few data are available to inform evidence-based recommendations regarding diagnostic testing. The yield of neuroimaging ranges from 43% to 80%. Genetic etiologies have been reported in 15.5% to 53.3%. The prevalence of metabolic disorders is unknown but is estimated to be 1%. Children with severe microcephaly (head circumference <−3 SD) are more likely (∼80%) to have imaging abnormalities and more severe developmental impairments than those with milder microcephaly (−2 to −3 SD; ∼40%). Coexistent conditions include epilepsy (∼40%), cerebral palsy (∼20%), mental retardation (∼50%), and ophthalmologic disorders (∼20% to ∼50%). Recommendations: Neuroimaging may be considered useful in identifying structural causes in the evaluation of the child with microcephaly (Level C). Targeted and specific genetic testing may be considered in the evaluation of the child with microcephaly who has clinical or imaging abnormalities that suggest a specific diagnosis or who shows no evidence of an acquired or environmental etiology (Level C). Screening for coexistent conditions such as cerebral palsy, epilepsy, and sensory deficits may also be considered (Level C). Further study is needed regarding the yield of diagnostic testing in children with microcephaly. GLOSSARY CP = cerebral palsy; GDD = global developmental delay; HC = head circumference; MRE = medically refractory epilepsy; OMIM = Online Mendelian Inheritance in Man. PMID:19752457

The diagnostic performance of expert dermoscopists vs a computer-vision system on small-diameter melanomas.

PubMed

Friedman, Robert J; Gutkowicz-Krusin, Dina; Farber, Michele J; Warycha, Melanie; Schneider-Kels, Lori; Papastathis, Nicole; Mihm, Martin C; Googe, Paul; King, Roy; Prieto, Victor G; Kopf, Alfred W; Polsky, David; Rabinovitz, Harold; Oliviero, Margaret; Cognetta, Armand; Rigel, Darrell S; Marghoob, Ashfaq; Rivers, Jason; Johr, Robert; Grant-Kels, Jane M; Tsao, Hensin

2008-04-01

To evaluate the performance of dermoscopists in diagnosing small pigmented skin lesions (diameter

Physical activity, sedentary behaviour and sleep in COPD guidelines: A systematic review

PubMed Central

Effing, Tanja W; Olds, Timothy; Williams, Marie T

2017-01-01

Objectives: Physical activity, sedentary and sleep behaviours have strong associations with health. This systematic review aimed to identify how clinical practice guidelines (CPGs) for the management of chronic obstructive pulmonary disease (COPD) report specific recommendations and strategies for these movement behaviours. Methods: A systematic search of databases (Medline, Scopus, CiNAHL, EMbase, Clinical Guideline), reference lists and websites identified current versions of CPGs published since 2005. Specific recommendations and strategies concerning physical activity, sedentary behaviour and sleep were extracted verbatim. The proportions of CPGs providing specific recommendations and strategies were reported. Results: From 2370 citations identified, 35 CPGs were eligible for inclusion. Of these, 21 (60%) provided specific recommendations for physical activity, while none provided specific recommendations for sedentary behaviour or sleep. The most commonly suggested strategies to improve movement behaviours were encouragement from a healthcare provider (physical activity n = 20; sedentary behaviour n = 2) and referral for a diagnostic sleep study (sleep n = 4). Conclusion: Since optimal physical activity, sedentary behaviour and sleep durations and patterns are likely to be associated with mitigating the effects of COPD, as well as with general health and well-being, there is a need for further COPD-specific research, consensus and incorporation of recommendations and strategies into CPGs. PMID:28774202

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

DTIC Science & Technology

1995-05-04

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

78 FR 54253 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-03

... every level of the social ecology, including individuals, families, and communities, and thus have the... effective population-based prevention strategies. Approximately 188 Colorado state and county employees and partners form the sample population. Specifically, state- and county-level employees working in welfare and...

34 CFR 200.47 - SEA responsibilities for supplemental educational services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... standards; (C) Are of high quality, research-based, and specifically designed to increase the academic... surveys, if any, regarding the success of the provider's instructional program in increasing student... recommendations or results from parent surveys regarding the success of the provider's instructional program in...

34 CFR 200.47 - SEA responsibilities for supplemental educational services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... standards; (C) Are of high quality, research-based, and specifically designed to increase the academic... surveys, if any, regarding the success of the provider's instructional program in increasing student... recommendations or results from parent surveys regarding the success of the provider's instructional program in...

34 CFR 200.47 - SEA responsibilities for supplemental educational services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... standards; (C) Are of high quality, research-based, and specifically designed to increase the academic... surveys, if any, regarding the success of the provider's instructional program in increasing student... recommendations or results from parent surveys regarding the success of the provider's instructional program in...

34 CFR 200.47 - SEA responsibilities for supplemental educational services.

Code of Federal Regulations, 2014 CFR

2014-07-01

... standards; (C) Are of high quality, research-based, and specifically designed to increase the academic... surveys, if any, regarding the success of the provider's instructional program in increasing student... recommendations or results from parent surveys regarding the success of the provider's instructional program in...

Evaluation of drug interaction microcomputer software: comparative study.

PubMed

Poirier, T I; Giudici, R

1991-01-01

Twelve drug interaction microcomputer software programs were evaluated and compared using general and specific criteria. This article summarizes and compares the features, ratings, advantages, and disadvantages of each program. Features of an ideal drug interaction program are noted. Recommended programs based on three price ranges are suggested.

Multidisciplinary Cleft Palate Program at BC Children's Hospital: Are We Meeting the Standards of Care?

PubMed

Dahiya, Anita; Courtemanche, Rebecca; Courtemanche, Douglas J

2018-05-01

To characterize current Cleft Palate Program (CPP) practices and evaluate the timeliness of appointments with respect to patient age and diagnosis based on American Cleft Palate-Craniofacial Association (ACPA) population guidelines and CPP patient-specific recommendations. A retrospective review of CPP patient appointments from November 6, 2012, to March 31, 2015, was done. Data were analyzed using descriptive and inferential statistics. The study was conducted using data from the CPP at BC Children's Hospital. A total of 1214 appointments were considered in the analysis, including syndromic and nonsyndromic patients of 0 to 27 years of age. Percentage of patients meeting follow-up targets by ACPA standards and CPP team recommendations. Our results showed patients 5 years and younger or nonsyndromic were more likely to be seen on time ( P < .001). No relationship between the timeliness of an appointment and specific patient diagnoses or distance to clinic was found. With the exception of nursing (97% of appointments were on time), all disciplines had less than 45% of appointments on time with 51% of appointments meeting ACPA guidelines for timeliness and 32% of all appointments meeting CPP recommendations. Timely care for the cleft/craniofacial patient populations represents a challenge for the CPP. Although half of patients may meet the general ACPA guidelines, only 32% of patients are meeting the CPP patient-specific recommendations. To provide better patient care, future adjustments are needed, which may include improved resource allotment and program support.

Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation.

PubMed

Shiffman, Richard N; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge.

Estimating the cost of delivering direct nutrition interventions at scale: national and subnational level insights from India.

PubMed

Menon, Purnima; McDonald, Christine M; Chakrabarti, Suman

2016-05-01

India's national nutrition and health programmes are largely designed to provide evidence-based nutrition-specific interventions, but intervention coverage is low due to a combination of implementation challenges, capacity and financing gaps. Global cost estimates for nutrition are available but national and subnational costs are not. We estimated national and subnational costs of delivering recommended nutrition-specific interventions using the Scaling Up Nutrition (SUN) costing approach. We compared costs of delivering the SUN interventions at 100% scale with those of nationally recommended interventions. Target populations (TP) for interventions were estimated using national population and nutrition data. Unit costs (UC) were derived from programmatic data. The cost of delivering an intervention at 100% coverage was calculated as (UC*projected TP). Cost estimates varied; estimates for SUN interventions were lower than estimates for nationally recommended interventions because of differences in choice of intervention, target group or unit cost. US$5.9bn/year are required to deliver a set of nationally recommended nutrition interventions at scale in India, while US$4.2bn are required for the SUN interventions. Cash transfers (49%) and food supplements (40%) contribute most to costs of nationally recommended interventions, while food supplements to prevent and treat malnutrition contribute most to the SUN costs. We conclude that although such costing is useful to generate broad estimates, there is an urgent need for further costing studies on the true unit costs of the delivery of nutrition-specific interventions in different local contexts to be able to project accurate national and subnational budgets for nutrition in India. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice.

PubMed

Souberbielle, Jean-Claude; Body, Jean-Jacques; Lappe, Joan M; Plebani, Mario; Shoenfeld, Yehuda; Wang, Thomas J; Bischoff-Ferrari, Heike A; Cavalier, Etienne; Ebeling, Peter R; Fardellone, Patrice; Gandini, Sara; Gruson, Damien; Guérin, Alain P; Heickendorff, Lene; Hollis, Bruce W; Ish-Shalom, Sofia; Jean, Guillaume; von Landenberg, Philipp; Largura, Alvaro; Olsson, Tomas; Pierrot-Deseilligny, Charles; Pilz, Stefan; Tincani, Angela; Valcour, Andre; Zittermann, Armin

2010-09-01

There is increasing evidence that, in addition to the well-known effects on musculoskeletal health, vitamin D status may be related to a number of non-skeletal diseases. An international expert panel formulated recommendations on vitamin D for clinical practice, taking into consideration the best evidence available based on published literature today. In addition, where data were limited to smaller clinical trials or epidemiologic studies, the panel made expert-opinion based recommendations. Twenty-five experts from various disciplines (classical clinical applications, cardiology, autoimmunity, and cancer) established draft recommendations during a 2-day meeting. Thereafter, representatives of all disciplines refined the recommendations and related texts, subsequently reviewed by all panelists. For all recommendations, panelists expressed the extent of agreement using a 5-point scale. Recommendations were restricted to clinical practice and concern adult patients with or at risk for fractures, falls, cardiovascular or autoimmune diseases, and cancer. The panel reached substantial agreement about the need for vitamin D supplementation in specific groups of patients in these clinical areas and the need for assessing their 25-hydroxyvitamin D (25(OH)D) serum levels for optimal clinical care. A target range of at least 30 to 40 ng/mL was recommended. As response to treatment varies by environmental factors and starting levels of 25(OH)D, testing may be warranted after at least 3 months of supplementation. An assay measuring both 25(OH)D(2) and 25(OH)D(3) is recommended. Dark-skinned or veiled individuals not exposed much to the sun, elderly and institutionalized individuals may be supplemented (800 IU/day) without baseline testing. Copyright 2010 Elsevier B.V. All rights reserved.

Recommendations for the surgical treatment of endometriosis-part 1: ovarian endometrioma.

PubMed

Saridogan, Ertan; Becker, Christian M; Feki, Anis; Grimbizis, Grigoris F; Hummelshoj, Lone; Keckstein, Joerg; Nisolle, Michelle; Tanos, Vasilios; Ulrich, Uwe A; Vermeulen, Nathalie; De Wilde, Rudy Leon

2017-01-01

What does this document on the surgical treatment of endometriosis jointly prepared by the European Society for Gynaecological Endoscopy (ESGE), ESHRE, and the World Endometriosis Society (WES) provide? This document provides recommendations covering technical aspects of different methods of surgery for endometriomas in women of reproductive age. Endometriomas (ovarian endometriotic cysts) are a commonly diagnosed form of endometriosis, owing to the relative ease and accuracy of ultrasound diagnosis. They frequently present a clinical dilemma as to whether and how to treat them when found during imaging or incidentally during surgery. Previously published guidelines have provided recommendations based on the best available evidence, but without technical details on the management of endometriosis. A working group of ESGE, ESHRE and WES collaborated on writing recommendations on the practical aspects of endometrioma surgery. This document focused on endometrioma surgery. Further documents in this series will provide recommendations for surgery of deep and peritoneal endometriosis. The document presents general recommendations for surgery of endometrioma and specific recommendations for cystectomy, ablation by laser or by plasma energy, electrocoagulation and a combination of these techniques applied together or with an interval between them. Owing to the limited evidence available, recommendations are mostly based on clinical expertise. These recommendations complement previous guidelines on the management of endometriosis. The meetings of the working group were funded by ESGE, ESHRE and WES. CB declares to be a member of the independent data monitoring committee for a clinical study by ObsEva and receiving research grants from Bayer, Roche Diagnostics, MDNA Life Sciences and Volition. ES received honoraria for provision of training to healthcare professionals from Ethicon, Olympus and Gedeon Richter. The other authors declare that they have no conflict of interest.

Usability Guidelines for Product Recommenders Based on Example Critiquing Research

NASA Astrophysics Data System (ADS)

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

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

A High Diet Quality Based on Dietary Recommendations Is Not Associated with Lower Incidence of Type 2 Diabetes in the Malmö Diet and Cancer Cohort

PubMed Central

Mandalazi, Emmanuel; Drake, Isabel; Wirfält, Elisabet; Orho-Melander, Marju; Sonestedt, Emily

2016-01-01

A high diet quality index based on Swedish nutrition recommendations has previously been associated with reduced risk of cardiovascular disease and mortality in the Malmö Diet and Cancer (MDC) cohort. The aim of the present study was to investigate whether this diet quality index was associated with the risk for type 2 diabetes. Of 26,868 participants (44–74 years) in the MDC cohort study, 3838 type 2 diabetes cases were identified from registers during 17 years of follow-up. A diet quality index (from a modified diet history method) was constructed based on adherence to the recommended intakes of saturated fat, polyunsaturated fat, fish, fiber, fruit and vegetables, and sucrose. After adjusting for potential confounders, we observed no significant association between the diet quality index and type 2 diabetes risk. The HR for the highest vs. lowest index category was 1.06 (95% CI: 0.94, 1.20; p-trend = 0.56). Because of the protective associations shown for cardiovascular disease and mortality, the specific dietary components that were chosen to represent adherence to the recommendations may be less applicable to type 2 diabetes risk. PMID:27338354

Evidence-based drug treatment practice and the child welfare system: the example of methadone.

PubMed

Lundgren, Lena M; Schilling, Robert F; Peloquin, Susan D

2005-01-01

This article examined the extent to which methadone maintenance (MM) is considered a treatment alternative for drug-dependent parents, as reflected in the social work and child welfare literature and in child welfare policies. Findings were derived from a review of 15 social work journals published from 1996 through 2002 and from a review of child welfare policies in 27 states in regard to treatment recommendations for substance-abusing parents. These reviews found that 23 articles focused on child welfare-substance abuse issues; no article specifically discussed MM as a treatment option for heroin-using parents; and of the 27 states, only three included methadone as a treatment option in their child welfare policy recommendations. Practice and policy recommendations are discussed.

STS-61 mission director's post-mission report

NASA Technical Reports Server (NTRS)

Newman, Ronald L.

1995-01-01

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

Position Statement Executive Summary: Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

PubMed Central

Arnold, Mark; Bakris, George L.; Bruns, David E.; Horvath, Andrea Rita; Kirkman, M. Sue; Lernmark, Ake; Metzger, Boyd E.; Nathan, David M.

2011-01-01

BACKGROUND Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory analysis in patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. A draft of the guidelines was posted on the Internet, and the document was modified in response to comments. The guidelines were reviewed by the joint Evidence-Based Laboratory Medicine Committee of the AACC and the National Academy of Clinical Biochemistry and were accepted after revisions by the Professional Practice Committee and subsequent approval by the Executive Committee of the American Diabetes Association. CONTENT In addition to the long-standing criteria based on measurement of venous plasma glucose, diabetes can be diagnosed by demonstrating increased hemoglobin A1c (HbA1c) concentrations in the blood. Monitoring of glycemic control is performed by the patients measuring their own plasma or blood glucose with meters and by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended. PMID:21617111

Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus.

PubMed

Sacks, David B; Arnold, Mark; Bakris, George L; Bruns, David E; Horvath, Andrea Rita; Kirkman, M Sue; Lernmark, Ake; Metzger, Boyd E; Nathan, David M

2011-06-01

Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (HbA(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.

Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus.

PubMed

Sacks, David B; Arnold, Mark; Bakris, George L; Bruns, David E; Horvath, Andrea Rita; Kirkman, M Sue; Lernmark, Ake; Metzger, Boyd E; Nathan, David M

2011-06-01

Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (Hb A(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.

Position statement executive summary: guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus.

PubMed

Sacks, David B; Arnold, Mark; Bakris, George L; Bruns, David E; Horvath, Andrea Rita; Kirkman, M Sue; Lernmark, Ake; Metzger, Boyd E; Nathan, David M

2011-06-01

Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. An expert committee compiled evidence-based recommendations for the use of laboratory analysis in patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. A draft of the guidelines was posted on the Internet, and the document was modified in response to comments. The guidelines were reviewed by the joint Evidence-Based Laboratory Medicine Committee of the AACC and the National Academy of Clinical Biochemistry and were accepted after revisions by the Professional Practice Committee and subsequent approval by the Executive Committee of the American Diabetes Association. In addition to the long-standing criteria based on measurement of venous plasma glucose, diabetes can be diagnosed by demonstrating increased hemoglobin A(1c) (HbA(1c)) concentrations in the blood. Monitoring of glycemic control is performed by the patients measuring their own plasma or blood glucose with meters and by laboratory analysis of HbA(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.

Using satellite observations in performance evaluation for regulatory air quality modeling: Comparison with ground-level measurements

NASA Astrophysics Data System (ADS)

Odman, M. T.; Hu, Y.; Russell, A.; Chai, T.; Lee, P.; Shankar, U.; Boylan, J.

2012-12-01

Regulatory air quality modeling, such as State Implementation Plan (SIP) modeling, requires that model performance meets recommended criteria in the base-year simulations using period-specific, estimated emissions. The goal of the performance evaluation is to assure that the base-year modeling accurately captures the observed chemical reality of the lower troposphere. Any significant deficiencies found in the performance evaluation must be corrected before any base-case (with typical emissions) and future-year modeling is conducted. Corrections are usually made to model inputs such as emission-rate estimates or meteorology and/or to the air quality model itself, in modules that describe specific processes. Use of ground-level measurements that follow approved protocols is recommended for evaluating model performance. However, ground-level monitoring networks are spatially sparse, especially for particulate matter. Satellite retrievals of atmospheric chemical properties such as aerosol optical depth (AOD) provide spatial coverage that can compensate for the sparseness of ground-level measurements. Satellite retrievals can also help diagnose potential model or data problems in the upper troposphere. It is possible to achieve good model performance near the ground, but have, for example, erroneous sources or sinks in the upper troposphere that may result in misleading and unrealistic responses to emission reductions. Despite these advantages, satellite retrievals are rarely used in model performance evaluation, especially for regulatory modeling purposes, due to the high uncertainty in retrievals associated with various contaminations, for example by clouds. In this study, 2007 was selected as the base year for SIP modeling in the southeastern U.S. Performance of the Community Multiscale Air Quality (CMAQ) model, at a 12-km horizontal resolution, for this annual simulation is evaluated using both recommended ground-level measurements and non-traditional satellite retrievals. Evaluation results are assessed against recommended criteria and peer studies in the literature. Further analysis is conducted, based upon these assessments, to discover likely errors in model inputs and potential deficiencies in the model itself. Correlations as well as differences in input errors and model deficiencies revealed by ground-level measurements versus satellite observations are discussed. Additionally, sensitivity analyses are employed to investigate errors in emission-rate estimates using either ground-level measurements or satellite retrievals, and the results are compared against each other considering observational uncertainties. Recommendations are made for how to effectively utilize satellite retrievals in regulatory air quality modeling.

Summary of astronaut inputs on automation and robotics for Space Station Freedom

NASA Technical Reports Server (NTRS)

Weeks, David J.

1990-01-01

Astronauts and payload specialists present specific recommendations in the form of an overview that relate to the use of automation and robotics on the Space Station Freedom. The inputs are based on on-orbit operations experience, time requirements for crews, and similar crew-specific knowledge that address the impacts of automation and robotics on productivity. Interview techniques and specific questionnaire results are listed, and the majority of the responses indicate that incorporating automation and robotics to some extent and with human backup can improve productivity. Specific support is found for the use of advanced automation and EVA robotics on the Space Station Freedom and for the use of advanced automation on ground-based stations. Ground-based control of in-flight robotics is required, and Space Station activities and crew tasks should be analyzed to assess the systems engineering approach for incorporating automation and robotics.

Bone Marrow Synoptic Reporting for Hematologic Neoplasms: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center.

PubMed

Sever, Cordelia; Abbott, Charles L; de Baca, Monica E; Khoury, Joseph D; Perkins, Sherrie L; Reichard, Kaaren Kemp; Taylor, Ann; Terebelo, Howard R; Colasacco, Carol; Rumble, R Bryan; Thomas, Nicole E

2016-09-01

-There is ample evidence from the solid tumor literature that synoptic reporting improves accuracy and completeness of relevant data. No evidence-based guidelines currently exist for synoptic reporting for bone marrow samples. -To develop evidence-based recommendations to standardize the basic components of a synoptic report template for bone marrow samples. -The College of American Pathologists Pathology and Laboratory Quality Center convened a panel of experts in hematopathology to develop recommendations. A systematic evidence review was conducted to address 5 key questions. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus. -Nine guideline statements were established to provide pathology laboratories with a framework by which to develop synoptic reporting templates for bone marrow samples. The guideline calls for specific data groups in the synoptic section of the pathology report; provides a list of evidence-based parameters for key, pertinent elements; and addresses ancillary testing. -A framework for bone marrow synoptic reporting will improve completeness of the final report in a manner that is clear, succinct, and consistent among institutions.

Moving research tools into practice: the successes and challenges in promoting uptake of classification tools.

PubMed

Cunningham, Barbara Jane; Hidecker, Mary Jo Cooley; Thomas-Stonell, Nancy; Rosenbaum, Peter

2018-05-01

In this paper, we present our experiences - both successes and challenges - in implementing evidence-based classification tools into clinical practice. We also make recommendations for others wanting to promote the uptake and application of new research-based assessment tools. We first describe classification systems and the benefits of using them in both research and practice. We then present a theoretical framework from Implementation Science to report strategies we have used to implement two research-based classification tools into practice. We also illustrate some of the challenges we have encountered by reporting results from an online survey investigating 58 Speech-language Pathologists' knowledge and use of the Communication Function Classification System (CFCS), a new tool to classify children's functional communication skills. We offer recommendations for researchers wanting to promote the uptake of new tools in clinical practice. Specifically, we identify structural, organizational, innovation, practitioner, and patient-related factors that we recommend researchers address in the design of implementation interventions. Roles and responsibilities of both researchers and clinicians in making implementations science a success are presented. Implications for rehabilitation Promoting uptake of new and evidence-based tools into clinical practice is challenging. Implementation science can help researchers to close the knowledge-to-practice gap. Using concrete examples, we discuss our experiences in implementing evidence-based classification tools into practice within a theoretical framework. Recommendations are provided for researchers wanting to implement new tools in clinical practice. Implications for researchers and clinicians are presented.

Problems with the 2015 Dietary Guidelines for Americans: An Alternative.

PubMed

DiNicolantonio, James J; Harcombe, Zoë; O'Keefe, James H

2016-01-01

Abstract The updated 2015 Dietary Guidelines for Americans, published in January 2016, have stirred much controversy since the advisory report first appeared. Several important changes have been made, with some recommendations having greater scientific evidence for their support than others. The focus of this review is to discuss specific recommendations from the 2015 Dietary Guidelines for Americans that lack sound scientific evidence; these include: 1) Allowing approximately half of all grains to be refined; 2) The continued recommendations for fat-free or low-fat dairy and limitation of saturated fat intake to < 10% of calories; 3) Sodium intake < 2,300 mg/day; and 4) Consumption of up to 27 grams/day of "oils" (high in polyunsaturated fat or monounsaturated fat). Based on our review, the aforementioned recommendations found in the updated 2015 Dietary Guideline for Americans may increase the incidence of cardiometabolic disease, diabetes, obesity, dyslipidemia, cardiovascular disease, and possibly cancer.

[Methodological limitations and recommendations in publications on migrant population health in Spain].

PubMed

Monge, Susana; Ronda, Elena; Pons-Vigués, Mariona; Vives Cases, Carmen; Malmusi, Davide; Gil-González, Diana

2015-01-01

Our objective was to describe the methodological limitations and recommendations identified by authors of original articles on immigration and health in Spain. A literature review was conducted of original articles published in Spanish or English between 1998 and 2012 combining keywords on immigration and health. A total of 311 articles were included; of these, 176 (56.6%) mentioned limitations, and 15 (4.8%) made recommendations. The most frequently mentioned limitations included the following: reduced sample sizes; internal validity and sample representativeness issues, with under- or overrepresentation of specific groups; problems of validity of the collected information and missing data mostly related to measurement tools; and absence of key variables for adjustment or stratification. Based on these results, a series of recommendations are proposed to minimise common limitations and advance the quality of scientific production on immigration and health in our setting. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

A Service Brokering and Recommendation Mechanism for Better Selecting Cloud Services

PubMed Central

Gui, Zhipeng; Yang, Chaowei; Xia, Jizhe; Huang, Qunying; Liu, Kai; Li, Zhenlong; Yu, Manzhu; Sun, Min; Zhou, Nanyin; Jin, Baoxuan

2014-01-01

Cloud computing is becoming the new generation computing infrastructure, and many cloud vendors provide different types of cloud services. How to choose the best cloud services for specific applications is very challenging. Addressing this challenge requires balancing multiple factors, such as business demands, technologies, policies and preferences in addition to the computing requirements. This paper recommends a mechanism for selecting the best public cloud service at the levels of Infrastructure as a Service (IaaS) and Platform as a Service (PaaS). A systematic framework and associated workflow include cloud service filtration, solution generation, evaluation, and selection of public cloud services. Specifically, we propose the following: a hierarchical information model for integrating heterogeneous cloud information from different providers and a corresponding cloud information collecting mechanism; a cloud service classification model for categorizing and filtering cloud services and an application requirement schema for providing rules for creating application-specific configuration solutions; and a preference-aware solution evaluation mode for evaluating and recommending solutions according to the preferences of application providers. To test the proposed framework and methodologies, a cloud service advisory tool prototype was developed after which relevant experiments were conducted. The results show that the proposed system collects/updates/records the cloud information from multiple mainstream public cloud services in real-time, generates feasible cloud configuration solutions according to user specifications and acceptable cost predication, assesses solutions from multiple aspects (e.g., computing capability, potential cost and Service Level Agreement, SLA) and offers rational recommendations based on user preferences and practical cloud provisioning; and visually presents and compares solutions through an interactive web Graphical User Interface (GUI). PMID:25170937

Automated personnel data base system specifications, Task V. Final report

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

Bartley, H.J.; Bocast, A.K.; Deppner, F.O.

1978-11-01

The full title of this study is 'Development of Qualification Requirements, Training Programs, Career Plans, and Methodologies for Effective Management and Training of Inspection and Enforcement Personnel.' Task V required the development of an automated personnel data base system for NRC/IE. This system is identified as the NRC/IE Personnel, Assignment, Qualifications, and Training System (PAQTS). This Task V report provides the documentation for PAQTS including the Functional Requirements Document (FRD), the Data Requirements Document (DRD), the Hardware and Software Capabilities Assessment, and the Detailed Implementation Schedule. Specific recommendations to facilitate implementation of PAQTS are also included.

Controlling corporate influence in health policy making? An assessment of the implementation of article 5.3 of the World Health Organization framework convention on tobacco control.

PubMed

Fooks, Gary Jonas; Smith, Julia; Lee, Kelley; Holden, Chris

2017-03-08

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) stands to significantly reduce tobacco-related mortality by accelerating the introduction of evidence-based tobacco control measures. However, the extent to which States Parties have implemented the Convention varies considerably. Article 5.3 of the FCTC, is intended to insulate policy-making from the tobacco industry's political influence, and aims to address barriers to strong implementation of the Convention associated with tobacco industry political activity. This paper quantitatively assesses implementation of Article 5.3's Guidelines for Implementation, evaluates the strength of Parties' efforts to implement specific recommendations, and explores how different approaches to implementation expose the policy process to continuing industry influence. We cross-referenced a broad range of documentary data (including FCTC Party reports and World Bank data on the governance of conflicts of interest in public administration) against Article 5.3 implementation guidelines (n = 24) for 155 Parties, and performed an in-depth thematic analysis to examine the strength of implementation for specific recommendations. Across all Parties, 16% of guideline recommendations reviewed have been implemented. Eighty-three percent of Parties that have taken some action under Article 5.3 have introduced less than a third of the guidelines. Most compliance with the guidelines is achieved through pre-existing policy instruments introduced independently of the FCTC, which rarely cover all relevant policy actors and fall short of the guideline recommendations. Measures introduced in response to the FCTC are typically restricted to health ministries and not explicit about third parties acting on behalf of the industry. Parties systematically overlook recommendations that facilitate industry monitoring. Highly selective and incomplete implementation of specific guideline recommendations facilitates extensive ongoing opportunities for industry policy influence. Stronger commitment to implementation is required to ensure consistently strong compliance with the FCTC internationally.

Accuracy and adequacy of waist circumference cut-off points currently recommended in Brazilian adults.

PubMed

Vianna, Carolina Avila; da Silva Linhares, Rogério; Bielemann, Renata Moraes; Machado, Eduardo Coelho; González-Chica, David Alejandro; Matijasevich, Alicia Manitto; Gigante, Denise Petrucci; da Silva Dos Santos, Iná

2014-04-01

To evaluate the adequacy and accuracy of cut-off values currently recommended by the WHO for assessment of cardiovascular risk in southern Brazil. Population-based study aimed at determining the predictive ability of waist circumference for cardiovascular risk based on the use of previous medical diagnosis for hypertension, diabetes mellitus and/or dyslipidaemia. Descriptive analysis was used for the adequacy of current cut-off values of waist circumference, receiver operating characteristic curves were constructed and the most accurate criteria according to the Youden index and points of optimal sensitivity and specificity were identified. Pelotas, southern Brazil. Individuals (n 2112) aged ≥20 years living in the city were selected by multistage sampling, since these individuals did not report the presence of previous myocardial infarction, angina pectoris or stroke. The cut-off values currently recommended by WHO were more appropriate in men than women, with overestimation of cardiovascular risk in women. The area under the receiver operating characteristic curve showed moderate predictive ability of waist circumference in men (0.74, 95% CI 0.71, 0.76) and women (0.75, 95% CI 0.73, 0.77). The method of optimal sensitivity and specificity showed better performance in assessing the accuracy, identifying the values of 95 cm in men and 87 cm in women as the best cut-off values of waist circumference to assess cardiovascular risk. The cut-off values currently recommended for waist circumference are not suitable for women. Longitudinal studies should be conducted to evaluate the consistency of the findings.

U.S. Selected Practice Recommendations for Contraceptive Use, 2016.

PubMed

Curtis, Kathryn M; Jatlaoui, Tara C; Tepper, Naomi K; Zapata, Lauren B; Horton, Leah G; Jamieson, Denise J; Whiteman, Maura K

2016-07-29

The 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2013 U.S. SPR (CDC. U.S. selected practice recommendations for contraceptive use, 2013. MMWR 2013;62[No. RR-5]). Major updates include 1) revised recommendations for starting regular contraception after the use of emergency contraceptive pills and 2) new recommendations for the use of medications to ease insertion of intrauterine devices. The recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. Health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options.

Construction of a Clinical Decision Support System for Undergoing Surgery Based on Domain Ontology and Rules Reasoning

PubMed Central

Bau, Cho-Tsan; Huang, Chung-Yi

2014-01-01

Abstract Objective: To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. Materials and Methods: The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé–Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. Results: The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. Conclusions: The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia. PMID:24730353

Construction of a clinical decision support system for undergoing surgery based on domain ontology and rules reasoning.

PubMed

Bau, Cho-Tsan; Chen, Rung-Ching; Huang, Chung-Yi

2014-05-01

To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé-Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia.

An independent jury-based consensus conference model for the development of recommendations in medico-surgical practice.

PubMed

Lesurtel, Mickaël; Perrier, Arnaud; Bossuyt, Patrick M M; Langer, Bernard; Clavien, Pierre-Alain

2014-03-01

There is an increasing demand for standardization in the choice of treatments for specific conditions, so-called personalized medicine. The task is far from trivial, because the perspectives from many stakeholders must be respected, including patients and health care providers, as well as payers or governments to better control costs while optimizing quality of care. One approach to provide widely accepted therapies is the consensus conference. We describe a novel methodology to achieve consensus in controversial areas with the main goal to minimize biases. The principle of this approach relies on a clear distinction between those who provide the evidence (experts) and those who draw the final recommendations (the jury). The jury consists of individuals with sufficient background knowledge to cover the perspectives of all stakeholders' without being involved directly in the topic under evaluation. The organizing committee, the experts, and the jury interact within 3 phases: Preparation, the actual consensus conference, and deliberations. Each question is addressed by a panel of experts, leading to the proposition of recommendations at the conference meeting, which are challenged by the jury and the audience. Based on all available information, the jury finalizes the consensus recommendations, which are eventually published and made available to all. This novel model of consensus conference allows the construction of consensual, evidence-based, explicit recommendations for therapies in a process that may also identify issues for further research, eventually fostering progress in the field. Copyright © 2014 Mosby, Inc. All rights reserved.

75 FR 69094 - Solicitation for Nominations for Members of the U.S. Preventive Services Task Force (USPSTF)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-10

... final recommendation documents, and participating in workgroups on specific topics or methods. A... literature and in the methods of evidence review; 2. Understanding and experience in the application of... based on their expertise in methodological issues such as medical decisionmaking, clinical epidemiology...

Research and Theory into Instructional Practice: A Realistic Challenge or an Impossible Dream.

ERIC Educational Resources Information Center

French, Margaret

Theorists, researchers, and practitioners should be problem solvers, and need to integrate research findings within practical models. Given a defined instructional problem, the recommendation of an appropriate solution should be based on the realization that only prescriptive design theory emphasizes methods and presentation specifications, and…

Factors That Influence Faculty Adoption of Learning-Centered Approaches

ERIC Educational Resources Information Center

Blumberg, Phyllis

2016-01-01

This article proposes a recommended course of action for faculty development based upon Rogers' theory of Diffusion of Innovations and data collected in a study looking at the prevalence of use of learning-centered teaching practices. Specific faculty development strategies are aligned with Rogers' factors influencing decisions to adopt…

Vocational Education and At-Risk Youth in the United States.

ERIC Educational Resources Information Center

Bishop, John H.

1995-01-01

Recommendations favoring generic academic rather than occupationally specific skills are based on false premises. Research evidence contradicts the following assertions: (1) academic skills are good substitutes for occupational skills; (2) skill obsolescence reduces the payoff to vocational training; and (3) rising job turnover reduces the payoff…

Plan for the Development of Library Service in Montana.

ERIC Educational Resources Information Center

Warncke, Ruth

This plan for the development of Montana library service is based on the experiences of other states, opinions of library experts, written information on Montana libraries, visits to several libraries, and attendance at meetings of the Montana Library Association and its committees. Specific recommendations include: moving the State Library…

Evaluation of Motorist Warning Systems for Fog-Related Incidents in the Tampa Bay Area

DOT National Transportation Integrated Search

1997-06-01

The purpose of this evaluation is to investigate and define the specific Tampa : Bay area conditions for fog and fog-related crashes that may exist and recommend an area-wide plan based on these findings to ensure that drivers react more consistently...

Social Cognitive Theory Recommendations for Improving Modeling in Adolescent Substance Abuse Prevention Programs.

ERIC Educational Resources Information Center

Cleaveland, Bonnie L.

1994-01-01

Current state-of-the-art substance abuse prevention programs are mostly social cognitive theory based. However, there are few publications which review specifically how modeling is applied to adolescent substance abuse prevention programs. This article reviews theoretical considerations for implementing modeling for this purpose. (Author/LKS)

Development and Exploratory Validation of an Organizational Efficacy Scale

ERIC Educational Resources Information Center

Bohn, James G.

2010-01-01

Although many instruments have been developed to measure organizational constructs such as citizenship, climate, and organization-based esteem, to date no scale has been designed specifically to measure efficacy at the organizational level. Tools to measure organizational efficacy in a business context have been recommended for over two decades.…

The Principles of Economics from Now until Then: A Comment.

ERIC Educational Resources Information Center

Amacher, Ryan C.

1988-01-01

Comments on Bell's article "The Principles of Economics from Now until Then," responding to the author's two general premises as well as citing specific arguments. Concludes that Bell's premises are based on a small and unrepresentative number of textbooks. Many textbooks that present material according to the recommendations were…

Achieving Competency in Electroconvulsive Therapy: A Model Curriculum

ERIC Educational Resources Information Center

Dolenc, Tamara J.; Philbrick, Kemuel L.

2007-01-01

Objective: This article illustrates a model electroconvulsive therapy (ECT) curriculum with specific parameters of both practice-based learning and medical knowledge. Method: The authors review the recommendations of the APA Task Force on ECT as they relate to training in ECT in psychiatry residency programs, and discuss diverse educational…

Managing "Helicobacter Pylori" in College Health, with Special Considerations for International Students

ERIC Educational Resources Information Center

Hillard, James Randolph; Kashup, Suman

2016-01-01

Objective: "Helicobacter pylori" infection is the major cause of dyspepsia, peptic ulcer disease, and gastric cancer. This paper will make specific recommendations for a diagnostic and treatment strategy tailored to the international student population. Participants/Methods: This paper is a case report and narrative review based on…

ICCS/ESCCA consensus guidelines to detect GPI-deficient cells in paroxysmal nocturnal hemoglobinuria (PNH) and related disorders part 4 - assay validation and quality assurance.

PubMed

Oldaker, Teri; Whitby, Liam; Saber, Maryam; Holden, Jeannine; Wallace, Paul K; Litwin, Virginia

2018-01-01

Over the past six years, a diverse group of stakeholders have put forth recommendations regarding the analytical validation of flow cytometric methods and described in detail the differences between cell-based and traditional soluble analyte assay validations. This manuscript is based on these general recommendations as well as the published experience of experts in the area of PNH testing. The goal is to provide practical assay-specific guidelines for the validation of high-sensitivity flow cytometric PNH assays. Examples of the reports and validation data described herein are provided in Supporting Information. © 2017 International Clinical Cytometry Society. © 2017 International Clinical Cytometry Society.

Never enough sleep: a brief history of sleep recommendations for children.

PubMed

Matricciani, Lisa Anne; Olds, Tim S; Blunden, Sarah; Rigney, Gabrielle; Williams, Marie T

2012-03-01

There is a common belief that children are not getting enough sleep and that children's total sleep time has been declining. Over the century, many authors have proposed sleep recommendations. The aim of this study was to describe historical trends in recommended and actual sleep durations for children and adolescents, and to explore the rationale of sleep recommendations. A systematic literature review was conducted to identify recommendations for children's sleep requirements and data reporting children's actual total sleep time. For each recommendation identified, children's actual sleep time was determined by identifying studies reporting the sleep duration of children of the same age, gender, and country in the same years. Historical trends in age-adjusted recommended sleep times and trends in children's actual sleep time were calculated. A thematic analysis was conducted to determine the rationale and evidence-base for recommendations. Thirty-two sets of recommendations were located dating from 1897 to 2009. On average, age-specific recommended sleep decreased at the rate of -0.71 minute per year. This rate of decline was almost identical to the decline in the actual sleep duration of children (-0.73 minute per year). Recommended sleep was consistently ∼37 minutes greater than actual sleep, although both declined over time. A lack of empirical evidence for sleep recommendations was universally acknowledged. Inadequate sleep was seen as a consequence of "modern life," associated with technologies of the time. No matter how much sleep children are getting, it has always been assumed that they need more.

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

Peck, T; Sparkman, D; Storch, N

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

A game theory-based trust measurement model for social networks.

PubMed

Wang, Yingjie; Cai, Zhipeng; Yin, Guisheng; Gao, Yang; Tong, Xiangrong; Han, Qilong

2016-01-01

In social networks, trust is a complex social network. Participants in online social networks want to share information and experiences with as many reliable users as possible. However, the modeling of trust is complicated and application dependent. Modeling trust needs to consider interaction history, recommendation, user behaviors and so on. Therefore, modeling trust is an important focus for online social networks. We propose a game theory-based trust measurement model for social networks. The trust degree is calculated from three aspects, service reliability, feedback effectiveness, recommendation credibility, to get more accurate result. In addition, to alleviate the free-riding problem, we propose a game theory-based punishment mechanism for specific trust and global trust, respectively. We prove that the proposed trust measurement model is effective. The free-riding problem can be resolved effectively through adding the proposed punishment mechanism.

Recommendations and strategies for using reclaimed asphalt pavement in the Flemish Region based on a first life cycle assessment research

NASA Astrophysics Data System (ADS)

Van den bergh, Wim; Kara, Patricia; Anthonissen, Joke; Margaritis, Alexandros; Jacobs, Geert; Couscheir, Karolien

2017-09-01

In Flanders, using Reclaimed Asphalt Pavement (RAP) is allowed in asphalt mixes for base layers. Primary economic and secondary laboratory-measured mechanical properties are given as justification for higher amounts in specific mixes. However, one should evaluate the performance of these mixes on long-term by environmental impact of the production until end-of-life. In this paper recommendations and strategies for using RA, based on current research, are discussed in a broader perspective such as using a carbon-footprint tool and warm-mix asphalt production in the Flemish Region. The paper aims to a wide discussion by reporting several outcomes of laboratory research, statistics and practical application in order to set a general strategy for the road engineering sector in the Flemish Region.

Does GEM-encoding clinical practice guidelines improve the quality of knowledge bases? A study with the rule-based formalism.

PubMed

Georg, Georg; Séroussi, Brigitte; Bouaud, Jacques

2003-01-01

The aim of this work was to determine whether the GEM-encoding step could improve the representation of clinical practice guidelines as formalized knowledge bases. We used the 1999 Canadian recommendations for the management of hypertension, chosen as the knowledge source in the ASTI project. We first clarified semantic ambiguities of therapeutic sequences recommended in the guideline by proposing an interpretative framework of therapeutic strategies. Then, after a formalization step to standardize the terms used to characterize clinical situations, we created the GEM-encoded instance of the guideline. We developed a module for the automatic derivation of a rule base, BR-GEM, from the instance. BR-GEM was then compared to the rule base, BR-ASTI, embedded within the critic mode of ASTI, and manually built by two physicians from the same Canadian guideline. As compared to BR-ASTI, BR-GEM is more specific and covers more clinical situations. When evaluated on 10 patient cases, the GEM-based approach led to promising results.

Extending WS-Agreement with Multi-round Negotiation Capability

NASA Astrophysics Data System (ADS)

Rumpl, Angela; Wäldrich, Oliver; Ziegler, Wolfgang

The WS-Agreement specification of the Open Grid Forum defines a language and a protocol for advertising the capabilities of service providers and creating agreements based on templates, and for monitoring agreement compliance at runtime. While the specification, which currently is in the process of transition from a proposed recommendation of the Open Grid Forum to a full recommendation, has been widely used after the initial publication in May 2007, it became obvious that the missing possibility to negotiate an agreement rather than just accepting an offer is limiting or inhibiting the use of WS-Agreement for a number of use-cases. Therefore, the Grid Resource Allocation Agreement Working Group of the Open Grid Forum started in 2008 to prepare an extension of WS-Agreement that adds negotiation capabilities without changing the current specification in a way, which leads to an incompatible new version of WS-Agreement. In this paper we present the results of this process with an updated version of the specification in mind and the first implementation in the European project SmartLM.

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

PubMed Central

2013-01-01

Background Risk-stratified treatment recommendations facilitate treatment decision-making that balances patient-specific risks and preferences. It is unclear if and how such recommendations are developed in clinical practice guidelines (CPGs). Our aim was to assess if and how CPGs develop risk-stratified treatment recommendations for the prevention or treatment of common chronic diseases. Methods We searched the United States National Guideline Clearinghouse for US, Canadian and National Institute for Health and Clinical Excellence (United Kingdom) CPGs for heart disease, stroke, cancer, chronic obstructive pulmonary disease and diabetes that make risk-stratified treatment recommendations. We included only those CPGs that made risk-stratified treatment recommendations based on risk assessment tools. Two reviewers independently identified CPGs and extracted information on recommended risk assessment tools; type of evidence about treatment benefits and harms; methods for linking risk estimates to treatment evidence and for developing treatment thresholds; and consideration of patient preferences. Results We identified 20 CPGs that made risk-stratified treatment recommendations out of 133 CPGs that made any type of treatment recommendations for the chronic diseases considered in this study. Of the included 20 CPGs, 16 (80%) used evidence about treatment benefits from randomized controlled trials, meta-analyses or other guidelines, and the source of evidence was unclear in the remaining four (20%) CPGs. Nine CPGs (45%) used evidence on harms from randomized controlled trials or observational studies, while 11 CPGs (55%) did not clearly refer to harms. Nine CPGs (45%) explained how risk prediction and evidence about treatments effects were linked (for example, applying estimates of relative risk reductions to absolute risks), but only one CPG (5%) assessed benefit and harm quantitatively and three CPGs (15%) explicitly reported consideration of patient preferences. Conclusions Only a small proportion of CPGs for chronic diseases make risk-stratified treatment recommendations with a focus on heart disease and stroke prevention, diabetes and breast cancer. For most CPGs it is unclear how risk-stratified treatment recommendations were developed. As a consequence, it is uncertain if CPGs support patients and physicians in finding an acceptable benefit- harm balance that reflects both profile-specific outcome risks and preferences. PMID:23302096

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM).

PubMed

Hinkelbein, Jochen; Böhm, Lennert; Braunecker, Stefan; Genzwürker, Harald V; Kalina, Steffen; Cirillo, Fabrizio; Komorowski, Matthieu; Hohn, Andreas; Siedenburg, Jörg; Bernhard, Michael; Janicke, Ilse; Adler, Christoph; Jansen, Stefanie; Glaser, Eckard; Krawczyk, Pawel; Miesen, Mirko; Andres, Janusz; De Robertis, Edoardo; Neuhaus, Christopher

2018-05-05

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

Canadian supportive care recommendations for the management of neutropenia in patients with cancer.

PubMed

Kouroukis, C T; Chia, S; Verma, S; Robson, D; Desbiens, C; Cripps, C; Mikhael, J

2008-01-01

Hematologic toxicities of cancer chemotherapy are common and often limit the ability to provide treatment in a timely and dose-intensive manner. These limitations may be of utmost importance in the adjuvant and curative intent settings. Hematologic toxicities may result in febrile neutropenia, infections, fatigue, and bleeding, all of which may lead to additional complications and prolonged hospitalization. The older cancer patient and patients with significant comorbidities may be at highest risk of neutropenic complications. Colony-stimulating factors (csfs) such as filgrastim and pegfilgrastim can effectively attenuate most of the neutropenic consequences of chemotherapy, improve the ability to continue chemotherapy on the planned schedule, and minimize the risk of febrile neutropenia and infectious morbidity and mortality. The present consensus statement reviews the use of csfs in the management of neutropenia in patients with cancer and sets out specific recommendations based on published international guidelines tailored to the specifics of the Canadian practice landscape. We review existing international guidelines, the indications for primary and secondary prophylaxis, the importance of maintaining dose intensity, and the use of csfs in leukemia, stem-cell transplantation, and radiotherapy. Specific disease-related recommendations are provided related to breast cancer, non-Hodgkin lymphoma, lung cancer, and gastrointestinal cancer. Finally, csf dosing and schedules, duration of therapy, and associated acute and potential chronic toxicities are examined.

Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity.

PubMed

Oxman, Andrew D; Schünemann, Holger J; Fretheim, Atle

2006-12-05

The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 12th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. We reviewed the literature on incorporating considerations of equity in guidelines and recommendations. We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. We found few directly relevant empirical methodological studies. These answers are based largely on logical arguments. When and how should inequities be addressed in systematic reviews that are used as background documents for recommendations? The following question should routinely be considered: Are there plausible reasons for anticipating differential relative effects across disadvantaged and advantaged populations? If there are plausible reasons for anticipating differential effects, additional evidence should be included in a review to inform judgments about the likelihood of differential effects. What questions about equity should routinely be addressed by those making recommendations on behalf of WHO? The following additional questions should routinely be considered: How likely is it that the results of available research are applicable to disadvantaged populations and settings? How likely are differences in baseline risk that would result in differential absolute effects across disadvantaged and advantaged populations? How likely is it that there are important differences in trade-offs between the expected benefits and harms across disadvantaged and advantaged populations? Are there different implications for disadvantaged and advantaged populations, or implications for addressing inequities? What context specific information is needed to inform adaptation and decision making in a specific setting with regard to impacts on equity? Those making recommendations on behalf of WHO should routinely consider and offer advice about the importance of the following types of context specific data that might be needed to inform adaptation and decision making in a specific setting: Effect modifiers for disadvantaged populations and for the likelihood of differential effects. Baseline risk in relationship to social and economic status. Utilization and access to care in relationship to social and economic status. Costs in relationship to social and economic status. Ethics and laws that may impact on strategies for addressing inequities. Availability of resources to address inequities. What implementation strategies are likely be needed to ensure that recommendations are implemented equitably? Organisational changes are likely to be important to address inequities. While it may only be possible to consider these in relationship to specific settings, consideration should be given to how best to provide support for identifying and addressing needs for organisational changes. In countries with pervasive inequities institutional, cultural and political changes may first be needed. Appropriate indicators of social and economic status should be used to monitor the effects of implementing recommendations on disadvantaged populations and on changes in social and economic status.

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

PubMed

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

2011-01-01

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

Survey of Current Practice in the Fitting and Fine-Tuning of Common Signal-Processing Features in Hearing Aids for Adults.

PubMed

Anderson, Melinda C; Arehart, Kathryn H; Souza, Pamela E

2018-02-01

Current guidelines for adult hearing aid fittings recommend the use of a prescriptive fitting rationale with real-ear verification that considers the audiogram for the determination of frequency-specific gain and ratios for wide dynamic range compression. However, the guidelines lack recommendations for how other common signal-processing features (e.g., noise reduction, frequency lowering, directional microphones) should be considered during the provision of hearing aid fittings and fine-tunings for adult patients. The purpose of this survey was to identify how audiologists make clinical decisions regarding common signal-processing features for hearing aid provision in adults. An online survey was sent to audiologists across the United States. The 22 survey questions addressed four primary topics including demographics of the responding audiologists, factors affecting selection of hearing aid devices, the approaches used in the fitting of signal-processing features, and the strategies used in the fine-tuning of these features. A total of 251 audiologists who provide hearing aid fittings to adults completed the electronically distributed survey. The respondents worked in a variety of settings including private practice, physician offices, university clinics, and hospitals/medical centers. Data analysis was based on a qualitative analysis of the question responses. The survey results for each of the four topic areas (demographics, device selection, hearing aid fitting, and hearing aid fine-tuning) are summarized descriptively. Survey responses indicate that audiologists vary in the procedures they use in fitting and fine-tuning based on the specific feature, such that the approaches used for the fitting of frequency-specific gain differ from other types of features (i.e., compression time constants, frequency lowering parameters, noise reduction strength, directional microphones, feedback management). Audiologists commonly rely on prescriptive fitting formulas and probe microphone measures for the fitting of frequency-specific gain and rely on manufacturers' default settings and recommendations for both the initial fitting and the fine-tuning of signal-processing features other than frequency-specific gain. The survey results are consistent with a lack of published protocols and guidelines for fitting and adjusting signal-processing features beyond frequency-specific gain. To streamline current practice, a transparent evidence-based tool that enables clinicians to prescribe the setting of other features from individual patient characteristics would be desirable. American Academy of Audiology

Summary Report on the Audit of Defense Logistics Agency 1995 Defense Base Realignment and Closure Data Collection Process.

DTIC Science & Technology

1995-06-19

VXW-ÄVAVKVX’AWXW/XVXV:*: OFFICE OF THE INSPECTOR GENERAL SUMMARY REPORT ON THE AUDIT OF DEFENSE LOGISTICS AGENCY 1995 DEFENSE BASE REALIGNMENT...FOR DIRECTOR, DEFENSE LOGISTICS AGENCY SUBJECT: Summary Report on the Audit of Defense Logistics Agency 1995 Defense Base Realignment and Closure...the data that DLA provides to support recommendations for the 1995 Commission. The specific objective for the audits was to determine whether the

The flipped classroom: now or never?

PubMed

Hawks, Sharon J

2014-08-01

Pedagogical changes and new models of delivering educational content should be considered in the effort to address the recommendations of the 2007 Institute of Medicine report and Benner's recommendations on the radical transformation of nursing. Transition to the nurse anesthesia practice doctorate addresses the importance of these recommendations, but educational models and specific strategies on how to implement changes in educational models and systems are still emerging. The flipped classroom (FC) is generating a considerable amount of buzz in academic circles. The FC is a pedagogical model that employs asynchronous video lectures, reading assignments, practice problems, and other digital, technology-based resources outside the classroom, and interactive, group-based, problem-solving activities in the classroom. This FC represents a unique combination of constructivist ideology and behaviorist principles, which can be used to address the gap between didactic education and clinical practice performance. This article reviews recent evidence supporting use of the FC in health profession education and suggests ways to implement the FC in nurse anesthesia educational programs.

The New CCSDS Image Compression Recommendation

NASA Technical Reports Server (NTRS)

Yeh, Pen-Shu; Armbruster, Philippe; Kiely, Aaron; Masschelein, Bart; Moury, Gilles; Schaefer, Christoph

2005-01-01

The Consultative Committee for Space Data Systems (CCSDS) data compression working group has recently adopted a recommendation for image data compression, with a final release expected in 2005. The algorithm adopted in the recommendation consists of a two-dimensional discrete wavelet transform of the image, followed by progressive bit-plane coding of the transformed data. The algorithm can provide both lossless and lossy compression, and allows a user to directly control the compressed data volume or the fidelity with which the wavelet-transformed data can be reconstructed. The algorithm is suitable for both frame-based image data and scan-based sensor data, and has applications for near-Earth and deep-space missions. The standard will be accompanied by free software sources on a future web site. An Application-Specific Integrated Circuit (ASIC) implementation of the compressor is currently under development. This paper describes the compression algorithm along with the requirements that drove the selection of the algorithm. Performance results and comparisons with other compressors are given for a test set of space images.

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

PubMed Central

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

2011-01-01

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

S3-guideline "helicobacter pylori and gastroduodenal ulcer disease" of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e. V., German society for rheumatology, AWMF-registration-no. 021 / 001.

PubMed

Fischbach, W; Malfertheiner, P; Hoffmann, J C; Bolten, W; Bornschein, J; Götze, O; Höhne, W; Kist, M; Koletzko, S; Labenz, J; Layer, P; Miehlke, St; Morgner, A; Peitz, U; Preiss, J; Prinz, C; Rosien, U; Schmidt, W; Schwarzer, A; Suerbaum, St; Timmer, A; Treiber, G; Vieth, M

2009-12-01

This guideline updates a prior consensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE), and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based S 3 level consensus guideline and has also implemented grading criteria according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics, and therapy were taken into account.

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region

PubMed Central

Cameron, Donald; Hock, Quak Seng; Kadim, Musal; Mohan, Neelam; Ryoo, Eell; Sandhu, Bhupinder; Yamashiro, Yuichiro; Jie, Chen; Hoekstra, Hans; Guarino, Alfredo

2017-01-01

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials. PMID:29259371

2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

PubMed

Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

2015-10-01

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. © 2015, American College of Rheumatology.

Implementation of evidence-based weekend service recommendations for allied health managers: a cluster randomised controlled trial protocol.

PubMed

Sarkies, Mitchell N; White, Jennifer; Morris, Meg E; Taylor, Nicholas F; Williams, Cylie; O'Brien, Lisa; Martin, Jenny; Bardoel, Anne; Holland, Anne E; Carey, Leeanne; Skinner, Elizabeth H; Bowles, Kelly-Ann; Grant, Kellie; Philip, Kathleen; Haines, Terry P

2018-04-24

It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers. This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up. Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice. This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) ( ACTRN12618000029291 ). Universal Trial Number (UTN): U1111-1205-2621.

Lunar base launch and landing facility conceptual design, 2nd edition

NASA Technical Reports Server (NTRS)

1988-01-01

This report documents the Lunar Base Launch and Landing Facility Conceptual Design study. The purpose of this study was to examine the requirements for launch and landing facilities for early lunar bases and to prepare conceptual designs for some of these facilities. The emphasis of this study is on the facilities needed from the first manned landing until permanent occupancy. Surface characteristics and flight vehicle interactions are described, and various facility operations are related. Specific recommendations for equipment, facilities, and evolutionary planning are made, and effects of different aspects of lunar development scenarios on facilities and operations are detailed. Finally, for a given scenario, a specific conceptual design is developed and presented.

Practice-based Research Network Research Good Practices (PRGPs): Summary of Recommendations.

PubMed

Dolor, Rowena J; Campbell-Voytal, Kimberly; Daly, Jeanette; Nagykaldi, Zsolt J; O'Beirne, Maeve; Sterling, Pamela; Fagnan, Lyle J; Levy, Barcey; Michaels, LeAnn; Louks, Hannah A; Smith, Paul; Aspy, Cheryl B; Patterson, V Beth; Kano, Miria; Sussman, Andrew L; Williams, Robert; Neale, Anne Victoria

2015-12-01

Practice-based research networks (PBRNs) conduct research in community settings, which poses quality control challenges to the integrity of research, such as study implementation and data collection. A foundation for improving research processes within PBRNs is needed to ensure research integrity. Network directors and coordinators from seven U.S.-based PBRNs worked with a professional team facilitator during semiannual in-person meetings and monthly conference calls to produce content for a compendium of recommended research practices specific to the context of PBRNs. Participants were assigned to contribute content congruent with their expertise. Feedback on the draft document was obtained from attendees at the preconference workshop at the annual PBRN meeting in 2013. A revised document was circulated to additional PBRN peers prior to finalization. The PBRN Research Good Practices (PRGPs) document is organized into four chapters: (1) Building PBRN Infrastructure; (2) Study Development and Implementation; (3) Data Management, and (4) Dissemination Policies. Each chapter contains an introduction, detailed procedures for each section, and example resources with information links. The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. © 2015 Wiley Periodicals, Inc.

Application of Recommended Design Practices for Conceptual Nuclear Fusion Space Propulsion Systems

NASA Technical Reports Server (NTRS)

Williams, Craig H.

2004-01-01

An AIAA Special Project Report was recently produced by AIAA's Nuclear and Future Flight Propulsion Technical Committee and is currently in peer review. The Report provides recommended design practices for conceptual engineering studies of nuclear fusion space propulsion systems. Discussion and recommendations are made on key topics including design reference missions, degree of technological extrapolation and concomitant risk, thoroughness in calculating mass properties (nominal mass properties, weight-growth contingency and propellant margins, and specific impulse), and thoroughness in calculating power generation and usage (power-flow, power contingencies, specific power). The report represents a general consensus of the nuclear fusion space propulsion system conceptual design community and proposes 15 recommendations. This paper expands on the Report by providing specific examples illustrating how to apply each of the recommendations.

Clinical Practice Guidelines for Diagnosis and Treatment of Chronic Lymphocytic Leukemia (CLL) in The Netherlands.

PubMed

Kersting, Sabina; Neppelenbroek, Suzanne I M; Visser, Hein P J; van Gelder, Michel; Levin, Mark-David; Mous, Rogier; Posthuma, Ward; van der Straaten, Hanneke M; Kater, Arnon P

2018-01-01

In recent years, considerable progress has been made in the treatment of patients with chronic lymphocytic leukemia (CLL), and new potent drugs have become available. Therefore, the CLL working party revised the Dutch guidelines. Not only efficacy but also quality of life and socio-economic impact were taken into account in the formulation of treatment recommendations. The working party discussed a set of questions regarding diagnostic tests and treatment and wrote the draft guideline. This was evidence-based whenever possible, but in cases of low evidence, an expert-based recommendation was formulated with input of the entire working party. The draft guideline was sent to all hematologists in the Netherlands for comment and was subsequently approved. Recommendations were formulated on diagnostic tests and work-up before treatment. Also, recommendations were made for treatment with fludarabine-cyclophosphamide-rituximab, bendamustine-rituximab, chlorambucil with anti-CD20 antibody, ibrutinib, idelalisib-rituximab, venetoclax, and allogeneic stem cell transplantation. In the revised Dutch CLL guidelines, chemo-immunotherapy is still the cornerstone of CLL treatment with novel targeted drugs for specific risk groups. Copyright © 2017 Elsevier Inc. All rights reserved.

Translating Guidelines Into Practice: Interpreting the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk.

PubMed

Waite, Laura H; Phan, Yvonne L; Spinler, Sarah A

2017-10-01

In 2016, the American College of Cardiology released a decision pathway, based on expert consensus, to guide use of non-statin agents in the management of atherosclerotic cardiovascular disease risk. The purpose of this article is to assist practitioners, health systems and managed care entities with interpreting this consensus statement in order to simplify implementation of the recommendations into patient care. Major themes from the consensus statement are briefly summarized and explained. Drug therapy recommendations are condensed into a single algorithm, while tables correlate each recommended regimen with the appropriate patient population from both a patient-level and systems-level perspective. Finally, a patient case with evidence-based decision support is explored. These tools allow practitioners to make appropriate patient-specific decisions about the use of non-statin pharmacotherapy and enable health systems and managed care entities to more readily identify guideline-appropriate use of these agents upon review of patient profiles or prescribing patterns. This article provides resources for healthcare providers that facilitate uptake of these recommendations into clinical practice.

Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus.

PubMed

Dematteis, Maurice; Auriacombe, Marc; D'Agnone, Oscar; Somaini, Lorenzo; Szerman, Néstor; Littlewood, Richard; Alam, Farrukh; Alho, Hannu; Benyamina, Amine; Bobes, Julio; Daulouede, Jean Pierre; Leonardi, Claudio; Maremmani, Icro; Torrens, Marta; Walcher, Stephan; Soyka, Michael

2017-12-01

Management of patients with opioid use disorder (OUD) commonly includes opioid agonist therapy (OAT) as a part of an integrated treatment plan. These interventions are associated with proven benefits to the individual and society. Areas covered: The use of methadone and buprenorphine within an integrated treatment plan in the management of patients with OUD: this work provides consensus recommendation on pharmacotherapy in OUD to assist clinicians with practical decision making in this field. Expert opinion: Pharmacotherapy is recommended as part of an integrated OUD treatment approach with psychosocial interventions, with the goal of reducing risks of illicit opioid use, overdose mortality, infection with HIV or HCV, improving health, psychological and social outcomes. Access to OAT should be prioritised in the treatment of OUD. Treatment choices in OUD pharmacotherapy should be based on the needs of the individual and characteristics of medications. Recommendations for choices of OAT are based on clinical efficacy, safety, patient preference, side effects, pharmacological interactions, quality of life, dose titration potential and outcomes (control craving, ongoing opioids consumption or other drugs, and potentially psychiatric comorbidities). Special groups, pregnant women, prisoners, patients with mental health problems have specific needs which must be addressed with expert input.

Lidar base specification

USGS Publications Warehouse

Heidemann, Hans Karl

2012-08-17

In late 2009, a $14.3 million allocation from the American Recovery and Reinvestment Act (ARRA) for new light detection and ranging (lidar) elevation data acquisition prompted the U.S. Geological Survey (USGS) National Geospatial Program (NGP) to develop a common minimum specification for all lidar data acquired for The National Map. Released as a working draft in 2010 and formally published in 2012, the USGS–NGP Lidar Base Specification (LBS) was quickly embraced by numerous States, counties, and foreign countries as the foundation for their own lidar specifications.Prompted by a growing appreciation for the wide applicability and inherent value of lidar, a consortium of Federal agencies commissioned the National Enhanced Elevation Assessment (NEEA) study in 2010 to quantify the costs and benefits of a national lidar program. Published in 2012, the NEEA report documented a substantial return on such an investment, defined five quality levels (QL) for elevation data, and recommended an 8-year collection cycle of QL2 lidar data as the optimum balance of benefit and affordability. In response to the study, the USGS–NGP established the 3D Elevation Program (3DEP) in 2013 as the interagency vehicle through which the NEEA recommendations could be realized.Lidar is a quickly evolving technology and much has changed in the industry since the previous version of the Lidar Base Specification (LBS) was published. Lidar data have improved in accuracy and spatial resolution, the American Society for Photogrammetry and Remote Sensing has revised the geospatial accuracy standards, industry standard file formats have been expanded, additional applications for lidar have become accepted, and the need for interoperable data across collections has been realized. This revision to the LBS addresses some of those changes and provides continued guidance towards a nationally consistent lidar dataset.

Annual Conference on HAN-Based Liquid Propellants. Volume 1

DTIC Science & Technology

1989-05-01

Fischer . This situation is obviously not ideal and effort is being made to find a suitable method . However we have been assured that there has been...CLASSIFICATION OF HAN-BASED LIQUID PROPELLANT LP101. S. Westlake --..---- ------------ 64 POSSIBLE TEST METHODS TO STUDY THE THERMAL STABILITY OF...specifications for LP. The phase of the program which is now in progress has dealt with (1) reviewing. recommending and developing applicable analytical methods

Estimation of the optimal number of radiotherapy fractions for breast cancer: A review of the evidence.

PubMed

Wong, Karen; Delaney, Geoff P; Barton, Michael B

2015-08-01

There is variation in radiotherapy fractionation practice, however, there is no evidence-based benchmark for appropriate activity. An evidence-based model was constructed to estimate the optimal number of fractions for the first course of radiotherapy for breast cancer to aid in services planning and performance benchmarking. The published breast cancer radiotherapy utilisation model was adapted. Evidence-based number of fractions was added to each radiotherapy indication. The overall optimal number of fractions was calculated based on the frequency of specific clinical conditions where radiotherapy is indicated and the recommended number of fractions for each condition. Sensitivity analysis was performed to assess the impact of uncertainties on the model. For the entire Australian breast cancer patient population, the estimated optimal number of fractions per patient was 16.8, 14.6, 13.7 and 0.8 for ductal carcinoma in situ, early, advanced and metastatic breast cancer respectively. Overall, the optimal number of fractions per patient was 14.4 (range 14.4-18.7). These results allow comparison with actual practices, and workload prediction to aid in services planning. The model can be easily adapted to other countries by inserting population-specific epidemiological data, and to future changes in cancer incidence, stage distribution and fractionation recommendations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Exobiology in Earth orbit: The results of science workshops held at NASA, Ames Research Center

NASA Technical Reports Server (NTRS)

Defrees, D. (Editor); Brownlee, D. (Editor); Tarter, J. (Editor); Usher, D. (Editor); Irvine, W. (Editor); Klein, H. (Editor)

1989-01-01

The Workshops on Exobiology in Earth Orbit were held to explore concepts for orbital experiments of exobiological interest and make recommendations on which classes of experiments should be carried out. Various observational and experimental opportunities in Earth orbit are described including those associated with the Space Shuttle laboratories, spacecraft deployed from the Space Shuttle and expendable launch vehicles, the Space Station, and lunar bases. Specific science issues and technology needs are summarized. Finally, a list of recommended experiments in the areas of observational exobiology, cosmic dust collection, and in situ experiments is presented.

The future of warfarin pharmacogenetics in under-represented minority groups

PubMed Central

Cavallari, Larisa H; Perera, Minoli A

2012-01-01

Genotype-based dosing recommendations are provided in the US FDA-approved warfarin labeling. However, data that informed these recommendations were from predominately Caucasian populations. Studies show that variants contributing to warfarin dose requirements in Caucasians provide similar contributions to dose requirements in US Hispanics, but significantly lesser contributions in African–Americans. Further data demonstrate that variants occurring commonly in individuals of African ancestry, but rarely in other racial groups, significantly influence dose requirements in African–Americans. These data suggest that it is important to consider variants specific for African–Americans when implementing genotype-guided warfarin dosing in this population. PMID:22871196

American College of Medical Genetics guideline on the cytogenetic evaluation of the individual with developmental delay or mental retardation

PubMed Central

Shaffer, Lisa G.

2005-01-01

The following are the recommendations of the American College of Medical Genetics (ACMG) Professional Practice and Guidelines Committee, which was convened to assist health care professionals in making decisions regarding cytogenetic diagnostic testing and counseling for mental retardation (MR) and developmental delay (DD). This document reviews available evidence concerning the value of conventional and molecular cytogenetic testing for the identification of chromosomal anomalies that play a role in the etiology of MR/DD, and, based on this evidence, specific recommendations for each method of testing are provided. PMID:16301868

[Comments on current guidelines of type 2 diabetes mellitus treatment].

PubMed

Martinka, Emil

In an effort to facilitate the widest possible application of recent findings in diabetology and the related medical fields, with regard to characteristics of medicines and current possibilities of using modern procedures, but also to their limitations due to the financial capacities of health insurance companies, SDS innovates its therapeutic recommendations for the treatment of diabetes mellitus on a regular basis. The most recent recommendations were issued by SDS in August 2016. The review discusses and describes several factors which the authors considered during their preparation: (1) Compliance with the findings of evidence-based medicine, compliance with reference recommendations (therapeutic recommendations ADA/EASD), compliance with summary characteristics of active substances in the treatment of diabetes mellitus and approved possibilities of their use, and compliance with indica-tive restrictions (IO) which define medical and economic conditions for health insurance covered treatment. (2) Certain departure from the "glucocentric" approach to therapy, in favour of the approach preferring the selection of drugs based on clinical characteristics of the patient and proven benefits/risks of individual drugs (3) Preference of groups as well as individual active substances within groups based on evidence medicine regarding the individual active substances for specific patient groups. (4) Emphasis on individualization of goals for glycemic control (5) Emphasis on the right classification of diabetes mellitus as the basic condition for the selection of an optimum thera-peutic procedure, and (6) Emphasis on education and overcoming of clinical inertia, and patient medication adherence and medication "literacy" as the basic condition for successful therapy. The discussion also considers the outcomes of the most recent studies including of the studies focusing on empagliflozin and liraglutide, as well as recent modifications of the therapeutic recommendations of the American and Canadian Diabetes Association.Key words: type 2 diabetes mellitus - therapeutic recommendations - algorithm - empagliflozin - liraglutide.

Characterizing the Mechanical Properties of Running-Specific Prostheses

PubMed Central

Beck, Owen N.; Taboga, Paolo; Grabowski, Alena M.

2016-01-01

The mechanical stiffness of running-specific prostheses likely affects the functional abilities of athletes with leg amputations. However, each prosthetic manufacturer recommends prostheses based on subjective stiffness categories rather than performance based metrics. The actual mechanical stiffness values of running-specific prostheses (i.e. kN/m) are unknown. Consequently, we sought to characterize and disseminate the stiffness values of running-specific prostheses so that researchers, clinicians, and athletes can objectively evaluate prosthetic function. We characterized the stiffness values of 55 running-specific prostheses across various models, stiffness categories, and heights using forces and angles representative of those measured from athletes with transtibial amputations during running. Characterizing prosthetic force-displacement profiles with a 2nd degree polynomial explained 4.4% more of the variance than a linear function (p<0.001). The prosthetic stiffness values of manufacturer recommended stiffness categories varied between prosthetic models (p<0.001). Also, prosthetic stiffness was 10% to 39% less at angles typical of running 3 m/s and 6 m/s (10°-25°) compared to neutral (0°) (p<0.001). Furthermore, prosthetic stiffness was inversely related to height in J-shaped (p<0.001), but not C-shaped, prostheses. Running-specific prostheses should be tested under the demands of the respective activity in order to derive relevant characterizations of stiffness and function. In all, our results indicate that when athletes with leg amputations alter prosthetic model, height, and/or sagittal plane alignment, their prosthetic stiffness profiles also change; therefore variations in comfort, performance, etc. may be indirectly due to altered stiffness. PMID:27973573

Diagnosing Sexual Dysfunction in Men and Women: Sexual History Taking and the Role of Symptom Scales and Questionnaires.

PubMed

Hatzichristou, Dimitris; Kirana, Paraskevi-Sofia; Banner, Linda; Althof, Stanley E; Lonnee-Hoffmann, Risa A M; Dennerstein, Lorraine; Rosen, Raymond C

2016-08-01

A detailed sexual history is the cornerstone for all sexual problem assessments and sexual dysfunction diagnoses. Diagnostic evaluation is based on an in-depth sexual history, including sexual and gender identity and orientation, sexual activity and function, current level of sexual function, overall health and comorbidities, partner relationship and interpersonal factors, and the role of cultural and personal expectations and attitudes. To propose key steps in the diagnostic evaluation of sexual dysfunctions, with special focus on the use of symptom scales and questionnaires. Critical assessment of the current literature by the International Consultation on Sexual Medicine committee. A revised algorithm for the management of sexual dysfunctions, level of evidence, and recommendation for scales and questionnaires. The International Consultation on Sexual Medicine proposes an updated algorithm for diagnostic evaluation of sexual dysfunction in men and women, with specific recommendations for sexual history taking and diagnostic evaluation. Standardized scales, checklists, and validated questionnaires are additional adjuncts that should be used routinely in sexual problem evaluation. Scales developed for specific patient groups are included. Results of this evaluation are presented with recommendations for clinical and research uses. Defined principles, an algorithm and a range of scales may provide coherent and evidence based management for sexual dysfunctions. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Brain Resuscitation in the Drowning Victim

PubMed Central

Topjian, Alexis A.; Berg, Robert A.; Bierens, Joost J. L. M.; Branche, Christine M.; Clark, Robert S.; Friberg, Hans; Hoedemaekers, Cornelia W. E.; Holzer, Michael; Katz, Laurence M.; Knape, Johannes T. A.; Kochanek, Patrick M.; Nadkarni, Vinay; van der Hoeven, Johannes G.

2013-01-01

Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32–34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders. PMID:22956050

Recommended Standards: Common to All Programs; Specific to Production Agriculture, Secondary; Specific to Adult Education for Quality Agriculture/Agribusiness Programs in Kansas.

ERIC Educational Resources Information Center

Kansas State Univ., Manhattan. Dept. of Adult and Occupational Education.

This document contains recommended standards for quality vocational programs in agricultural/agribusiness education which are divided into (1) standards common to all programs, (2) standards specific to adult education in agriculture/agribusiness, and (3) standards specific to production agriculture, secondary. The sixty common standards are…

Clinical practice guidelines on the evidence-based use of integrative therapies during and following breast cancer treatment

PubMed Central

Greenlee, Heather; DuPont-Reyes, Melissa J.; Balneaves, Lynda G.; Carlson, Linda E.; Cohen, Misha R.; Deng, Gary; Johnson, Jillian A.; Mumber, Matthew; Seely, Dugald; Zick, Suzanna; Boyce, Lindsay; Tripathy, Debu

2018-01-01

Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. PMID:28436999

The role of language in suicide reporting: Investigating the influence of problematic suicide referents.

PubMed

Arendt, Florian; Scherr, Sebastian; Niederkrotenthaler, Thomas; Till, Benedikt

2018-02-14

Although suicide experts recommend using neutral suicide referents in news media reporting, this recommendation has not yet been tested empirically. This recommendation, based on the empirically yet untested assumption that problematic suicide referents carry meaning that is inappropriate from a prevention perspective, may lead to a different perspective on suicide, termed "framing effects." For example, in German-speaking countries, the neutral term Suizid (suicide) is recommended. Conversely, Freitod ("free death") and Selbstmord ("self-murder") convey associative meanings related to problematic concepts such as free will (Freitod) and crime/murder (Selbstmord), and are therefore not recommended. Using a web-based randomized controlled trial focused on German speakers (N = 451), we tested whether the news media's use of Suizid, Selbstmord, and Freitod elicits framing effects. Participants read identical news reports about suicide. Only the specific suicide referents varied depending on the experimental condition. Post-reading, participants wrote short summaries of the news reports, completed a word-fragment completion test and a questionnaire targeting suicide-related attitudes. We found that the news frame primed some frame-related concepts in the memory and also increased frame-related word choice. Importantly, we found that participants reading the free will-related Freitod frame showed greater attitudinal support for suicide among individuals suffering from incurable diseases. This study highlights the importance of how the news media write about suicide and supports the language recommendations put forward by suicide experts. Copyright © 2018 Elsevier Ltd. All rights reserved.

ACOEM practice guidelines: elbow disorders.

PubMed

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

2013-11-01

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

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

PubMed Central

Beam, Joel W.; Buckley, Bernadette; Holcomb, William R.; Ciocca, Mario

2016-01-01

Objective: To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients. Background: Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications. Recommendations: These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma. PMID:28092169

Implementing AORN recommended practices for environmental cleaning.

PubMed

Allen, George

2014-05-01

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

Paediatric Intestinal Pseudo-obstruction: Evidence and Consensus-based Recommendations From an ESPGHAN-Led Expert Group.

PubMed

Thapar, Nikhil; Saliakellis, Efstratios; Benninga, Marc A; Borrelli, Osvaldo; Curry, Joe; Faure, Christophe; De Giorgio, Roberto; Gupte, Girish; Knowles, Charles H; Staiano, Annamaria; Vandenplas, Yvan; Di Lorenzo, Carlo

2018-06-01

Chronic intestinal pseudo-obstructive (CIPO) conditions are considered the most severe disorders of gut motility. They continue to present significant challenges in clinical care despite considerable recent progress in our understanding of pathophysiology, resulting in unacceptable levels of morbidity and mortality. Major contributors to the disappointing lack of progress in paediatric CIPO include a dearth of clarity and uniformity across all aspects of clinical care from definition and diagnosis to management. In order to assist medical care providers in identifying, evaluating, and managing children with CIPO, experts in this condition within the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition as well as selected external experts, were charged with the task of developing a uniform document of evidence- and consensus-based recommendations. Ten clinically relevant questions addressing terminology, diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to June 2017 using a number of established electronic databases as well as repositories. The approach of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate outcome measures for the research questions. Levels of evidence and quality of evidence were assessed using the classification system of the Oxford Centre for Evidence-Based Medicine (diagnosis) and the GRADE system (treatment). Each of the recommendations were discussed, finalized, and voted upon using the nominal voting technique to obtain consensus. This evidence- and consensus-based position paper provides recommendations specifically for chronic intestinal pseudo-obstruction in infants and children. It proposes these be termed paediatric intestinal pseudo-obstructive (PIPO) disorders to distinguish them from adult onset CIPO. The manuscript provides guidance on the diagnosis, evaluation, and treatment of children with PIPO in an effort to standardise the quality of clinical care and improve short- and long-term outcomes. Key recommendations include the development of specific diagnostic criteria for PIPO, red flags to alert clinicians to the diagnosis and guidance on the use of available investigative modalities. The group advocates early collaboration with expert centres where structured diagnosis and management is guided by a multi-disciplinary team, and include targeted nutritional, medical, and surgical interventions as well as transition to adult services. This document is intended to be used in daily practice from the time of first presentation and definitive diagnosis PIPO through to the complex management and treatment interventions such as intestinal transplantation. Significant challenges remain to be addressed through collaborative clinical and research interactions.

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.

Teacher Attitudes toward Subject-Specific Acceleration: Instrument Development and Validation

ERIC Educational Resources Information Center

Rambo, Karen E.; McCoach, D. Betsy

2012-01-01

Despite the research supporting acceleration, some teachers are still hesitant to recommend acceleration for advanced students. The Teacher Attitudes Toward Subject-Specific Acceleration (TATSSA) instrument was designed to uncover the factors that influence teacher decisions to recommend students for subject-specific acceleration. First, we…

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

PubMed Central

Arnold, Mark; Bakris, George L.; Bruns, David E.; Horvath, Andrea Rita; Kirkman, M. Sue; Lernmark, Ake; Metzger, Boyd E.; Nathan, David M.

2011-01-01

BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (HbA1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended. PMID:21617108

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

PubMed Central

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

2017-01-01

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

Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia.

PubMed

Boccardi, Marina; Festari, Cristina; Altomare, Daniele; Gandolfo, Federica; Orini, Stefania; Nobili, Flavio; Frisoni, Giovanni B

2018-04-30

FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use. Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use. Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold-/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24% of the examined papers; 38% used an acceptable reference-standard (clinical follow-up); and 38% compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence. An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations.

Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

PubMed Central

Harris, Lyndsay N.; McShane, Lisa M.; Andre, Fabrice; Collyar, Deborah E.; Gonzalez-Angulo, Ana M.; Hammond, Elizabeth H.; Kuderer, Nicole M.; Liu, Minetta C.; Mennel, Robert G.; Van Poznak, Catherine; Bast, Robert C.; Hayes, Daniel F.

2016-01-01

Purpose To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. Methods A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert panel members used informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 50 relevant studies. One randomized clinical trial and 18 prospective-retrospective studies were found to have evaluated the clinical utility, as defined by the guideline, of specific biomarkers for guiding decisions on the need for adjuvant systemic therapy. No studies that met guideline criteria for clinical utility were found to guide choice of specific treatments or regimens. Recommendations In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2, the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX, EndoPredict, PAM50, Breast Cancer Index, and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer. No biomarker except for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens. Treatment decisions should also consider disease stage, comorbidities, and patient preferences. PMID:26858339

A survey of probiotic use practices among patients at a tertiary medical centre.

PubMed

Draper, K; Ley, C; Parsonnet, J

2017-05-30

Probiotic use has skyrocketed in recent years. Little is known, however, about patient knowledge and practices regarding probiotic use, especially in the context of antibiotic use. An invitation to complete a short, anonymous, electronic survey was sent by email to 965 patients at a tertiary medical centre in California who had agreed to be contacted for participation in research studies. Questions were asked about both probiotic and antibiotic use in the prior three months. Of 333 survey respondents, 55% had recently used probiotics, including food products and/or supplements (90 and 60% of probiotic users, respectively). Women were more likely than men to have used probiotics (odds ratio (OR): 1.99; 95% confidence interval (CI): 1.2-3.4). Health care providers (HCP) had prescribed antibiotics to 79 (24%) respondents in the preceding three months. Among antibiotic users, 33% had initiated or changed probiotics at the time of antibiotic use, usually without a recommendation from their prescribing HCP (72%). Only 12% of those who took probiotics with antibiotics had received a specific recommendation from their HCP. Most patients chose to take probiotic mixtures (56%), with few selecting evidence-based strains, such as Lactobacillus rhamnosus GG (11%). Regular probiotic use among patients is common. Typically, these probiotics are not recommended by a HCP, even in conjunction with antibiotic prescriptions. While a growing body of evidence supports specific probiotic strains for the prevention of antibiotic-associated diarrhoea, patients are often not receiving a specific recommendation from their HCP and appear to be taking strains without guidance from supporting evidence.

Travel vaccination recommendations and endemic infection risks in solid organ transplantation recipients.

PubMed

Trubiano, Jason A; Johnson, Douglas; Sohail, Asma; Torresi, Joseph

2016-06-01

Solid organ transplant (SOT) recipients are often heavily immunosuppressed and consequently at risk of serious illness from vaccine preventable viral and bacterial infections or with endemic fungal and parasitic infections. We review the literature to provide guidance regarding the timing and appropriateness of vaccination and pathogen avoidance related to the immunological status of SOT recipients. A PUBMED search ([Vaccination OR vaccine] AND/OR ["specific vaccine"] AND/OR [immunology OR immune response OR cytokine OR T lymphocyte] AND transplant was performed. A review of the literature was performed in order to develop recommendations on vaccination for SOT recipients travelling to high-risk destinations. Whilst immunological failure of vaccination in SOT is primarily the result of impaired B-cell responses, the role of T-cells in vaccine failure and success remains unknown. Vaccination should be initiated at least 4 weeks prior to SOT or more than 6 months post-SOT. Avoidance of live vaccination is generally recommended, although some live vaccines may be considered in the specific situations (e.g. yellow fever). The practicing physician requires a detailed understanding of region-specific endemic pathogen risks. We provide a vaccination and endemic pathogen guide for physicians and travel clinics involved in the care of SOT recipients. In addition, recommendations based on timing of anticipated immunological recovery and available evidence regarding vaccine immunogenicity in SOT recipients are provided to help guide pre-travel consultations. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

Pathway to Prevention of Nosocomial Clostridium difficile Infection.

PubMed

Goldstein, Ellie J C; Johnson, Stuart; Maziade, Pierre-Jean; McFarland, Lynne V; Trick, William; Dresser, Linda; Millette, Mathieu; Mazloum, Hadi; Low, Donald E

2015-05-15

To address the significant morbidity and mortality rates associated with nosocomial Clostridium difficile-associated diarrhea (CDAD), a series of recommendations and a pathway to prevention were developed. An expert panel of infectious disease (ID) specialists participated in a modified Delphi process with specific objectives: (1) conduct a review for CDAD and prevention; (2) develop statements based upon panel members' opinions; (3) hold a panel meeting during the 2012 IDWeek; and (4) review the final recommendations and prevention pathway prior to submission for publication. The panel voted on (1) antibiotic stewardship (7 of 8 panelists); (2) reduction of other potentially modifiable risk factors (variable); (3) utilization of specific probiotics to prevent C. difficile overgrowth (8/8); (4) staff education regarding CDAD preventive measures (8/8); (5) appropriate hand hygiene for everyone (7/8); (6) environmental cleaning (8/8); (7) medical equipment disinfection (7/8); (8) early detection of CDAD in symptomatic patients (7/8); (9) usage of protective clothing/gloves (8/8); (10) proper measures during outbreak (8/8); and (11) surveillance to monitor efficacy data of preventive measures (8/8). The panel members agreed with 11 of 17 recommendations presented. The additional recommendations by the panel were proton pump inhibitor use as a risk factor and the use of adjunctive therapy with specific probiotic, as it was approved by Health Canada for the risk reduction of CDAD in hospitalized patients. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Bridging the Guideline Implementation Gap: A Systematic, Document-Centered Approach to Guideline Implementation

PubMed Central

Shiffman, Richard N.; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

Objective: A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. Design: This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. Results: The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Conclusion: Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge. PMID:15187061

Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice.

PubMed

Cooney, Lewis; Loke, Yoon K; Golder, Su; Kirkham, Jamie; Jorgensen, Andrea; Sinha, Ian; Hawcutt, Daniel

2017-06-02

Many medicines are dosed to achieve a particular therapeutic range, and monitored using therapeutic drug monitoring (TDM). The evidence base for a therapeutic range can be evaluated using systematic reviews, to ensure it continues to reflect current indications, doses, routes and formulations, as well as updated adverse effect data. There is no consensus on the optimal methodology for systematic reviews of therapeutic ranges. An overview of systematic reviews of therapeutic ranges was undertaken. The following databases were used: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts and Reviews of Effects (DARE) and MEDLINE. The published methodologies used when systematically reviewing the therapeutic range of a drug were analyzed. Step by step recommendations to optimize such systematic reviews are proposed. Ten systematic reviews that investigated the correlation between serum concentrations and clinical outcomes encompassing a variety of medicines and indications were assessed. There were significant variations in the methodologies used (including the search terms used, data extraction methods, assessment of bias, and statistical analyses undertaken). Therapeutic ranges should be population and indication specific and based on clinically relevant outcomes. Recommendations for future systematic reviews based on these findings have been developed. Evidence based therapeutic ranges have the potential to improve TDM practice. Current systematic reviews investigating therapeutic ranges have highly variable methodologies and there is no consensus of best practice when undertaking systematic reviews in this field. These recommendations meet a need not addressed by standard protocols.

Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

PubMed

Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

2017-06-22

The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta-algorithm illustrates a superordinate process that permanently keeps the entire patient in view. The meta-algorithm represents the back bone of the multimorbidity guideline of the German College of General Practitioners and Family Physicians. This article presents solely the development phase; the meta-algorithm needs to be piloted before it can be implemented. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Dementia-specific training for nursing home staff : A systematic literature review.

PubMed

Riesch, Julia; Meyer, Lucy; Lehr, Bosco; Severin, Thomas

2017-08-22

For people with dementia high-quality care is vital, since at present dementia cannot be cured. In nursing homes this care is provided by the staff, who therefore require dementia-specific training enabling them to improve the quality of life for people with dementia. This article compares existing dementia-specific training for nursing home staff with recommendations, based on the current state of research, by the Alzheimer's Association and the National Institute for Health and Care Excellence, and discusses the outcome of this training. A systematic review of the literature was conducted to identify studies addressing dementia-specific training. The electronic databases Embase, Medline, Cochrane, CINAHL, PsychINFO, PSYNDEX, and ScienceDirect were searched. The training topics most commonly considered were person-centered care, communicating with people affected by dementia, and information about dementia. The roles of different social and healthcare professionals, palliative care of people with dementia, and understanding family dynamics are least featured in the training. There are training concepts which focus not only on the transfer of knowledge but also on practical exercises. In general, the recommended topics were addressed in dementia-specific training concepts, but there is potential for optimization. Further research is needed to identify success criteria in dementia-specific training and identify the successful combination of theoretical knowledge and practical exercise.

Evaluation of H3A for determination of plant available P vs. FeAIO strips

USDA-ARS?s Scientific Manuscript database

Phosphorus is an essential nutrient for plant growth but in excess is a source of environmental pollution. Fertilizer additions of P are recommended based on soil tests; however, the commonly applied P extractants are often applied outside of their design criteria (specifically soil pH). As a resu...

Requirements for Programming Languages in Computer-Based Instructional Systems.

ERIC Educational Resources Information Center

Zinn, Karl

The author reviews the instructional programing languages which already exist and describes their methods of presentation, organization, and preparation. He recommends that all research and development projects remain flexible in their choice of programing language for a time yet. He suggests ways to adapt to specific uses and users, to exploit…

Beyond ABCs and 123s: Enhancing Teacher-Child Relationship Quality to Promote Children's Behavioral Development

ERIC Educational Resources Information Center

Vick Whittaker, Jessica E.; Jones Harden, Brenda

2010-01-01

Results from a study of 100 Head Start children and their teachers suggested that teacher-child relationship quality was associated with children's classroom behaviors. Specifically, teacher-child conflict was strongly related to children's externalizing behaviors. Based on these findings, we present recommendations for the development of policies…

Automated storm water sampling on small watersheds

USGS Publications Warehouse

Harmel, R.D.; King, K.W.; Slade, R.M.

2003-01-01

Few guidelines are currently available to assist in designing appropriate automated storm water sampling strategies for small watersheds. Therefore, guidance is needed to develop strategies that achieve an appropriate balance between accurate characterization of storm water quality and loads and limitations of budget, equipment, and personnel. In this article, we explore the important sampling strategy components (minimum flow threshold, sampling interval, and discrete versus composite sampling) and project-specific considerations (sampling goal, sampling and analysis resources, and watershed characteristics) based on personal experiences and pertinent field and analytical studies. These components and considerations are important in achieving the balance between sampling goals and limitations because they determine how and when samples are taken and the potential sampling error. Several general recommendations are made, including: setting low minimum flow thresholds, using flow-interval or variable time-interval sampling, and using composite sampling to limit the number of samples collected. Guidelines are presented to aid in selection of an appropriate sampling strategy based on user's project-specific considerations. Our experiences suggest these recommendations should allow implementation of a successful sampling strategy for most small watershed sampling projects with common sampling goals.

EAN consensus review on prevention, diagnosis and management of tick-borne encephalitis.

PubMed

Taba, P; Schmutzhard, E; Forsberg, P; Lutsar, I; Ljøstad, U; Mygland, Å; Levchenko, I; Strle, F; Steiner, I

2017-10-01

Tick-borne encephalitis (TBE) is an infection of the central nervous system (CNS) caused by tick-borne encephalitis virus (TBEV) and transmitted by ticks, with a variety of clinical manifestations. The incidence of TBE in Europe is increasing due to an extended season of the infection and the enlargement of endemic areas. Our objectives are to provide recommendations on the prevention, diagnosis and management of TBE, based on evidence or consensus decisions. For systematic evaluation, the literature was searched from 1970 to 2015 (including early online publications of 2016), and recommendations were based on evidence or consensus decisions of the Task Force when evidence-based data were not available. Vaccination against TBE is recommended for all age groups above 1 year in highly endemic areas (≥5 cases/100 000/year), but also for individuals at risk in areas with a lower incidence. Travellers to endemic areas should be vaccinated if their visits will include extensive outdoor activities. Post-exposure prophylaxis after a tick bite is not recommended. A case of TBE is defined by the presence of clinical signs of meningitis, meningoencephalitis or meningoencephalomyelitis with cerebrospinal fluid (CSF) pleocytosis (>5 × 10 6 cells/l) and the presence of specific TBEV serum immunoglobulin M (IgM) and IgG antibodies, CSF IgM antibodies or TBEV IgG seroconversion. TBEV-specific polymerase chain reaction in blood is diagnostic in the first viremic phase but it is not sensitive in the second phase of TBE with clinical manifestations of CNS inflammation. Lumbar puncture should be performed in all patients with suspected CNS infection unless there are contraindications. Imaging of the brain and spinal cord has a low sensitivity and a low specificity, but it is useful for differential diagnosis. No effective antiviral or immunomodulating therapy is available for TBE; therefore the treatment is symptomatic. Patients with a potentially life threatening meningoencephalitis or meningoencephalomyelitis should be admitted to an intensive care unit. In the case of brain oedema, analgosedation should be deepened; osmotherapy and corticosteroids are not routinely recommended. If intracranial pressure is increased, therapeutic hypothermia or decompressive craniectomy might be considered. Seizures should be treated as any other symptomatic epileptic seizures. Tick-borne encephalitis is a viral CNS infection that may result in long-term neurological sequelae. Since its incidence in Europe is increasing due to broadening of endemic areas and prolongation of the tick activity season, the health burden of TBE is enlarging. There is no effective antiviral treatment for TBE, but the disease may be effectively prevented by vaccination. © 2017 EAN.

Associations of Acculturation With Self-Report and Objective Physical Activity and Sedentary Behaviors Among Latinas.

PubMed

Perez, Lilian G; Chavez, Adrian; Marquez, David X; Soto, Sandra C; Haughton, Jessica; Arredondo, Elva M

2017-06-01

Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas' activity and sedentary levels are unclear. To examine associations of acculturation with Latinas' domain-specific and total PA as well as sedentary time. We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18-65 years) from a PA promotion intervention in San Diego, CA ( Fe en Acción/ Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas' PA and sedentary behaviors.

The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study.

PubMed

Narayanaswami, Pushpa; Gronseth, Gary; Dubinsky, Richard; Penfold-Murray, Rebecca; Cox, Julie; Bever, Christopher; Martins, Yolanda; Rheaume, Carol; Shouse, Denise; Getchius, Thomas S D

2015-08-13

Evidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences. Our aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines "Complementary and alternative medicine in multiple sclerosis" ("CAM in MS") and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations. Outcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians ("physicians"). The primary outcome was the difference in participants' intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS). Response rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional dissemination (absolute difference, 95% confidence interval: physicians 36%, 95% CI 25-46, and patients 10%, 95% CI 1-11) but did not increase further after novel dissemination (physicians 0%, 95% CI -11 to 11, and patients -4%, 95% CI -6 to 14). Intent to discuss CAM also increased after traditional dissemination but did not change after novel dissemination (traditional: physicians 12%, 95% CI 2-22, and patients 19%, 95% CI 3-33; novel: physicians 11%, 95% CI -1 to -21, and patients -8%, 95% CI -22 to 8). Knowledge of CPG recommendations and behavior regarding CAM use in MS did not change after either traditional dissemination or novel dissemination. Social media-based dissemination methods did not confer additional benefit over print-, email-, and Internet-based methods in increasing CPG awareness and changing intent in physicians or patients. Research on audience selection, message formatting, and message delivery is required to utilize Web 2.0 technologies optimally for dissemination.

The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study

PubMed Central

Gronseth, Gary; Dubinsky, Richard; Penfold-Murray, Rebecca; Cox, Julie; Bever Jr, Christopher; Martins, Yolanda; Rheaume, Carol; Shouse, Denise; Getchius, Thomas SD

2015-01-01

Background Evidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences. Objective Our aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines “Complementary and alternative medicine in multiple sclerosis” (“CAM in MS”) and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations. Methods Outcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians (“physicians”). The primary outcome was the difference in participants’ intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS). Results Response rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional dissemination (absolute difference, 95% confidence interval: physicians 36%, 95% CI 25-46, and patients 10%, 95% CI 1-11) but did not increase further after novel dissemination (physicians 0%, 95% CI -11 to 11, and patients -4%, 95% CI -6 to 14). Intent to discuss CAM also increased after traditional dissemination but did not change after novel dissemination (traditional: physicians 12%, 95% CI 2-22, and patients 19%, 95% CI 3-33; novel: physicians 11%, 95% CI -1 to -21, and patients -8%, 95% CI -22 to 8). Knowledge of CPG recommendations and behavior regarding CAM use in MS did not change after either traditional dissemination or novel dissemination. Conclusions Social media-based dissemination methods did not confer additional benefit over print-, email-, and Internet-based methods in increasing CPG awareness and changing intent in physicians or patients. Research on audience selection, message formatting, and message delivery is required to utilize Web 2.0 technologies optimally for dissemination. PMID:26272267

Empirical validation of guidelines for the management of pharyngitis in children and adults.

PubMed

McIsaac, Warren J; Kellner, James D; Aufricht, Peggy; Vanjaka, Anita; Low, Donald E

2004-04-07

Recent guidelines for management of pharyngitis vary in their recommendations concerning empirical antibiotic treatment and the need for laboratory confirmation of group A streptococcus (GAS). To assess the impact of guideline recommendations and alternative approaches on identification and treatment of GAS pharyngitis in children and adults. Throat cultures and rapid antigen tests were performed on 787 children and adults aged 3 to 69 years with acute sore throat attending a family medicine clinic in Calgary, Alberta, from September 1999 to August 2002. Recommendations from 2 guidelines (those of the Infectious Diseases Society of America and of the American College of Physicians-American Society of Internal Medicine/American Academy of Family Physicians/US Centers for Disease Control and Prevention) were compared with rapid testing alone, a clinical prediction rule (ie, the modified Centor score), and a criterion standard of treatment for positive throat culture results only. Sensitivity and specificity of each strategy for identifying GAS pharyngitis, total antibiotics recommended, and unnecessary antibiotic prescriptions. In children, sensitivity for streptococcal infection ranged from 85.8% (133/155; 95% confidence interval [CI], 79.3%-90.0%) for rapid testing to 100% for culturing all. In adults, sensitivity ranged from 76.7% (56/73; 95% CI, 65.4%-85.8%) for rapid testing without culture confirmation of negative results to 100% for culturing all. In children, specificity ranged from 90.3% (270/299; 95% CI, 86.4%-93.4%) for use of modified Centor score and throat culture to 100% for culturing all. In adults, specificity ranged from 43.8% (114/260; 95% CI, 37.7%-50.1%) for empirical treatment based on a modified Centor score of 3 or 4 to 100% for culturing all. Total antibiotic prescriptions were lowest with rapid testing (24.7% [194/787]; 95% CI, 21.7%-27.8%) and highest with empirical treatment of high-risk adults (45.7% [360/787]; 95% CI, 42.2%-49.3%), due to a high rate of unnecessary prescriptions in adults (43.8% [146/333]; 95% CI, 38.4%-49.4%). Guideline recommendations for the selective use of throat cultures but antibiotic treatment based only on positive rapid test or throat culture results can reduce unnecessary use of antibiotics for treatment of pharyngitis. However, empirical treatment of adults having a Centor score of 3 or 4 is associated with a high rate of unnecessary antibiotic use. In children, strategies incorporating throat culture or throat culture confirmation of negative rapid antigen test results are highly sensitive and specific. Throat culture of all adults or those selected on the basis of a clinical prediction rule had the highest sensitivity and specificity.

Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer.

PubMed

Greenlee, Heather; Balneaves, Lynda G; Carlson, Linda E; Cohen, Misha; Deng, Gary; Hershman, Dawn; Mumber, Matthew; Perlmutter, Jane; Seely, Dugald; Sen, Ananda; Zick, Suzanna M; Tripathy, Debu

2014-11-01

The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies. Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system. The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I). Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Hierarchy of evidence: a simple system for orthopaedic research?

PubMed

Pemberton, Julia; Kraeva, Juliana; Bhandari, Mohit

2007-01-01

To be able to make a sound recommendation for a treatment based on the best available evidence, it is necessary to follow specific steps in acquiring literature, appraising the study design and quality, and assessing the results. Evidence-based medicine is founded on the concepts of using best evidence, levels of evidence, and grades of recommendation, and aims to provide clinicians with standardized rules to help them appraise the validity of published research. A number of systems have been developed to categorize research studies into consistent levels of evidence. These systems are based primarily on consensus expert opinion, and have not been validated to any extent. The use of different systems does not allow for effective communication between users; there is a lack of accord even between users of the same system. The GRADE working group has devised a new rating system that attempts to address deficiencies seen within other systems.

Brief Strategic Family Therapy: Implementing evidence-based models in community settings

PubMed Central

Szapocznik, José; Muir, Joan A.; Duff, Johnathan H.; Schwartz, Seth J.; Brown, C. Hendricks

2014-01-01

Reflecting a nearly 40-year collaborative partnership between clinical researchers and clinicians, the present article reviews the authors’ experience in developing, investigating, and implementing the Brief Strategic Family Therapy (BSFT) model. The first section of the article focuses on the theory, practice, and studies related to this evidence-based family therapy intervention targeting adolescent drug abuse and delinquency. The second section focuses on the implementation model created for the BSFT intervention– a model that parallels many of the recommendations furthered within the implementation science literature. Specific challenges encountered during the BSFT implementation process are reviewed, along with ways of conceptualizing and addressing these challenges from a systemic perspective. The implementation approach that we employ uses the same systemic principles and intervention techniques as those that underlie the BSFT model itself. Recommendations for advancing the field of implementation science, based on our on-the-ground experiences, are proposed. PMID:24274187

Preventive health services implemented by family physicians in Portugal—a cross-sectional study based on two clinical scenarios

PubMed Central

Martins, Carlos; Azevedo, Luís Filipe; Santos, Cristina; Sá, Luísa; Santos, Paulo; Couto, Maria; Pereira, Altamiro; Hespanhol, Alberto

2014-01-01

Objectives To assess whether Portuguese family physicians perform preventive health services in accordance with scientific evidence, based on the recommendations of the United States Preventive Services Task Force (USPSTF). Design Cross-sectional study. Setting Primary healthcare, Portuguese National Health Service. Participants 255 Portuguese family physicians selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. Outcomes Prevalence of compliance with USPSTF recommendations for screening, given a male and female clinical scenario and a set of proposed medical interventions, including frequency of the intervention and performance in their own daily practice. Results A response rate of 95.7% was obtained (n=244). 98–100% of family physicians answered according to the USPSTF recommendations in most interventions. In the male scenario, the lowest concordance was observed in the evaluation of prostate-specific antigen with 37% of family physicians answering according to the USPSTF recommendations. In the female scenario, the lowest concordance was for cholesterol testing with 2% of family physicians complying. Family physicians younger than 50 years had significantly better compliance scores than older ones (mean 77% vs 72%; p<0.001). Conclusions We found a high degree of agreement with USPSTF recommendations among Portuguese family physicians. However, we also found results suggesting excessive use of some medical interventions, raising concerns related to possible harm associated with overdiagnosis and overtreatment. PMID:24861550

Systems biology of personalized nutrition

PubMed Central

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

2017-01-01

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

Recommendations by the Spanish Society of Rheumatology for the management of patients diagnosed with rheumatoid arthritis who cannot be treated with methotrexate.

PubMed

García-Vicuña, Rosario; Martín-Martínez, María Auxiliadora; Gonzalez-Crespo, María Rosa; Tornero-Molina, Jesús; Fernández-Nebro, Antonio; Blanco-García, Francisco Javier; Blanco-Alonso, Ricardo; Marsal-Barril, Sara

To establish a set of recommendations for the management of patients diagnosed with rheumatoid arthritis (RA) who cannot be treated with methotrexate (MTX) due to contraindications, drug toxicity or lack of adherence, and to establish therapeutic strategies more effective and safer in these RA patients. A qualitative analysis of the scientific evidence available to June 2015. The 2-round Delphi technique of consensus was used to collect and establish expert opinion based on the participants' clinical experience when only low quality evidence was available. A total of eighteen recommendations were developed for the management of this patient profile. Fourteen of these recommendations were related to drug safety aspects. Recommendations on contraindication and toxicity of MTX have been updated. The experts recommend the use of biological monotherapy, a preferred treatment option, in patients whose profiles reveal a contraindication, intolerance or circumstances that prevent us against the use of MTX. There is some high-quality scientific evidence that supports contraindication and establishes certain conditions of MTX use in RA patients with specific clinical profiles. Copyright © 2016. Publicado por Elsevier España, S.L.U.

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

PubMed

Candelaria, Myrna; Cervera-Ceballos, Eduardo; Meneses-García, Abelardo; Avilés-Salas, Alejandro; Lome-Maldonado, Carmen; Zárate-Osorno, Alejandra; Ortiz-Hidalgo, Carlos; Rodríguez-Moguel, Leticia; Quiñónez-Urrego, Enoe Enedina; Ramos-Salazar, Patricia; Romero-Guadarrama, Mónica Belinda; Lara-Torres, César; Ramírez-Aceves, Rocío; López-Navarro, Omar; Rivas-Vera, Silvia; Díaz-Meneses, Iván Eudaldo; Estrada-Lobato, Enrique; Cervera-Ceballos, José; Rojas-Marín, Carlos Enrique; Hernández-Rodriguez, José Mario; Pérez-López, Berenice; Gómez-Almaguer, David; Altamirano-Ley, Javier; Baz, Patricia; Valero-Saldaña, Luis Manuel; Navarrete-Herrera, José René; Torres-Salgado, Francisco Gerardo; Solano-Murillo, Pedro; Nambo-Lucio, María de Jesús; Rivas-Llamas, Ramón; Aquino-Salgado, Jorge Luis; Avila-Arreguín, Elsa Verónica; Cortês-Esteban, Patricia; Chongo-Alfaro, Martha Lilia; Pérez-Ramírez, Oscar de Jesús; Toledano-Cuevas, Diana Vanesa; Lobato-Mendizábal, Eduardo; Martínez-Ramírez, Mario Alberto; Morales-Maravilla, Adrián; Sosa-Camas, Rosa Elena; Agreda-Vásquez, Gladys P; Camacho-Hernández, Alejandro; Aguayo-González, Alvaro; Espinoza-Zamora, José Ramiro; Sánchez-Guerrero, Sergio A; Lozano-Zavaleta, Valentín; Selva-Pallares, Julio Edgar; Hernádez-Rodríguez, Juan Manuel; Cardiel-Silva, Mariela; Castillo-Rivera, Manuel Héctor; Villela, Luis; Loarca-Piña, Luis Martín; Zurita-Martínez, Hugo; Graham-Casassus, Juan; Azaola-Espinosa, Patricio; Silva-López, Salvador; Armenta-San Sebastián, Jorge Antonio; Mijangos-Huesca, Francisco; Pérez-Osorio, Jorge Eduardo; Aldaco-Sarvide, Fernando; Castellanos, Guillermo; Ramírez-Ibarguen, Ana Florencia; Zapata-Canto, Nidia; Labardini-Méndez, Juan Rafael

2013-06-01

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

The Development of a Mindfulness-Based Music Therapy (MBMT) Program for Women Receiving Adjuvant Chemotherapy for Breast Cancer

PubMed Central

Lesiuk, Teresa

2016-01-01

Problems with attention and symptom distress are common clinical features reported by women who receive adjuvant chemotherapy for breast cancer. Mindfulness practice significantly improves attention and mindfulness programs significantly reduce symptom distress in patients with cancer, and, more specifically, in women with breast cancer. Recently, a pilot investigation of a music therapy program, built on core attitudes of mindfulness practice, reported significant benefits of enhanced attention and decreased negative mood and fatigue in women with breast cancer. This paper delineates the design and development of the mindfulness-based music therapy (MBMT) program implemented in that pilot study and includes clients’ narrative journal responses. Conclusions and recommendations, including recommendation for further exploration of the function of music in mindfulness practice are provided. PMID:27517966

[On the interdisciplinary S3 guidelines for the treatment of chronic idiopathic tinnitus].

PubMed

Zenner, H-P; Delb, W; Kröner-Herwig, B; Jäger, B; Peroz, I; Hesse, G; Mazurek, B; Goebel, G; Gerloff, C; Trollmann, R; Biesinger, E; Seidler, H; Langguth, B

2015-06-01

Tinnitus is a frequent symptom, which, particularly in combination with comorbidities, can result in a severe disease-related burden. Chronic idiopathic tinnitus (CIT) is the most frequent type of tinnitus. A considerable number of treatment strategies are used to treat CIT-for many of which there is no evidence of efficacy. In order to enable scientific evidence-based treatment of CIT, German interdisciplinary S3 guidelines have recently been constructed for the first time. Here we present a short form of these S3 guidelines. The guidelines were constructed based on a meta-analysis of the treatment of chronic tinnitus performed by the authors. Additionally, a systematic literature search was performed in the PubMed and Cochrane Library databases. Furthermore, a systematic search for international guidelines was performed in Google, as well as in the Guidelines International Network and National Guideline Clearinghouse (USA) database. Evidence was classified according to the Oxford Centre for Evidence-Based Medicine system. According to the guidelines, alongside counselling, manualized structured tinnitus-specific cognitive behavioral therapy (tCBT) with a validated treatment manual is available as evidence-based therapy. In addition, the guidelines recommend concurrent treatment of comorbidities, including drug-based treatment, where appropriate. Particularly important is treatment of anxiety and depression. Where a psychic or psychiatric comorbidity is suspected, further diagnosis and treatment should be performed by an appropriately qualified specialist (psychiatrist, neurologist, psychosomatic medicine consultant) or psychological psychotherapist. In cases accompanied by deafness or hearing loss bordering on deafness, cochlear implants may be indicated. No recommendations can be made for drug-based treatment of CIT, audiotherapy, transcranial magnetic or electrical stimulation, specific forms of acoustic stimulation or music therapy; or such recommendations must remain open due to the lack of available evidence. Polypragmatic tinnitus treatment with therapeutic strategies for which there is no evidence of efficacy from controlled studies is to be refused.

DoD’s War on Hazardous Waste. Volume 3. Identifying Specifications That Require the Use of Hazardous Substances

DTIC Science & Technology

1991-07-01

of all DoD and Federal standardization documents on file, refer to one or more of the 132 hazardous materials. Based on our... the use of the material as an option. In addition , we found 200 documents (14 percent) that specifically prohibit the use of one or more of the ...hazardous materials. Listing of standardization documents referring to chemicals are provided. We recommend more sophisticated review approaches and the provision

Recommendations on basic requirements for intensive care units: structural and organizational aspects.

PubMed

Valentin, Andreas; Ferdinande, Patrick

2011-10-01

To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version. The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems. This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESICM.

Energy expenditure estimates during school physical education: Potential vs. reality?

PubMed

Kahan, David; McKenzie, Thomas L

2017-02-01

Schools are salient locations for addressing the high prevalence of overweight and obesity. Most US states require some physical education (PE) and the energy expended during PE has potential to positively affect energy balance. We previously used 2012 data to examine state policies for PE to calculate estimated student energy expenditure (EEE) under potential (i.e., recommendations followed) and existing conditions. Since then, data have been updated on both state policies and the conduct of PE. Based on updated data, we used PE frequency, duration, and intensity, student mass, and class size to calculate EEE for the delivery of PE under (a) national professional recommendations, (b) 2016 state policies, and (c) school-reported conditions. Although increased from four years ago, only 22 states currently have policies mandating specific PE minutes. EEE over 10years shows the enormous impact PE could have on energy balance. For the average recommended-size PE class, resultant annual EEE based on professional recommendations for min/week far exceeded those based on average state (n=22) policy for min/week by 44.5% for elementary, 62.7% for middle, and 59.5% for high schools. Since 2012 more states adopted policies for PE minutes than dropped them, however, EEE over 10years showed a net loss of 1200kcal/student. With no overall recent improvements in state PE policy and professional recommendations currently not being met, PE remains an underutilized public health resource for EEE. Strong policies, coupled with enhanced accountability of PE teachers and administrators, are needed to ensure PE exists in schools. Copyright © 2016 Elsevier Inc. All rights reserved.

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.

PubMed

Bahn Chair, Rebecca S; Burch, Henry B; Cooper, David S; Garber, Jeffrey R; Greenlee, M Carol; Klein, Irwin; Laurberg, Peter; McDougall, I Ross; Montori, Victor M; Rivkees, Scott A; Ross, Douglas S; Sosa, Julie Ann; Stan, Marius N

2011-06-01

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.

PubMed

Bahn, Rebecca S; Burch, Henry B; Cooper, David S; Garber, Jeffrey R; Greenlee, M Carol; Klein, Irwin; Laurberg, Peter; McDougall, I Ross; Montori, Victor M; Rivkees, Scott A; Ross, Douglas S; Sosa, Julie Ann; Stan, Marius N

2011-01-01

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

Critical appraisal of cardiology guidelines on revascularisation: clinical practice.

PubMed

Dobies, David R; Barber, Kimberly R

2018-01-01

Evidence-based medicine (EBM) provides clinicians with beneficial information. Nonetheless, study findings are often arbitrary, speculative or provisional. The current state of misleading evidence exists in all applications, including those for guideline recommendations. We conductedan appraisal of the American College of Cardiologyand European Society of Cardiology Guidelines for revascularisation of complex coronary anatomy to determine the veracity of the evidence that recommendations were based on. Study-specific critical appraisals were conducted by the authors on the 5-year Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and future revascularisation evaluation in patients with diabetes mellitus: optimal management of multivessel disease (FREEDOM) Trials. Each appraisal was performed according the standard EBM practices. A thorough design and analytic critique was performed for each study and the results presented and explained. The guideline recommendations were reviewed in terms of the veracity of the evidence cited. The relative difference in major adverse cardiac and cerebrovascular event (MAACE) rates between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are not the 30% level reported by the SYNTAX Trial but closer to 11% difference when study limitations are factored in. Similarly, the 30% effect size in MAACE rates between procedures from the FREEDOM Trial is closer to a non-significant 5% relative difference when limitations are adjusted for. Based on the actual findings of each study, outcomes from procedures by CABG or PCI for multivessel revascularisation are similar and contradict the conclusions of the study authors as well as the recommendations. These recommendations fail to inform current clinical practice.

The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders.

PubMed

Schaffer, Ayal; McIntosh, Diane; Goldstein, Benjamin I; Rector, Neil A; McIntyre, Roger S; Beaulieu, Serge; Swinson, Richard; Yatham, Lakshmi N

2012-02-01

Comorbid mood and anxiety disorders are commonly seen in clinical practice. The goal of this article is to review the available literature on the epidemiologic, etiologic, clinical, and management aspects of this comorbidity and formulate a set of evidence- and consensus-based recommendations. This article is part of a set of Canadian Network for Mood and Anxiety Treatments (CANMAT) Comorbidity Task Force papers. We conducted a PubMed search of all English-language articles published between January 1966 and November 2010. The search terms were bipolar disorder and major depressive disorder, cross-referenced with anxiety disorders/symptoms, panic disorder, agoraphobia, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Levels of evidence for specific interventions were assigned based on a priori determined criteria, and recommendations were developed by integrating the level of evidence and clinical opinion of the authors. Comorbid anxiety symptoms and disorders have a significant impact on the clinical presentation and treatment approach for patients with mood disorders. A set of recommendations are provided for the management of bipolar disorder (BD) with comorbid anxiety and major depressive disorder (MDD) with comorbid anxiety with a focus on comorbid posttraumatic stress disorder, use of cognitive-behavioral therapy across mood and anxiety disorders, and youth with mood and anxiety disorders. Careful attention should be given to correctly identifying anxiety comorbidities in patients with BD or MDD. Consideration of evidence- or consensus-based treatment recommendations for the management of both mood and anxiety symptoms is warranted.

An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation

PubMed Central

Collaco, Joseph M.; Baker, Christopher D.; Carroll, John L.; Sharma, Girish D.; Brozek, Jan L.; Finder, Jonathan D.; Ackerman, Veda L.; Arens, Raanan; Boroughs, Deborah S.; Carter, Jodi; Daigle, Karen L.; Dougherty, Joan; Gozal, David; Kevill, Katharine; Kravitz, Richard M.; Kriseman, Tony; MacLusky, Ian; Rivera-Spoljaric, Katherine; Tori, Alvaro J.; Ferkol, Thomas; Halbower, Ann C.

2016-01-01

Background: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. Purpose: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. Methods: The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. Results: Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. Conclusions: Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child’s care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available. PMID:27082538

Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008.

PubMed

Wright, Tina I; Baddour, Larry M; Berbari, Elie F; Roenigk, Randall K; Phillips, P Kim; Jacobs, M Amanda; Otley, Clark C

2008-09-01

Antibiotic prophylaxis is an important component of dermatologic surgery, and recommendations in this area should reflect the updated 2007 guidelines of the American Heart Association, the American Dental Association with the American Academy of Orthopaedic Surgeons guidelines, and recent prospective studies on surgical site infection. To provide an update on the indications for antibiotic prophylaxis in dermatologic surgery for the prevention of infective endocarditis, hematogenous total joint infection, and surgical site infection. A literature review was performed, expert consensus was obtained, and updated recommendations were created, consistent with the most current authoritative guidelines from the American Heart Association and the American Dental Association with the American Academy of Orthopaedic Surgeons. For patients with high-risk cardiac conditions, and a defined group of patients with prosthetic joints at high risk for hematogenous total joint infection, prophylactic antibiotics are recommended when the surgical site is infected or when the procedure involves breach of the oral mucosa. For the prevention of surgical site infections, antibiotics may be indicated for procedures on the lower extremities or groin, for wedge excisions of the lip and ear, skin flaps on the nose, skin grafts, and for patients with extensive inflammatory skin disease. These recommendations are not based on multiple, large-scale, prospective trials. There is a strong shift away from administration of prophylactic antibiotics in many dermatologic surgery settings, based on updated authoritative guidelines. These recommendations provide guidance to comply with the most current guidelines, modified to address dermatology-specific considerations. Managing physicians may utilize these guidelines while individualizing their approach based on all clinical considerations.

Product Recommendation System Based on Personal Preference Model Using CAM

NASA Astrophysics Data System (ADS)

Murakami, Tomoko; Yoshioka, Nobukazu; Orihara, Ryohei; Furukawa, Koichi

Product recommendation system is realized by applying business rules acquired by data maining techniques. Business rules such as demographical patterns of purchase, are able to cover the groups of users that have a tendency to purchase products, but it is difficult to recommend products adaptive to various personal preferences only by utilizing them. In addition to that, it is very costly to gather the large volume of high quality survey data, which is necessary for good recommendation based on personal preference model. A method collecting kansei information automatically without questionnaire survey is required. The constructing personal preference model from less favor data is also necessary, since it is costly for the user to input favor data. In this paper, we propose product recommendation system based on kansei information extracted by text mining and user's preference model constructed by Category-guided Adaptive Modeling, CAM for short. CAM is a feature construction method that can generate new features constructing the space where same labeled examples are close and different labeled examples are far away from some labeled examples. It is possible to construct personal preference model by CAM despite less information of likes and dislikes categories. In the system, retrieval agent gathers the products' specification and user agent manages preference model, user's likes and dislikes. Kansei information of the products is gained by applying text mining technique to the reputation documents about the products on the web site. We carry out some experimental studies to make sure that prefrence model obtained by our method performs effectively.

EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.

PubMed

Agca, R; Heslinga, S C; Rollefstad, S; Heslinga, M; McInnes, I B; Peters, M J L; Kvien, T K; Dougados, M; Radner, H; Atzeni, F; Primdahl, J; Södergren, A; Wallberg Jonsson, S; van Rompay, J; Zabalan, C; Pedersen, T R; Jacobsson, L; de Vlam, K; Gonzalez-Gay, M A; Semb, A G; Kitas, G D; Smulders, Y M; Szekanecz, Z; Sattar, N; Symmons, D P M; Nurmohamed, M T

2017-01-01

Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Diagnosis and treatment of dementia: 2. Diagnosis

PubMed Central

Feldman, Howard H.; Jacova, Claudia; Robillard, Alain; Garcia, Angeles; Chow, Tiffany; Borrie, Michael; Schipper, Hyman M.; Blair, Mervin; Kertesz, Andrew; Chertkow, Howard

2008-01-01

Background Dementia can now be accurately diagnosed through clinical evaluation, cognitive screening, basic laboratory evaluation and structural imaging. A large number of ancillary techniques are also available to aid in diagnosis, but their role in the armamentarium of family physicians remains controversial. In this article, we provide physicians with practical guidance on the diagnosis of dementia based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006. Methods We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that pertained to key diagnostic issues in dementia. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. Results Of the 1591 articles we identified on all aspects of dementia diagnosis, 1095 met our inclusion criteria; 620 were deemed to be of good or fair quality. From a synthesis of the evidence in these studies, we made 32 recommendations related to the diagnosis of dementia. There are clinical criteria for diagnosing most forms of dementia. A standard diagnostic evaluation can be performd by family physicians over multiple visits. It involves a clinical history (from patient and caregiver), a physical examination and brief cognitive testing. A list of core laboratory tests is recommended. Structural imaging with computed tomography or magnetic resonance imaging is recommended in selected cases to rule out treatable causes of dementia or to rule in cerebrovascular disease. There is insufficient evidence to recommend routine functional imaging, measurement of biomarkers or neuropsychologic testing. Interpretation The diagnosis of dementia remains clinically integrative based on history, physical examination and brief cognitive testing. A number of core laboratory tests are also recommended. Structural neuroimaging is advised in selected cases. Other diagnostic approaches, including functional neuroimaging, neuropsychological testing and measurement of biomarkers, have shown promise but are not yet recommended for routine use by family physicians. PMID:18362376

Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology.

PubMed

Nguyen, Geoffrey C; Bernstein, Charles N; Bitton, Alain; Chan, Anthony K; Griffiths, Anne M; Leontiadis, Grigorios I; Geerts, William; Bressler, Brian; Butzner, J Decker; Carrier, Marc; Chande, Nilesh; Marshall, John K; Williams, Chadwick; Kearon, Clive

2014-03-01

Guidelines for the management of venous thromboembolism (VTE) from the American College of Chest Physicians do not address patients with inflammatory bowel disease (IBD), a group with a high risk of both VTE and gastrointestinal bleeding. We present recommendations for the prevention and treatment of VTE in patients with IBD. A systematic literature search was performed to identify studies on VTE in IBD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were developed through an iterative online platform, then finalized and voted on by a working group of adult and pediatric gastroenterologists and thrombosis specialists. IBD patients have an approximately 3-fold higher risk of VTE compared with individuals without IBD, and disease flares further increase this risk. Anticoagulant thromboprophylaxis is recommended for IBD patients who are hospitalized with IBD flares without active bleeding and is suggested when bleeding is nonsevere. Anticoagulant thromboprophylaxis is suggested during moderate-severe IBD flares in outpatients with a history of VTE provoked by an IBD flare or an unprovoked VTE, but not otherwise. The recommended duration of anticoagulation after a first VTE is based on the presence of provoking factors. Specific suggestions are made for the prevention and treatment of VTE in pediatric and pregnant IBD patients. Using the American College of Chest Physicians' guidelines as a foundation, we have integrated evidence from IBD studies to develop specific recommendations for the management of VTE in this high-risk population. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

[Management of chronic heart failure - a systematic review of guidelines in the context of the DMP revision].

PubMed

Kötter, Thomas; Bartel, Carmen; Schramm, Susanne; Lange, Petra; Höfer, Eva; Hänsel, Michaela; Waffenschmidt, Siw; Waldt, Susanne Ein; Hoffmann-Eßer, Wiebke; Rüther, Alric; Lühmann, Dagmar; Scherer, Martin

2013-01-01

Disease Management Programmes (DMPs) are structured treatment programmes for chronic diseases. The DMP requirements are primarily derived from evidence-based guidelines. DMPs are regularly revised to ensure that they reflect current best practice and medical knowledge. The aim of this study was to assess the need for updating the German DMP module on heart failure by comparing it to relevant guidelines and identifying recommendations that should be revised. We systematically searched for clinical guidelines on heart failure published in German, English or French, and extracted relevant guideline recommendations. All included guidelines were assessed for methodological quality. To identify revision needs in the DMP, we performed a synoptic analysis of the extracted guideline recommendations and DMP requirements. 27 guidelines were included. The extracted recommendations covered all aspects of the management of heart failure. The comparison of guideline recommendations with DMP requirements showed that, overall, guideline recommendations were more detailed than DMP requirements, and that the guidelines covered topics not included in the DMP module. The DMP module is largely consistent with current guidelines on heart failure. We did not identify any need for significant revision of the DMP requirements. However, some specific recommendations of the DMP module could benefit from revision. Copyright © 2013. Published by Elsevier GmbH.

Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols: The SPIRIT-PRO Extension.

PubMed

Calvert, Melanie; Kyte, Derek; Mercieca-Bebber, Rebecca; Slade, Anita; Chan, An-Wen; King, Madeleine T; Hunn, Amanda; Bottomley, Andrew; Regnault, Antoine; Chan, An-Wen; Ells, Carolyn; O'Connor, Daniel; Revicki, Dennis; Patrick, Donald; Altman, Doug; Basch, Ethan; Velikova, Galina; Price, Gary; Draper, Heather; Blazeby, Jane; Scott, Jane; Coast, Joanna; Norquist, Josephine; Brown, Julia; Haywood, Kirstie; Johnson, Laura Lee; Campbell, Lisa; Frank, Lori; von Hildebrand, Maria; Brundage, Michael; Palmer, Michael; Kluetz, Paul; Stephens, Richard; Golub, Robert M; Mitchell, Sandra; Groves, Trish

2018-02-06

Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance. To develop international, consensus-based, PRO-specific protocol guidance (the SPIRIT-PRO Extension). The SPIRIT-PRO Extension was developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network's methodological framework for guideline development. This included (1) a systematic review of existing PRO-specific protocol guidance to generate a list of potential PRO-specific protocol items (published in 2014); (2) refinements to the list and removal of duplicate items by the International Society for Quality of Life Research (ISOQOL) Protocol Checklist Taskforce; (3) an international stakeholder survey of clinical trial research personnel, PRO methodologists, health economists, psychometricians, patient advocates, funders, industry representatives, journal editors, policy makers, ethicists, and researchers responsible for evidence synthesis (distributed by 38 international partner organizations in October 2016); (4) an international Delphi exercise (n = 137 invited; October 2016 to February 2017); and (5) consensus meeting (n = 30 invited; May 2017). Prior to voting, consensus meeting participants were informed of the results of the Delphi exercise and given data from structured reviews evaluating the PRO protocol content of 3 defined samples of trial protocols. The systematic review identified 162 PRO-specific protocol recommendations from 54 sources. The ISOQOL Taskforce (n = 21) reduced this to 56 items, which were considered by 138 international stakeholder survey participants and 99 Delphi panelists. The final wording of the SPIRIT-PRO Extension was agreed on at a consensus meeting (n = 29 participants) and reviewed by external group of experts during a consultation period. Eleven extensions and 5 elaborations to the SPIRIT 2013 checklist were recommended for inclusion in clinical trial protocols in which PROs are a primary or key secondary outcome. Extension items focused on PRO-specific issues relating to the trial rationale, objectives, eligibility criteria, concepts used to evaluate the intervention, time points for assessment, PRO instrument selection and measurement properties, data collection plan, translation to other languages, proxy completion, strategies to minimize missing data, and whether PRO data will be monitored during the study to inform clinical care. The SPIRIT-PRO guidelines provide recommendations for items that should be addressed and included in clinical trial protocols in which PROs are a primary or key secondary outcome. Improved design of clinical trials including PROs could help ensure high-quality data that may inform patient-centered care.

Clinical care of persons with dementia in the emergency department: a review of the literature and agenda for research.

PubMed

Clevenger, Carolyn K; Chu, Thasha A; Yang, Zhou; Hepburn, Kenneth W

2012-09-01

The segment of older adults who present to the emergency department (ED) with cognitive impairment ranges from 21% to 40%. Difficulties inherent in the chaotic ED setting combined with dementia may result in a number of unwanted clinical outcomes, but strategies to minimize these outcomes are lacking. A review of the literature was conducted to examine the practices undertaken in the care of persons with dementia (PWD) specific to the ED setting. PubMed and Cumulative Index to Nursing and Allied Health Literature were searched for published articles specific to the care of PWD provided in the ED. All English-language articles were reviewed; editorials and reflective journals were excluded. Seven articles ultimately met inclusion criteria; all provided Level 7 evidence: narrative review or opinions from authorities. The articles recommended clinical practices that can be categorized into five themes: assessment of cognitive impairment, dementia communication strategies, avoidance of adverse events, alterations to the physical environment, and education of ED staff. Many recommendations are extrapolated from residential care settings. Review results indicate that there is minimal guidance for the care of PWD specific to the ED setting. There are no empirical studies of the care (assessment, interventions) of PWD in the ED. The existing (Level 7) recommendations lack a research base to support their effectiveness or adoption as evidence-based practice. There is a significant opportunity for research to identify and test ways to meet the needs of PWD in the ED to ensure a safe visit, accurate diagnosis, and prudent transfer to the most appropriate level of care. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Treatment recommendations for DSM-5-defined mixed features.

PubMed

Rosenblat, Joshua D; McIntyre, Roger S

2017-04-01

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) mixed features specifier provides a less restrictive definition of mixed mood states, compared to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), including mood episodes that manifest with subthreshold symptoms of the opposite mood state. A limited number of studies have assessed the efficacy of treatments specifically for DSM-5-defined mixed features in mood disorders. As such, there is currently an inadequate amount of data to appropriately inform evidence-based treatment guidelines of DSM-5 defined mixed features. However, given the high prevalence and morbidity of mixed features, treatment recommendations based on the currently available evidence along with expert opinion may be of benefit. This article serves to provide these interim treatment recommendations while humbly acknowledging the limited amount of evidence currently available. Second-generation antipsychotics (SGAs) appear to have the greatest promise in the treatment of bipolar disorder (BD) with mixed features. Conventional mood stabilizing agents (ie, lithium and divalproex) may also be of benefit; however, they have been inadequately studied. In the treatment of major depressive disorder (MDD) with mixed features, the comparable efficacy of antidepressants versus other treatments, such as SGAs, remains unknown. As such, antidepressants remain first-line treatment of MDD with or without mixed features; however, there are significant safety concerns associated with antidepressant monotherapy when mixed features are present, which merits increased monitoring. Lurasidone is the only SGA monotherapy that has been shown to be efficacious specifically in the treatment of MDD with mixed features. Further research is needed to accurately determine the efficacy, safety, and tolerability of treatments specifically for mood episodes with mixed features to adequately inform future treatment guidelines.

Challenging Obesity: Patient, Provider, and Expert Perspectives on the Roles of Available and Emerging Nonsurgical Therapies

PubMed Central

Apovian, Caroline M.; Garvey, W. Timothy; Ryan, Donna H.

2015-01-01

Objective Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient’s disease status in addition to their individual needs, preferences, and attitudes regarding treatment. A central role and responsibility of healthcare professionals in this process is to inform and educate patients about their treatment options. Although current recommendations for the management of adult obesity provide general guidance regarding safe and proper implementation of lifestyle, pharmacological, and surgical interventions, healthcare professionals need awareness of specific evidence-based information that supports individualized clinical application of these therapies. More specifically, healthcare professionals should be up-to-date on approaches that promote successful lifestyle management and be knowledgeable about newer weight loss pharmacotherapies, so they can offer patients with obesity a wide range of options to personalize their treatment. Accordingly, this educational activity has been developed to provide participants with the latest information on treatment recommendations and therapeutic advances in lifestyle intervention and pharmacotherapy for adult obesity management. Design and Methods This supplement is based on the content presented at a live CME symposium held in conjunction with ObesityWeek 2014. Results This supplement provides an expert summary of current treatment recommendations and recent advances in nonsurgical therapies for the management of adult obesity. Patient and provider perspectives on obesity management are highlighted in embedded video clips available via QR codes, and new evidence will be applied using clinically relevant case studies. Conclusions This supplement provides a topical update of obesity management, including clinical practice examples, for healthcare professionals who treat or provide care for adults with obesity. PMID:26154880

Conducting Creativity Brainstorming Sessions in Small and Medium-Sized Enterprises Using Computer-Mediated Communication Tools

NASA Astrophysics Data System (ADS)

Murthy, Uday S.

A variety of Web-based low cost computer-mediated communication (CMC) tools are now available for use by small and medium-sized enterprises (SME). These tools invariably incorporate chat systems that facilitate simultaneous input in synchronous electronic meeting environments, allowing what is referred to as “electronic brainstorming.” Although prior research in information systems (IS) has established that electronic brainstorming can be superior to face-to-face brainstorming, there is a lack of detailed guidance regarding how CMC tools should be optimally configured to foster creativity in SMEs. This paper discusses factors to be considered in using CMC tools for creativity brainstorming and proposes recommendations for optimally configuring CMC tools to enhance creativity in SMEs. The recommendations are based on lessons learned from several recent experimental studies on the use of CMC tools for rich brainstorming tasks that require participants to invoke domain-specific knowledge. Based on a consideration of the advantages and disadvantages of the various configuration options, the recommendations provided can form the basis for selecting a CMC tool for creativity brainstorming or for creating an in-house CMC tool for the purpose.

Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement.

PubMed

Grossman, David C; Curry, Susan J; Owens, Douglas K; Bibbins-Domingo, Kirsten; Caughey, Aaron B; Davidson, Karina W; Doubeni, Chyke A; Ebell, Mark; Epling, John W; Kemper, Alex R; Krist, Alex H; Kubik, Martha; Landefeld, C Seth; Mangione, Carol M; Silverstein, Michael; Simon, Melissa A; Siu, Albert L; Tseng, Chien-Wen

2018-05-08

In the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 13%, and the lifetime risk of dying of prostate cancer is 2.5%. The median age of death from prostate cancer is 80 years. Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease. African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men. To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on prostate-specific antigen (PSA)-based screening for prostate cancer. The USPSTF reviewed the evidence on the benefits and harms of PSA-based screening for prostate cancer and subsequent treatment of screen-detected prostate cancer. The USPSTF also commissioned a review of existing decision analysis models and the overdiagnosis rate of PSA-based screening. The reviews also examined the benefits and harms of PSA-based screening in patient subpopulations at higher risk of prostate cancer, including older men, African American men, and men with a family history of prostate cancer. Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened. Potential harms of screening include frequent false-positive results and psychological harms. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence, and 2 in 3 men will experience long-term erectile dysfunction. Adequate evidence shows that the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment. The USPSTF concludes with moderate certainty that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men. How each man weighs specific benefits and harms will determine whether the overall net benefit is small. The USPSTF concludes with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harms. For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. (C recommendation) The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. (D recommendation).

Evidence-based guidelines for anti-allergic drug withdrawal times before allergen-specific intradermal and IgE serological tests in dogs.

PubMed

Olivry, Thierry; Saridomichelakis, Manolis

2013-04-01

Anti-allergic drugs (e.g. antihistamines, glucocorticoids and ciclosporin) are often administered to dogs with atopic dermatitis to relieve pruritus and skin lesions. Allergen-specific intradermal tests (IDT) and allergen-specific IgE serological (ASIS) tests are used to characterize the allergens to which dogs are hypersensitive. Anti-allergic drugs have the potential to influence the results or interpretation of these tests. To provide evidence-based recommendations for anti-allergic drug withdrawal times before IDT and ASIS tests. Three citation databases and abstracts from international meetings were searched for relevant studies. Studies were grouped based on similar interventions and types of tests. Withdrawal times for each type of drug and test were then extrapolated from the study results. Before the assessment of immediate reactions to IDT, proposed optimal withdrawal times for antihistamines, oral glucocorticoids, topical/otic glucocorticoids and ciclosporin are 7, 14, 14 and 0 days, respectively. Studies have provided no evidence for drug withdrawal prior to ASIS tests for oral ciclosporin or prednisone/prednisolone. Owing to a lack of studies, recommendations for withdrawal times before ASIS tests cannot be made for topical glucocorticoids and antihistamines. These proposed withdrawal times are based on the existing evidence at the end of 2011. Care must be taken before extrapolating the suggested withdrawal times to other species, higher dosages, different formulations and/or durations of administration of tested drugs, as well as to other medications from the same category. © 2013 The Authors. Veterinary Dermatology © 2013 ESVD and ACVD.

Drug offence sentencing practices in the United States of America.

PubMed

Weissman, J C

1984-01-01

The United States criminal justice system, in response to a variety of risks, makes available a range of options to help control drug offenders. Pre-arrest diversion, pre-trial diversion, pre-trial release, probation, split sentencing, warn release, incarceration and parole release are alternative dispositions involving a graduated scale of punishment, incarceration, specific deterrence and rehabilitation. New drug offence sentencing policies are emerging within the criminal justice system. Traditional values of rehabilitation are currently less favoured and contemporary doctrines advocate sentencing based on principles of uniformity and retribution. Drug law sentencing practices are a principal concern of this article and the major policy themes are systematically reviewed. Diversion, criminal responsibility, selective incapacitation, trafficking, and cocaine abuse are examined. Guidelines for policy development are recommended and the analysis covers the related concepts of sentencing ideology, decriminalization, and determinate sentencing models. Specific recommendations are offered for revision of drug offence sentencing policies to incorporate the emerging penal values.

[Fibroepithelial polyp of the ureter. Report of one case].

PubMed

Morales, Raúl; Manrique, Eduardo; Casanova, Rubén; Molina, Pedro; Falcón, Ramón

2004-05-01

To report the rare case of a patient with a ureteral polyp. We describe the case of a 55-year-old female patient receiving care at the Celia Sanchez Manduley University Hospital in Manzanillo, Cuba, who was fortuitously diagnosed of a fibroepithelial polyp of the right ureter during the work up and treatment of an ovarian tumor. This case is the first of its kind in this hospital after 22 years, which confirms the rarity of ureteral tumors, specifically those of benign etiology. The absence of symptoms, specifically hematuria and pain, does not correspond to the reviewed articles. The chosen treatment was exeresis of the polyp at its base and frozen biopsy, followed by re-establishment of the urinary passage, as various authors recommend. Currently the endoscopical approach is recommended for its multiple advantages. We conclude that this disease is very rare, may have a symptomatic course and the treatment of choice is surgery with very good results.

Enabling Open Research Data Discovery through a Recommender System

NASA Astrophysics Data System (ADS)

Devaraju, Anusuriya; Jayasinghe, Gaya; Klump, Jens; Hogan, Dominic

2017-04-01

Government agencies, universities, research and nonprofit organizations are increasingly publishing their datasets to promote transparency, induce new research and generate economic value through the development of new products or services. The datasets may be downloaded from various data portals (data repositories) which are general or domain-specific. The Registry of Research Data Repository (re3data.org) lists more than 2500 such data repositories from around the globe. Data portals allow keyword search and faceted navigation to facilitate discovery of research datasets. However, the volume and variety of datasets have made finding relevant datasets more difficult. Common dataset search mechanisms may be time consuming, may produce irrelevant results and are primarily suitable for users who are familiar with the general structure and contents of the respective database. Therefore, we need new approaches to support research data discovery. Recommender systems offer new possibilities for users to find datasets that are relevant to their research interests. This study presents a recommender system developed for the CSIRO Data Access Portal (DAP, http://data.csiro.au). The datasets hosted on the portal are diverse, published by researchers from 13 business units in the organisation. The goal of the study is not to replace the current search mechanisms on the data portal, but rather to extend the data discovery through an exploratory search, in this case by building a recommender system. We adopted a hybrid recommendation approach, comprising content-based filtering and item-item collaborative filtering. The content-based filtering computes similarities between datasets based on metadata such as title, keywords, descriptions, fields of research, location, contributors, etc. The collaborative filtering utilizes user search behaviour and download patterns derived from the server logs to determine similar datasets. Similarities above are then combined with different degrees of importance (weights) to determine the overall data similarity. We determined the similarity weights based on a survey involving 150 users of the portal. The recommender results for a given dataset are accessible programmatically via a RESTful web service. An offline evaluation involving data users demonstrates the ability of the recommender system to discover relevant and 'novel' datasets.

[GESIDA/National AIDS Plan: Consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (Updated January 2015)].

PubMed

2015-10-01

This consensus document is an update of combined antiretroviral therapy (cART) guidelines and recommendations for HIV-1 infected adult patients. To formulate these recommendations, a panel composed of members of the AIDS Study Group and the AIDS National Plan (GeSIDA/Plan Nacional sobre el Sida) reviewed the efficacy and safety advances in clinical trials, and cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. The strength of the recommendations, and the evidence that supports them, are based on modified criteria of the Infectious Diseases Society of America. In this update, cART is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and level of the recommendation depends on the CD4+T-lymphocyte count, the presence of opportunistic diseases or comorbid conditions, age, and prevention of transmission of HIV. The objective of cART is to achieve an undetectable plasma viral load. Initial cART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors, and a third drug from a different family. Three out of the ten recommended regimes are regarded as preferential (all of them with an integrase inhibitor as the third drug), and the other seven (based on a non-nucleoside reverse transcriptase inhibitor, a ritonavir-boosted protease inhibitor, or an integrase inhibitor) as alternatives. This update presents the causes and criteria for switching cART in patients with undetectable plasma viral load, and in cases of virological failure where rescue cART should comprise 3 (or at least 2) drugs that are fully active against the virus. An update is also provided for the specific criteria for cART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer). These new guidelines update previous recommendations related to cART (when to begin and what drugs should be used), how to monitor and what to do in case of viral failure or drug adverse reactions. cART specific criteria in comorbid patients and special situations are equally updated. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Information Retrieval and Graph Analysis Approaches for Book Recommendation.

PubMed

Benkoussas, Chahinez; Bellot, Patrice

2015-01-01

A combination of multiple information retrieval approaches is proposed for the purpose of book recommendation. In this paper, book recommendation is based on complex user's query. We used different theoretical retrieval models: probabilistic as InL2 (Divergence from Randomness model) and language model and tested their interpolated combination. Graph analysis algorithms such as PageRank have been successful in Web environments. We consider the application of this algorithm in a new retrieval approach to related document network comprised of social links. We called Directed Graph of Documents (DGD) a network constructed with documents and social information provided from each one of them. Specifically, this work tackles the problem of book recommendation in the context of INEX (Initiative for the Evaluation of XML retrieval) Social Book Search track. A series of reranking experiments demonstrate that combining retrieval models yields significant improvements in terms of standard ranked retrieval metrics. These results extend the applicability of link analysis algorithms to different environments.

Information Retrieval and Graph Analysis Approaches for Book Recommendation

PubMed Central

Benkoussas, Chahinez; Bellot, Patrice

2015-01-01

A combination of multiple information retrieval approaches is proposed for the purpose of book recommendation. In this paper, book recommendation is based on complex user's query. We used different theoretical retrieval models: probabilistic as InL2 (Divergence from Randomness model) and language model and tested their interpolated combination. Graph analysis algorithms such as PageRank have been successful in Web environments. We consider the application of this algorithm in a new retrieval approach to related document network comprised of social links. We called Directed Graph of Documents (DGD) a network constructed with documents and social information provided from each one of them. Specifically, this work tackles the problem of book recommendation in the context of INEX (Initiative for the Evaluation of XML retrieval) Social Book Search track. A series of reranking experiments demonstrate that combining retrieval models yields significant improvements in terms of standard ranked retrieval metrics. These results extend the applicability of link analysis algorithms to different environments. PMID:26504899

Update on the management of Helicobacter pylori infection. Position paper from the Catalan Society of Digestology.

PubMed

Sánchez Delgado, Jordi; García-Iglesias, Pilar; Titó, Llúcia; Puig, Ignasi; Planella, Montse; Gené, Emili; Saló, Joan; Martínez-Cerezo, Francesc; Molina-Infante, Javier; Gisbert, Javier P; Calvet, Xavier

2018-04-01

More than 30 years after its discovery, Helicobacter pylori (H. pylori) infection remains the most common cause of gastric and duodenal diseases. H. pylori is the leading cause of chronic gastritis, peptic ulcer, gastric MALT lymphoma and gastric adenocarcinoma. Several consensuses have recently been published on the management of H. pylori infection. The general guidelines of the Spanish consensus, the Toronto Consensus and the Maastricht V Consensus of 2016 are similar but concrete recommendations can vary significantly. In addition, the recommendations of some of these consensuses are decidedly complex. This position paper from the Catalan Society of Digestology is an update of evidence-based recommendations on the management and treatment of H. pylori infection. The aim of this document is to review this information in order to make recommendations for routine clinical practice that are simple, specific and easily applied to our setting. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Management of prediabetes: a comparison of the treatment approaches utilized by a family practice clinic and an internal medicine/endocrinology practice.

PubMed

Anderson, Zachary L; Scopelliti, Emily M; Trompeter, Jessica M; Havrda, Dawn E

2015-02-01

To compare the management of prediabetes between a family practice clinic and internal medicine/endocrinology practice. A randomized, retrospective evaluation of the medical history in 168 eligible patients with a diagnosis of prediabetes or abnormal blood glucose (BG) at a family practice clinic (n = 78) and an internal medicine/endocrinology practice (n = 90). The internal medicine/endocrinology practice provided more counseling regarding lifestyle modifications (91.1% vs 76.9%, P = .039), specific physical activity recommendations (26.7% vs 7.7%, P = .003), and recommended more patients receive 150 minutes/week of moderate exercise (8.9% vs 1.3%, P = .038). The family practice clinic provided more written dietary information (16.9% vs 13.3%, P = .044) and specific weight loss goals (20.5% vs 6.7%, P = .015). The internal medicine/endocrinology practice initiated pharmacological therapy in more patients (51.1% vs 3.8%, P< .001) and had a significant decrease in fasting BG from baseline compared to the family practice clinic (-9.0 vs -5.6 mg/dL, P< .001). Providers are likely to initiate nonpharmacological therapy but may not provide specific education recommended by the American Diabetes Association. The integration of a multidisciplinary team to provide guideline-based nonpharmacologic counseling may be beneficial in improving outcomes in the management of prediabetes. © The Author(s) 2013.

Examining the relative effectiveness of different message framing strategies for child passenger safety: recommendations for increased comprehension and compliance.

PubMed

Will, Kelli England; Decina, Lawrence E; Maple, Erin L; Perkins, Amy M

2015-06-01

Age-appropriate child restraints and rear seating dramatically reduce injury in vehicle crashes. Yet parents and caregivers struggle to comply with child passenger safety (CPS) recommendations, and frequently make mistakes when choosing and installing restraints. The purpose of this research was to evaluate various methods of framing CPS recommendations, and to examine the relative effectiveness on parents' knowledge, attitudes, and behavioral intentions related to best practices and proper use of child restraints. Emphasis framing is a persuasion technique that involves placing focus on specific aspects of the content in order to encourage or discourage certain interpretations of the content. A 5 (flyer group) X 2 (time) randomized experiment was conducted in which 300 parent participants answered a pre-survey, viewed one of four flyer versions or a no-education control version, and completed a post-survey. Surveys measured CPS knowledge, attitudes, perceptions of efficacy and risk, and behavioral intentions. The four flyers compared in this study all communicated the same CPS recommendations, but several versions were tested which each employed a different emphasis frame: (1) recommendations organized by the natural progression of seat types; (2) recommendations which focused on avoiding premature graduation; (3) recommendations which explained the risk-reduction rationale behind the information given; or (4) recommendations which were organized by age. In a fifth no-education (control) condition, participants viewed marketing materials. Analyses of covariance and pairwise comparisons indicated the risk-reduction rationale flyer outperformed other flyers for many subscales, and significantly differed from no-education control for the most subscales, including restraint selection, back seat knowledge, rear-facing knowledge and attitudes, total efficacy, overall attitudes, and stated intentions. This research provides insight for increasing caregiver understanding and compliance with CPS information. Recommendations for the field include communicating the rationale behind the information given, using behavior-based directives in headers, avoiding age-based headers, and incorporating back-seat positioning directives throughout. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ultra-accurate collaborative information filtering via directed user similarity

NASA Astrophysics Data System (ADS)

Guo, Q.; Song, W.-J.; Liu, J.-G.

2014-07-01

A key challenge of the collaborative filtering (CF) information filtering is how to obtain the reliable and accurate results with the help of peers' recommendation. Since the similarities from small-degree users to large-degree users would be larger than the ones in opposite direction, the large-degree users' selections are recommended extensively by the traditional second-order CF algorithms. By considering the users' similarity direction and the second-order correlations to depress the influence of mainstream preferences, we present the directed second-order CF (HDCF) algorithm specifically to address the challenge of accuracy and diversity of the CF algorithm. The numerical results for two benchmark data sets, MovieLens and Netflix, show that the accuracy of the new algorithm outperforms the state-of-the-art CF algorithms. Comparing with the CF algorithm based on random walks proposed by Liu et al. (Int. J. Mod. Phys. C, 20 (2009) 285) the average ranking score could reach 0.0767 and 0.0402, which is enhanced by 27.3% and 19.1% for MovieLens and Netflix, respectively. In addition, the diversity, precision and recall are also enhanced greatly. Without relying on any context-specific information, tuning the similarity direction of CF algorithms could obtain accurate and diverse recommendations. This work suggests that the user similarity direction is an important factor to improve the personalized recommendation performance.

Women's Values and Preferences for Thromboprophylaxis during Pregnancy: A Comparison of Direct-choice and Decision Analysis using Patient Specific Utilities

PubMed Central

Eckman, Mark H.; Alonso-Coello, Pablo; Guyatt, Gordon H.; Ebrahim, Shanil; Tikkinen, Kari A.O.; Lopes, Luciane Cruz; Neumann, Ignacio; McDonald, Sarah D.; Zhang, Yuqing; Zhou, Qi; Akl, Elie A.; Jacobsen, Ann Flem; Santamaría, Amparo; Annichino-Bizzacchi, Joyce Maria; Bitar, Wael; Sandset, Per Morten; Bates, Shannon M.

2016-01-01

Background Women with a history of venous thromboembolism (VTE) have an increased recurrence risk during pregnancy. Low molecular weight heparin (LMWH) reduces this risk, but is costly, burdensome, and may increase risk of bleeding. The decision to start thromboprophylaxis during pregnancy is sensitive to women's values and preferences. Our objective was to compare women's choices using a holistic approach in which they were presented all of the relevant information (direct-choice) versus a personalized decision analysis in which a mathematical model incorporated their preferences and VTE risk to make a treatment recommendation. Methods Multicenter, international study. Structured interviews were on women with a history of VTE who were pregnant, planning, or considering pregnancy. Women indicated their willingness to receive thromboprophylaxis based on scenarios using personalized estimates of VTE recurrence and bleeding risks. We also obtained women's values for health outcomes using a visual analog scale. We performed individualized decision analyses for each participant and compared model recommendations to decisions made when presented with the direct-choice exercise. Results Of the 123 women in the study, the decision model recommended LMWH for 51 women and recommended against LMWH for 72 women. 12% (6/51) of women for whom the decision model recommended thromboprophylaxis chose not to take LMWH; 72% (52/72) of women for whom the decision model recommended against thromboprophylaxis chose LMWH. Conclusions We observed a high degree of discordance between decisions in the direct-choice exercise and decision model recommendations. Although which approach best captures individuals’ true values remains uncertain, personalized decision support tools presenting results based on personalized risks and values may improve decision making. PMID:26033397

Women's values and preferences for thromboprophylaxis during pregnancy: a comparison of direct-choice and decision analysis using patient specific utilities.

PubMed

Eckman, Mark H; Alonso-Coello, Pablo; Guyatt, Gordon H; Ebrahim, Shanil; Tikkinen, Kari A O; Lopes, Luciane Cruz; Neumann, Ignacio; McDonald, Sarah D; Zhang, Yuqing; Zhou, Qi; Akl, Elie A; Jacobsen, Ann Flem; Santamaría, Amparo; Annichino-Bizzacchi, Joyce Maria; Bitar, Wael; Sandset, Per Morten; Bates, Shannon M

2015-08-01

Women with a history of venous thromboembolism (VTE) have an increased recurrence risk during pregnancy. Low molecular weight heparin (LMWH) reduces this risk, but is costly, burdensome, and may increase risk of bleeding. The decision to start thromboprophylaxis during pregnancy is sensitive to women's values and preferences. Our objective was to compare women's choices using a holistic approach in which they were presented all of the relevant information (direct-choice) versus a personalized decision analysis in which a mathematical model incorporated their preferences and VTE risk to make a treatment recommendation. Multicenter, international study. Structured interviews were on women with a history of VTE who were pregnant, planning, or considering pregnancy. Women indicated their willingness to receive thromboprophylaxis based on scenarios using personalized estimates of VTE recurrence and bleeding risks. We also obtained women's values for health outcomes using a visual analog scale. We performed individualized decision analyses for each participant and compared model recommendations to decisions made when presented with the direct-choice exercise. Of the 123 women in the study, the decision model recommended LMWH for 51 women and recommended against LMWH for 72 women. 12% (6/51) of women for whom the decision model recommended thromboprophylaxis chose not to take LMWH; 72% (52/72) of women for whom the decision model recommended against thromboprophylaxis chose LMWH. We observed a high degree of discordance between decisions in the direct-choice exercise and decision model recommendations. Although which approach best captures individuals' true values remains uncertain, personalized decision support tools presenting results based on personalized risks and values may improve decision making. Copyright © 2015 Elsevier Ltd. All rights reserved.

A technology-based patient and family engagement consult service for the pediatric hospital setting.

PubMed

Jackson, Gretchen P; Robinson, Jamie R; Ingram, Ebone; Masterman, Mary; Ivory, Catherine; Holloway, Diane; Anders, Shilo; Cronin, Robert M

2018-02-01

The Vanderbilt Children's Hospital launched an innovative Technology-Based Patient and Family Engagement Consult Service in 2014. This paper describes our initial experience with this service, characterizes health-related needs of families of hospitalized children, and details the technologies recommended to promote engagement and meet needs. We retrospectively reviewed consult service documentation for patient characteristics, health-related needs, and consultation team recommendations. Needs were categorized using a consumer health needs taxonomy. Recommendations were classified by technology type. Twenty-two consultations were conducted with families of patients ranging in age from newborn to 15 years, most with new diagnoses or chronic illnesses. The consultation team identified 99 health-related needs (4.5 per consultation) and made 166 recommendations (7.5 per consultation, 1.7 per need). Need categories included 38 informational needs, 26 medical needs, 23 logistical needs, and 12 social needs. The most common recommendations were websites (50, 30%) and mobile applications (30, 18%). The most frequent recommendations by need category were websites for informational needs (39, 50%), mobile applications for medical needs (15, 40%), patient portals for logistical needs (12, 44%), and disease-specific support groups for social needs (19, 56%). Families of hospitalized pediatric patients have a variety of health-related needs, many of which could be addressed by technology recommendations from an engagement consult service. This service is the first of its kind, offering a potentially generalizable and scalable approach to assessing health-related needs, meeting them with technologies, and promoting patient and family engagement in the inpatient setting. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

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

PubMed

Bourgeois, Isabelle; Whynot, Jane

2018-06-01

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

Perioperative antibiotic usage by facial plastic surgeons: national survey results and comparison with evidence-based guidelines.

PubMed

Grunebaum, Lisa Danielle; Reiter, David

2006-01-01

To determine current practice for use of perioperative antibiotics among facial plastic surgeons, to determine the extent of use of literature support for preferences of facial plastic surgeons, and to compare patterns of use with nationally supported evidence-based guidelines. A link to a Web site containing a questionnaire on perioperative antibiotic use was e-mailed to more than 1000 facial plastic surgeons in the United States. Responses were archived in a dedicated database and analyzed to determine patterns of use and methods of documenting that use. Current literature was used to develop evidence-based recommendations for perioperative antibiotic use, emphasizing current nationally supported guidelines. Preferences varied significantly for medication used, dosage and regimen, time of first dose relative to incision time, setting in which medication was administered, and procedures for which perioperative antibiotic was deemed necessary. Surgical site infection in facial plastic surgery can be reduced by better conformance to currently available evidence-based guidelines. We offer specific recommendations that are supported by the current literature.

Integrating HL7 RIM and ontology for unified knowledge and data representation in clinical decision support systems.

PubMed

Zhang, Yi-Fan; Tian, Yu; Zhou, Tian-Shu; Araki, Kenji; Li, Jing-Song

2016-01-01

The broad adoption of clinical decision support systems within clinical practice has been hampered mainly by the difficulty in expressing domain knowledge and patient data in a unified formalism. This paper presents a semantic-based approach to the unified representation of healthcare domain knowledge and patient data for practical clinical decision making applications. A four-phase knowledge engineering cycle is implemented to develop a semantic healthcare knowledge base based on an HL7 reference information model, including an ontology to model domain knowledge and patient data and an expression repository to encode clinical decision making rules and queries. A semantic clinical decision support system is designed to provide patient-specific healthcare recommendations based on the knowledge base and patient data. The proposed solution is evaluated in the case study of type 2 diabetes mellitus inpatient management. The knowledge base is successfully instantiated with relevant domain knowledge and testing patient data. Ontology-level evaluation confirms model validity. Application-level evaluation of diagnostic accuracy reaches a sensitivity of 97.5%, a specificity of 100%, and a precision of 98%; an acceptance rate of 97.3% is given by domain experts for the recommended care plan orders. The proposed solution has been successfully validated in the case study as providing clinical decision support at a high accuracy and acceptance rate. The evaluation results demonstrate the technical feasibility and application prospect of our approach. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Specific Primers for Rapid Detection of Microsporum audouinii by PCR in Clinical Samples▿

PubMed Central

Roque, H. D.; Vieira, R.; Rato, S.; Luz-Martins, M.

2006-01-01

This report describes application of PCR fingerprinting to identify common species of dermatophytes using the microsatellite primers M13, (GACA)4, and (GTG)5. The initial PCR analysis rendered a specific DNA fragment for Microsporum audouinii, which was cloned and sequenced. Based on the sequencing data of this fragment, forward (MA_1F) and reverse (MA_1R) primers were designed and verified by PCR to establish their reliability in the diagnosis of M. audouinii. These primers produced a singular PCR band of 431 bp specific only to strains and isolates of M. audouinii, based on a global test of 182 strains/isolates belonging to 11 species of dermatophytes. These findings indicate these primers are reliable for diagnostic purposes, and we recommend their use in laboratory analysis. PMID:17005755

Specific primers for rapid detection of Microsporum audouinii by PCR in clinical samples.

PubMed

Roque, H D; Vieira, R; Rato, S; Luz-Martins, M

2006-12-01

This report describes application of PCR fingerprinting to identify common species of dermatophytes using the microsatellite primers M13, (GACA)4, and (GTG)5. The initial PCR analysis rendered a specific DNA fragment for Microsporum audouinii, which was cloned and sequenced. Based on the sequencing data of this fragment, forward (MA_1F) and reverse (MA_1R) primers were designed and verified by PCR to establish their reliability in the diagnosis of M. audouinii. These primers produced a singular PCR band of 431 bp specific only to strains and isolates of M. audouinii, based on a global test of 182 strains/isolates belonging to 11 species of dermatophytes. These findings indicate these primers are reliable for diagnostic purposes, and we recommend their use in laboratory analysis.

Traditional Single-Sex Fraternities on College Campuses: Will They Survive in the 1990s?

ERIC Educational Resources Information Center

Horton, Nancy S.

1992-01-01

A discussion of the single-sex admission policy of college fraternities examines the potential for success of those policies in an era in which society and courts are pressing to abolish gender-based stereotypes and provide equal access to places of public accommodation. Five specific recommendations are made for fraternities wishing to preserve…

School-Based Physical Activity Interventions: Effectiveness, Trends, Issues, Implications and Recommendations for Practice

ERIC Educational Resources Information Center

Cale, Lorraine; Harris, Jo

2006-01-01

The promotion of physical activity within schools and physical education (PE) has attracted growing interest in recent years. Schools have been acknowledged as the primary institution with responsibility for promoting activity in young people and more specifically, school PE has been recognized as having a key role to play. Given this, and based…

An Intervention-Based Model of Student Retention in Adult Learners: Factors Predicting Intention to Consider Leaving or Staying

ERIC Educational Resources Information Center

Mooshegian, Stephanie E.

2010-01-01

The current study merges theory and research in higher education and organizational psychology in order to investigate student retention in adult learners. Factors that are associated with student retention were examined and points of intervention are recommended. Specifically, this study focuses on the role of campus environment, classroom…

School Counselors' Role in Dropout Prevention and Credit Recovery

ERIC Educational Resources Information Center

Tromski-Klingshirn, Donna; Miura, Yoko

2017-01-01

This article introduces credit recovery (CR) programs to school counseling. Traditionally the school counselors' role in CR has been limited to referring students who are, or who have, failed courses. Based on our own findings from a study of a large Midwest high school (N = 2,000) CR program, we make specific recommendations for school counselors…

Functional Specifications for Computer Aided Training Systems Development and Management (CATSDM) Support Functions. Final Report.

ERIC Educational Resources Information Center

Hughes, John; And Others

This report provides a description of a Computer Aided Training System Development and Management (CATSDM) environment based on state-of-the-art hardware and software technology, and including recommendations for off the shelf systems to be utilized as a starting point in addressing the particular systematic training and instruction design and…

Community-Based Long-Term Care and Mortality: Preliminary Findings of Georgia's Alternative Health Services Project.

ERIC Educational Resources Information Center

Skellie, F. Albert; Coan, Ruth E.

1980-01-01

Death rates among those referred to project services were lower within the first six months after enrollment, and the mortality rate difference was maintained throughout the first year. Death rate differences were related to specific long-term care services recommended and received, and to initial functional health status. (Author)

Task-Specific Optimization of Mammographic Systems

DTIC Science & Technology

2007-03-01

in Appendix II. 5.3 The results from the previous step will guide the creation for recommendations on the minimum allowable dose for...Degrees Earned Robert Saunders graduated with a doctorate in physics from Duke University in May 2006. Research Opportunities Received based on ...of dose in digital mammography has a measurable but modest impact on diagnostic accuracy.

Education Reform and Students At Risk. Volume I: Findings and Recommendations. Studies of Education Reform.

ERIC Educational Resources Information Center

Rossi, Robert J.; Stringfield, Samuel C.

Despite the widespread attention given to education reform, no substantial knowledge base has existed for identifying and implementing specific effective reforms. This document, the first of three volumes, presents findings of a study that sought to identify the essential mechanics of effective reforms for students at risk. The study also…

Simulation and control engineering studies of NASA-Ames 40 foot by 80 foot/80 foot by 120 foot wind tunnels

NASA Technical Reports Server (NTRS)

Bohn, J. G.; Jones, J. E.

1978-01-01

The development and use of a digital computer simulation of the proposed wind tunnel facility is described. The feasibility of automatic control of wind tunnel airspeed and other parameters was examined. Specifications and implementation recommendations for a computer based automatic control and monitoring system are presented.

Functional Foods Programs Serve as a Vehicle to Provide Nutrition Education to Groups

ERIC Educational Resources Information Center

Cirignano, Sherri M.

2011-01-01

An increase in consumer interest in functional foods provides an opportunity for FCS educators to use this topic in Extension programming to promote current nutrition recommendations. The Functional Foods for Life Educational Programs (FFL) are a curriculum of six evidence-based mini-seminars that highlight specific functional foods that have the…

Proposals for Standardizing and Improving the Policy of Adding Points on the Entrance Exam

ERIC Educational Resources Information Center

Yuhong, Deng

2013-01-01

This article reviews policies for adding points on the College Entrance Examination. It analyzes the rationales and specific implementation strategies of various policies for adding points on the entrance exam, as well as their advantages and pitfalls. Based on these observations and analysis, the author also offers policy recommendations on the…

Effectively Adapting the Sport Management Curricula: Harnessing Internal and External Resources to Address Industry-Specific Needs

ERIC Educational Resources Information Center

Braunstein-Minkove, Jessica R.; DeLuca, Jaime R.

2015-01-01

Academic programs must constantly evolve in order to ensure that students are best prepared for success in internships and subsequent post-collegiate endeavors within the dynamic, rapidly changing sport industry. Based upon qualitative research, this work assesses and recommends areas of development in sport management curricula using internal and…

Recommendations for sustainable development of non-timber forest products

Treesearch

Gina H. Mohammed

2001-01-01

Non-timber forest products--or NTFPs--are considered here to be botanical products harvested or originating from forest-based species, but excluding primary timber products, industrial boards and composites, and paper products. A recent study of non-timber forest products in Ontario, Canada, identified at least 50 types of NTFPs and hundreds of specific products used...

Polycystic ovary syndrome: a review for dermatologists: Part II. Treatment.

PubMed

Buzney, Elizabeth; Sheu, Johanna; Buzney, Catherine; Reynolds, Rachel V

2014-11-01

Dermatologists are in a key position to treat the manifestations of polycystic ovary syndrome (PCOS). The management of PCOS should be tailored to each woman's specific goals, reproductive interests, and particular constellation of symptoms. Therefore, a multidisciplinary approach is recommended. In part II of this continuing medical education article, we present the available safety and efficacy data regarding treatments for women with acne, hirsutism, and androgenetic alopecia. Therapies discussed include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs. Treatment recommendations are made based on the current available evidence. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

System Data Bases In European Satellites Programs: Lessons Learned and Recommendations

NASA Astrophysics Data System (ADS)

Passot, X.; Denuault, D.; Guiral, Ph.; Kerjean, L.; Lebreton, D.; Lecrvain, C.; Valera, S.

2007-08-01

This paper is intended for European space eningeers who must design or interact with all or part of a system database, hereafter referred to as 'SDB'. The document presents the objectives of a system database (SDB), describes the development of an SDB project from the specification stage until operations, and preovides recommendations so that an effective system can be obtained. As part of return on experience, the document gives an overview of exisiting systems in the European space industry. To prepare the new systems, it presents the services to be provided, the tools available and the emerging standars towards which SDBs must converge.

Recommendations for the interpretation of "black carbon" measurements

NASA Astrophysics Data System (ADS)

Petzold, A.; Ogren, J. A.; Fiebig, M.; Laj, P.; Li, S.-M.; Baltensperger, U.; Holzer-Popp, T.; Kinne, S.; Pappalardo, G.; Sugimoto, N.; Wehrli, C.; Wiedensohler, A.; Zhang, X.-Y.

2013-04-01

Although black carbon (BC) is one of the key atmospheric particulate components driving climate change and air quality, there is no agreement on the terminology that considers all aspects of specific properties, definitions, measurement methods, and related uncertainties. As a result, there is much ambiguity in the scientific literature of measurements and numerical models that refer to BC with different names and based on different properties of the particles, with no clear definition of the terms. The authors present here a recommended terminology to clarify the terms used for BC in atmospheric research, with the goal of establishing unambiguous links between terms, targeted material properties and associated measurement techniques.

Recommendations for reporting "black carbon" measurements

NASA Astrophysics Data System (ADS)

Petzold, A.; Ogren, J. A.; Fiebig, M.; Laj, P.; Li, S.-M.; Baltensperger, U.; Holzer-Popp, T.; Kinne, S.; Pappalardo, G.; Sugimoto, N.; Wehrli, C.; Wiedensohler, A.; Zhang, X.-Y.

2013-08-01

Although black carbon (BC) is one of the key atmospheric particulate components driving climate change and air quality, there is no agreement on the terminology that considers all aspects of specific properties, definitions, measurement methods, and related uncertainties. As a result, there is much ambiguity in the scientific literature of measurements and numerical models that refer to BC with different names and based on different properties of the particles, with no clear definition of the terms. The authors present here a recommended terminology to clarify the terms used for BC in atmospheric research, with the goal of establishing unambiguous links between terms, targeted material properties and associated measurement techniques.

Comparison of the Treatment Guidelines for Actinic Keratosis: A Critical Appraisal and Review.

PubMed

Fleming, Patrick; Zhou, Stephanie; Bobotsis, Robert; Lynde, Charles

There are currently several reputable guidelines on the treatment of actinic keratosis (AK) from groups in Canada, the United Kingdom, and Europe. These recommendations, based on evidence or expert consensus, offer clinicians a variety of treatment options for the different clinical presentations of AKs. Although the guidelines are similar in some regards, variations exist in treatment options, duration, and strength of recommendation. Some guidelines also lack input on specific therapies and certain types of AK, such as hypertrophic or thin presentations. The purpose of this article is to review and compare guidelines published by Canadian, UK, and European groups for the management of AKs in patients.

[Therapeutic drug monitoring of levetiracetam].

PubMed

Dailly, Eric; Bouquié, Régis; Bentué-Ferrer, Danièle

2010-01-01

Levetiracetam is an anticonvulsant drug used to treat partial seizures, myoclonic seizures of juvenile myoclonic epilepsy and primary generalized tonic-clonic seizures. A review of the literature with an evidence-based medicine method highlighted parameters (age, renal failure, pregnancy, combination with other anticonvulsant drugs) which affect levetiracetam pharmacokinetics but no significant relationship between plasma concentration of levetiracetam and efficacy or toxicity. Concentrations usually observed in therapeutics is from 6 to 18 mg/L. However, the determination of an individual therapeutic concentration, associated with an effective and well tolerated therapy, could be recommended particularly before pregnancy. Consequently, therapeutic drug monitoring of levetiracetam which is not currently recommended could be possibly useful in specific clinical situations.

Does GEM-Encoding Clinical Practice Guidelines Improve the Quality of Knowledge Bases? A Study with the Rule-Based Formalism

PubMed Central

Georg, Gersende; Séroussi, Brigitte; Bouaud, Jacques

2003-01-01

The aim of this work was to determine whether the GEM-encoding step could improve the representation of clinical practice guidelines as formalized knowledge bases. We used the 1999 Canadian recommendations for the management of hypertension, chosen as the knowledge source in the ASTI project. We first clarified semantic ambiguities of therapeutic sequences recommended in the guideline by proposing an interpretative framework of therapeutic strategies. Then, after a formalization step to standardize the terms used to characterize clinical situations, we created the GEM-encoded instance of the guideline. We developed a module for the automatic derivation of a rule base, BR-GEM, from the instance. BR-GEM was then compared to the rule base, BR-ASTI, embedded within the critic mode of ASTI, and manually built by two physicians from the same Canadian guideline. As compared to BR-ASTI, BR-GEM is more specific and covers more clinical situations. When evaluated on 10 patient cases, the GEM-based approach led to promising results. PMID:14728173

78 FR 55263 - Draft Guidance for Industry on Bioequivalence Recommendations for Fluticasone Propionate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-10

...] Draft Guidance for Industry on Bioequivalence Recommendations for Fluticasone Propionate; Salmeterol... ``Bioequivalence Recommendations for Fluticasone Propionate; Salmeterol Xinafoate.'' The recommendations provide specific guidance on the design of bioequivalence (BE) studies to support abbreviated new drug applications...

Dental fluorosis in the primary dentition and intake of manufactured soy-based foods with fluoride.

PubMed

de Carvalho, Cristiane Alves Paz; Zanlorenzi Nicodemo, César Augusto; Ferreira Mercadante, Daniela Cristiane; de Carvalho, Fábio Silva; Buzalaf, Marília Afonso Rabelo; de Carvalho Sales-Peres, Sílvia Helena

2013-06-01

To identify manufactured soy-based products more recommended by pediatricians and nutritionists; to determine fluoride concentrations in these products; to evaluate children concerning fluorosis in primary teeth and its association with the consumption of soy-based products. Pediatricians and Nutritionists answered a questionnaire about soy-based products they most recommended to children. Fluoride concentrations of the 10 products more cited were analyzed with the ion-specific electrode. Dental fluorosis exams were performed in 315 4-6-year-old children. Dean's Index was used to assess fluorosis. Among the children examined, 26 had lactose intolerance. Their parents answered a questionnaire about children's and family's profile, besides permitting the identification of soy-based products use. Chi-squared and Multivariable Logistic Regression tests were used (p < 0.05). Fluoride content in the analyzed products ranged from 0.03 to 0.50 μg F(-)/mL. Dental fluorosis was detected in 11% of the children, with very mild and mild degrees. Dental fluorosis in primary teeth was associated with lactose intolerance (p < 0.05), but there was no significant association with the use of manufactured soy-based products. Isolated consumption of soy-based products recommended by health professionals to children do not offer risk of dental fluorosis in primary teeth, which had a low prevalence and severity. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Task force on management and prevention of Acinetobacter baumannii infections in the ICU.

PubMed

Garnacho-Montero, José; Dimopoulos, George; Poulakou, Garyphallia; Akova, Murat; Cisneros, José Miguel; De Waele, Jan; Petrosillo, Nicola; Seifert, Harald; Timsit, Jean François; Vila, Jordi; Zahar, Jean-Ralph; Bassetti, Matteo

2015-12-01

Acinetobacter baumannii constitutes a dreadful problem in many ICUs worldwide. The very limited therapeutic options available for these organisms are a matter of great concern. No specific guidelines exist addressing the prevention and management of A. baumannii infections in the critical care setting. Clinical microbiologists, infectious disease specialists and intensive care physicians were invited by the Chair of the Infection Section of the ESICM to participate in a multidisciplinary expert panel. After the selection of clinically relevant questions, this document provides recommendations about the use of microbiological techniques for identification of A. baumannii in clinical laboratories, antibiotic therapy for severe infections and recommendations to control this pathogen in outbreaks and endemic situations. Evidence supporting each statement was graded according to the European Society of Clinical Microbiology and Infection Diseases (ESCMID) grading system. Empirical coverage of A. baumannii is recommended in severe infections (severe sepsis or septic shock) occurring during an A. baumannii outbreak, in an endemic setting, or in a previously colonized patient. For these cases, a polymyxin is suggested as part of the empirical treatment in cases of a high suspicion of a carbapenem-resistant (CR) A. baumannii strain. An institutional program including staff education, promotion of hand hygiene, strict contact and isolation precautions, environmental cleaning, targeted active surveillance, and antimicrobial stewardship should be instituted and maintained to combat outbreaks and endemic situations. Specific recommendations about prevention and management of A. baumannii infections in the ICU were elaborated by this multidisciplinary panel. The paucity of randomized controlled trials is noteworthy, so these recommendations are mainly based on observational studies and pharmacodynamics modeling.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

PubMed Central

Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-01-01

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education. PMID:27170809

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

PubMed

Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-04-25

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

PubMed

Greenlee, Heather; DuPont-Reyes, Melissa J; Balneaves, Lynda G; Carlson, Linda E; Cohen, Misha R; Deng, Gary; Johnson, Jillian A; Mumber, Matthew; Seely, Dugald; Zick, Suzanna M; Boyce, Lindsay M; Tripathy, Debu

2017-05-06

Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society. © 2017 American Cancer Society.

Experiences of Trans Women and Two-Spirit Persons Accessing Women-Specific Health and Housing Services in a Downtown Neighborhood of Vancouver, Canada.

PubMed

Lyons, Tara; Krüsi, Andrea; Pierre, Leslie; Smith, Adrienne; Small, Will; Shannon, Kate

2016-10-01

Little is known about trans womens' experiences accessing gender-segregated health and housing services, particularly services for marginalized individuals living in poverty. As such, we conducted a qualitative investigation into experiences of accessing women-specific health and housing services among trans women and two-spirit persons in a downtown neighborhood of Vancouver, Canada. Between June 2012 and May 2013 interviews were conducted with 32 trans women and two-spirit individuals who had accessed women-specific health and/or housing services. Participants were recruited from four open prospective cohorts of sex workers and individuals who use drugs. Interview data were analyzed using a participatory analysis approach with two participants who were hired as research assistants. Participants were generally able to access women-specific services in the neighborhood. However, there were reports of discrimination related to gender identity, discrimination based on gender expression (e.g., requirement of a feminine gender expression), and lack of staff intervention in harassment from other service users. Trans women and two-spirit persons in our study relied upon services for their health and safety and, therefore, exclusion from women-specific services had potentially severe adverse consequences such as homelessness and sexual violence. Recommendations to improve accessibility, including policy development and procedural recommendations, are put forth.

[Specific learning disabilities - from DSM-IV to DSM-5].

PubMed

Schulte-Körne, Gerd

2014-09-01

The publication of the DSM-5 means changes in the classification and recommendations for diagnosis of specific learning disabilities. Dyslexia and dyscalculia have been reintroduced into the DSM. Three specific learning disorders - impairment in reading, impairment in the written expression, and impairment in mathematics, described by subskills - are now part of the DSM-5. Three subcomponents of the reading disorder are expressly differentiated: word reading accuracy, reading rate, and fluency and reading comprehension. Impaired subskills of the specific learning disorder with impairment in written expression are spelling accuracy, grammar and punctuation accuracy, and clarity and organization of written expression. Four subskills are found in the mathematics disorder: number sense, memorization of arithmetic facts, accurate or fluent calculation, and accurate math reasoning. Each impaired academic domain and subskill should be recorded. A description of the severity degree was also included. The diagnosis is based on a variety of methods, including medical history, clinical interview, school report, teacher evaluation, rating scales, and psychometric tests. The IQ discrepancy criterion was abandoned, though that of age or class discrepancy criterion was retained. The application of a discrepancy is recommended by 1 to 2.5 SD. All three specific developmental disorders are common (prevalence 5 %-15 %), occur early during the first years of formal schooling, and persist into adulthood.

Systematic and transparent inclusion of ethical issues and recommendations in clinical practice guidelines: a six-step approach.

PubMed

Mertz, Marcel; Strech, Daniel

2014-12-04

Clinical practice guidelines (CPGs), a core tool to foster medical professionalism, differ widely in whether and how they address disease-specific ethical issues (DSEIs), and current manuals for CPG development are silent on this issue. The implementation of an explicit method faces two core challenges: first, it adds further complexity to CPG development and requires human and financial resources. Second, in contrast to the in-depth treatment of ethical issues that is standard in bioethics, the inclusion of DSEIs in CPGs need to be more pragmatic, reductive, and simplistic, but without rendering the resulting recommendations useless or insufficiently justified. This paper outlines a six-step approach, EthicsGuide, for the systematic and transparent inclusion of ethical issues and recommendations in CPGs. The development of EthicsGuide is based on (a) methodological standards in evidence-based CPG development, (b) principles of bioethics, (c) research findings on how DSEIs are currently addressed in CPGs, and (d) findings from two proof-of-concept analyses of the EthicsGuide approach. The six steps are 1) determine the DSEI spectrum and the need for ethical recommendations; 2) develop statements on which to base ethical recommendations; 3) categorize, classify, condense, and paraphrase the statements; 4) write recommendations in a standard form; 5) validate and justify recommendations, making any necessary modifications; and 6) address consent. All six steps necessarily come into play when including DSEIs in CPGs. If DSEIs are not explicitly addressed, they are unavoidably dealt with implicitly. We believe that as ethicists gain greater involvement in decision-making about health, personal rights, or economic issues, they should make their methods transparent and replicable by other researchers; and as ethical issues become more widely reflected in CPGs, CPG developers have to learn how to address them in a methodologically adequate way. The approach proposed should serve as a basis for further discussion on how to reach these goals. It breaks open the black box of what ethicists implicitly do when they develop recommendations. Further, interdisciplinary discussion and pilot tests are needed to explore the minimal requirements that guarantee a simplified procedure which is still acceptable and does not become mere window dressing.

Ottawa Panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight.

PubMed

Brosseau, Lucie; Wells, George A; Tugwell, Peter; Egan, Mary; Dubouloz, Claire-Jehanne; Casimiro, Lynn; Bugnariu, Nicoleta; Welch, Vivian A; De Angelis, Gino; Francoeur, Lilliane; Milne, Sarah; Loew, Laurianne; McEwan, Jessica; Messier, Steven P; Doucet, Eric; Kenny, Glen P; Prud'homme, Denis; Lineker, Sydney; Bell, Mary; Poitras, Stéphane; Li, Jing Xian; Finestone, Hillel M; Laferrière, Lucie; Haines-Wangda, Angela; Russell-Doreleyers, Marion; Lambert, Kim; Marshall, Alison D; Cartizzone, Margot; Teav, Adam

2011-06-01

The objective of this review was to construct an updated evidence-based clinical practice guideline on the use of physical activity and diet for the management of osteoarthritis (OA) in adults (>18 years of age) who are obese or overweight (body mass index ≥25 kg/m(2)). Articles were extracted from the following databases: MEDLINE, EMBASE (Current Contents), SPORTDiscus, SUM, Scopus, CINAHL, AMED, BIOMED, PubMed, ERIC, the Cochrane Controlled Trials, and PEDro. The Ottawa Panel and research assistance team strictly applied the inclusion and exclusion criteria from previous Ottawa Panel publications. An a priori literature search was conducted for articles related to obesity and OA of the lower extremities that were published from January 1, 1966, to November 30, 2010. Inclusion criteria and the methods to grade the recommendations were created by the Ottawa Panel. were graded based on the strength of evidence (A, B, C, C+, D, D+, or D-) as well as experimental design (I for randomized controlled trials and II for nonrandomized studies). In agreement with previous Ottawa Panel methods, Cochrane Collaboration methods were utilized for statistical analysis. Clinical significance was established by an improvement of ≥15% in the experimental group compared with the control group. There were a total of 79 recommendations from 9 articles. From these recommendations, there were 36 positive recommendations: 21 grade A and 15 grade C+. There were no grade B recommendations, and all recommendations were of clinical benefit. Further research is needed, as more than half of the trials were of low methodological quality. This review suggests that physical activity and diet programs are beneficial, specifically for pain relief (9 grade A recommendations) and improved functional status (6 grade A and 7 grade C+ recommendations), for adults with OA who are obese or overweight. The Ottawa Panel was able to demonstrate that when comparing physical activity alone, diet alone, physical activity combined with diet, and control groups, the intervention including physical activity and diet produced the most beneficial results.

US DOE Perspectives on Advisory Board Effectiveness - 13539

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

Adler, David

2013-07-01

Federal missions on the Oak Ridge Reservation began with the Manhattan Project, and continues today with major facilities supporting the Nation's Science and National Security missions. While most of the land area on the Oak Ridge Reservation is free of environmental impacts from these activities, significant legacy contamination is associated with specific facilities and past waste management areas. In 1989, the Oak Ridge Reservation (ORR) was placed on National Priorities List, and DOE established its Office of Environmental Management that same year. Three years later, in 1992, the Federal Facility Agreement for the reservation was signed. Three years afterward, themore » Oak Ridge Site Specific Advisory Board was established to augment ongoing public involvement activities related to Oak Ridge Reservation cleanup activities. One of the early and most impactful decisions the board made was to organize the End Use Working Group. This broad-based group of board members, DOE representatives, and members of the public was formed in 1997 to study future uses for contaminated areas of the reservation. The group was instrumental in building consensus in the Oak Ridge community regarding the long-term end state of reservation lands. The group's recommendations were a fundamental input into Record's of Decision subsequently developed to establish cleanup requirements across the ORR, and they continue to influence decisions being made today. In developing its recommendations on end states, the End Use Working Group came to the realization that long-term stewardship of contaminated areas of the reservation would be necessary, in some cases in perpetuity. It was from this concept that the Oak Ridge SSAB's 15-year involvement in stewardship would begin. A stewardship committee formed by the End Use Working Group wrote Volume 1 of the Stakeholder Report on Stewardship. This document-and its companion Volume 2, which was written a year later-form a crucial foundation for stewardship planning in Oak Ridge and have been referenced around the DOE complex as other sites consider stewardship planning. From these two broad-based initiatives, the board's focus has evolved to increasingly hone in on more specific, project-based recommendations and initiatives. The Oak Ridge Reservation Site Specific Advisory Board has been a highly effective forum for soliciting community input on Oak Ridge Reservation cleanup. Experience in Oak Ridge indicates that the utility of Board recommendations is far higher when the Board is asked to focus on broad programmatic issues, and less useful when the Board attempts to provide advice and recommendations on matters related to technical or project management issues. In Oak Ridge the Board has helped shape the program on many levels including definition of end-state cleanup objectives, budget development, program sequencing, waste management, and decisions concerning preservation of history related to missions implemented on the Oak Ridge Reservation. (authors)« less

European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe.

PubMed

Jobst, A; Brakemeier, E-L; Buchheim, A; Caspar, F; Cuijpers, P; Ebmeier, K P; Falkai, P; Jan van der Gaag, R; Gaebel, W; Herpertz, S; Kurimay, T; Sabaß, L; Schnell, K; Schramm, E; Torrent, C; Wasserman, D; Wiersma, J; Padberg, F

2016-03-01

Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Benign proliferative breast disease with and without atypia].

PubMed

Coutant, C; Canlorbe, G; Bendifallah, S; Beltjens, F

2015-12-01

In the last few years, diagnostics of high-risk breast lesions (atypical ductal hyperplasia [ADH], flat epithelial atypia [FEA], lobular neoplasia: atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], radial scar [RS], usual ductal hyperplasia [UDH], adenosis, sclerosing adenosis [SA], papillary breast lesions, mucocele-like lesion [MLL]) have increased with the growing number of breast percutaneous biopsies. The management of these lesions is highly conditioned by the enlarged risk of breast cancer combined with either an increased probability of finding cancer after surgery, either a possible malignant transformation (in situ or invasive cancer), or an increased probability of developing cancer on the long range. An overview of the literature reports grade C recommendations concerning the management and follow-up of these lesions: in case of ADH, FEA, ALH, LCIS, RS, MLL with atypia, diagnosed on percutaneous biopsies: surgical excision is recommended; in case of a diagnostic based on vacuum-assisted core biopsy with complete disappearance of radiological signal for FEA or RS without atypia: surgical abstention is a valid alternative approved by multidisciplinary meeting. In case of ALH (incidental finding) associated with benign lesion responsible of radiological signal: abstention may be proposed; in case of UDH, adenosis, MLL without atypia, diagnosed on percutaneous biopsies: the concordance of radiology and histopathology findings must be ensured. No data is available to recommend surgery; in case of non-in sano resection for ADH, FEA, ALH, LCIS (except pleomorphic type), RS, MLL: surgery does not seem to be necessary; in case of previous ADH, ALH, LCIS: a specific follow-up is recommended in accordance with HAS's recommendations. In case of FEA and RS or MLL combined with atypia, little data are yet available to differ the management from others lesions with atypia; in case of UDH, usual sclerosing adenosis, RS without atypia, fibro cystic disease: no specific follow-up is recommended in agreement with HAS's recommendations. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Age-related differences in recommended anthropometric cut-off point validity to identify cardiovascular risk factors in ostensibly healthy women

PubMed Central

Björkelund, Cecilia; Guo, Xinxin; Skoog, Ingmar; Bosaeus, Ingvar; Lissner, Lauren

2014-01-01

Aim: To investigate validity of widely recommended anthropometric and total fat percentage cut-off points in screening for cardiovascular risk factors in women of different ages. Methods: A population-based sample of 1002 Swedish women aged 38, 50, 75 (younger, middle-aged and elderly, respectively) underwent anthropometry, health examinations and blood tests. Total fat was estimated (bioimpedance) in 670 women. Sensitivity, specificity of body mass index (BMI; ≥25 and ≥30), waist circumference (WC; ≥80 cm and ≥88 cm) and total fat percentage (TF; ≥35%) cut-off points for cardiovascular risk factors (dyslipidaemias, hypertension and hyperglycaemia) were calculated for each age. Cut-off points yielding high sensitivity together with modest specificity were considered valid. Women reporting hospital admission for cardiovascular disease were excluded. Results: The sensitivity of WC ≥80 cm for one or more risk factors was ~60% in younger and middle-aged women, and 80% in elderly women. The specificity of WC ≥80 cm for one or more risk factors was 69%, 57% and 40% at the three ages (p < .05 for age trends). WC ≥80 cm yielded ~80% sensitivity for two or more risk factors across all ages. However, specificity decreased with increasing age (p < .0001), being 33% in elderly. WC ≥88 cm provided better specificity in elderly women. BMI and TF % cut-off points were not better than WC. Conclusions: Validity of recommended anthropometric cut-off points in screening asymptomatic women varies with age. In younger and middle-age, WC ≥80 cm yielded high sensitivity and modest specificity for two or more risk factors, however, sensitivity for one or more risk factor was less than optimal. WC ≥88 cm showed better validity than WC ≥80 cm in elderly. Our results support age-specific screening cut-off points for women. PMID:25294689

Age-related differences in recommended anthropometric cut-off point validity to identify cardiovascular risk factors in ostensibly healthy women.

PubMed

Subramoney, Sreevidya; Björkelund, Cecilia; Guo, Xinxin; Skoog, Ingmar; Bosaeus, Ingvar; Lissner, Lauren

2014-12-01

To investigate validity of widely recommended anthropometric and total fat percentage cut-off points in screening for cardiovascular risk factors in women of different ages. A population-based sample of 1002 Swedish women aged 38, 50, 75 (younger, middle-aged and elderly, respectively) underwent anthropometry, health examinations and blood tests. Total fat was estimated (bioimpedance) in 670 women. Sensitivity, specificity of body mass index (BMI; ≥25 and ≥30), waist circumference (WC; ≥80 cm and ≥88 cm) and total fat percentage (TF; ≥35%) cut-off points for cardiovascular risk factors (dyslipidaemias, hypertension and hyperglycaemia) were calculated for each age. Cut-off points yielding high sensitivity together with modest specificity were considered valid. Women reporting hospital admission for cardiovascular disease were excluded. The sensitivity of WC ≥80 cm for one or more risk factors was ~60% in younger and middle-aged women, and 80% in elderly women. The specificity of WC ≥80 cm for one or more risk factors was 69%, 57% and 40% at the three ages (p < .05 for age trends). WC ≥80 cm yielded ~80% sensitivity for two or more risk factors across all ages. However, specificity decreased with increasing age (p < .0001), being 33% in elderly. WC ≥88 cm provided better specificity in elderly women. BMI and TF % cut-off points were not better than WC. Validity of recommended anthropometric cut-off points in screening asymptomatic women varies with age. In younger and middle-age, WC ≥80 cm yielded high sensitivity and modest specificity for two or more risk factors, however, sensitivity for one or more risk factor was less than optimal. WC ≥88 cm showed better validity than WC ≥80 cm in elderly. Our results support age-specific screening cut-off points for women. © 2014 the Nordic Societies of Public Health.

Recommendations for ethical approaches to genotype-driven research recruitment

PubMed Central

Beskow, Laura M.; Fullerton, Stephanie M.; Namey, Emily E.; Nelson, Daniel K.; Davis, Arlene M.; Wilfond, Benjamin S.

2013-01-01

Recruiting research participants based on genetic information generated about them in a prior study is a potentially powerful way to study the functional significance of human genetic variation. However, it also presents significant ethical challenges that, to date, have received only minimal consideration. We convened a multi-disciplinary workshop to discuss key issues relevant to the conduct and oversight of genotype-driven recruitment and to translate those considerations into practical policy recommendations. Workshop participants were invited from around the U.S., and included genomic researchers and study coordinators, research participants, clinicians, bioethics scholars, experts in human research protections, and government representatives. Discussion was directed by experienced facilitators and informed by empirical data collected in a national survey of IRB chairs and in-depth interviews with research participants in studies where genotype-driven recontact occurred. A high degree of consensus was attained on the resulting 7 recommendations, which cover informed consent disclosures and choices, the process for how and by whom participants are recontacted, the disclosure of individual genetic research results, and the importance of tailoring approaches based on specific contextual factors. These recommendations are intended to represent a balanced approach—protecting research participants, yet avoiding overly restrictive policies that hinder advancement on important scientific questions. PMID:22622788

The challenges of nutrition policymaking.

PubMed

Slavin, Joanne L

2015-02-07

In my over three decades of work in the field of food and nutrition, I have participated in many efforts that seek new policy initiatives in the hopes that these programs can curb rates of obesity and chronic disease and help consumers make healthier dietary choices. Because of the profound effect that many of these policies have on consumers, the food environment, federal nutrition assistance programs and subsequent policy and regulatory recommendations, it is imperative that only the strongest, best available evidence is used to set policy. This review evaluates methods by which current nutrition policies use scientific research as well as provides recommendations for how best to ensure future nutrition policies are truly science-based and likely to have a meaningful impact on public health. Specifically, this review will: Describe the current food and nutrition policy environment in the US Examine how science is used in federal food and nutrition policymaking efforts, using the Dietary Guidelines for Americans (DGA) as an example Describe strong versus weak science as well as what types of studies are most appropriate for use in policymaking Discuss the potential effects and consequences of making policy recommendations in the absence of scientific consensus or agreement Make recommendations to support the present and ongoing development of science-based policy likely to positively impact public health.

Planetary Protection Requirements for Mars Sample Return Missions: Recommendations from a 2009 NRC Report

NASA Astrophysics Data System (ADS)

Race, Margaret; Farmer, Jack

A 2009 report by the National Research Council (NRC) reviewed a previous study on Mars Sample Return (1997) and provided updated recommendations for future sample return mis-sions based on our current understanding about Mars and its biological potential, as well as advances in technology and analytical capabilities. The committee* made 12 specific recommen-dations that fall into three general categories—one related to current scientific understanding, ten based on changes in the technical and/or policy environment, and one aimed at public com-munication. Substantive changes from the 1997 report relate mainly to protocols and methods, technology and infrastructure, and general oversight. This presentation provides an overview of the 2009 report and its recommendations and analyzes how they may impact mission designs and plans. The full report, Assessment of Planetary Protection Requirements for Mars Sample Return Missions is available online at: http://www.nap.edu/catalog.php?recordi d = 12576 * Study participants: Jack D. Farmer, Arizona State University (chair) James F. Bell III, Cornell University Kathleen C. Benison, Central Michigan University William V. Boynton, University of Arizona Sherry L. Cady, Portland State University F. Grant Ferris, University of Toronto Duncan MacPherson, Jet Propulsion Laboratory Margaret S. Race, SETI Institute Mark H. Thiemens, University of California, San Diego Meenakshi Wadhwa, Arizona State University

Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer: CHEST Guideline and Expert Panel Report.

PubMed

Molassiotis, Alex; Smith, Jaclyn A; Mazzone, Peter; Blackhall, Fiona; Irwin, Richard S

2017-04-01

Cough among patients with lung cancer is a common but often undertreated symptom. We used a 2015 Cochrane systematic review, among other sources of evidence, to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic. The CHEST methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on data from the Cochrane systematic review on the topic, uncontrolled studies, case studies, and the clinical context. Final grading was reached by consensus according to the Delphi method. The Cochrane systematic review identified 17 trials of primarily low-quality evidence. Such evidence was related to both nonpharmacologic (cough suppression) and pharmacologic (demulcents, opioids, peripherally acting antitussives, or local anesthetics) treatments, as well as endobronchial brachytherapy. Compared with the 2006 CHEST Cough Guideline, the current recommendations and suggestions are more specific and follow a step-up approach to the management of cough among patients with lung cancer, acknowledging the low-quality evidence in the field and the urgent need to develop more effective, evidence-based interventions through high-quality research. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Practice‐based Research Network Research Good Practices (PRGPs): Summary of Recommendations

PubMed Central

Campbell‐Voytal, Kimberly; Daly, Jeanette; Nagykaldi, Zsolt J.; O'Beirne, Maeve; Sterling, Pamela; Fagnan, Lyle J.; Levy, Barcey; Michaels, LeAnn; Louks, Hannah A.; Smith, Paul; Aspy, Cheryl B.; Patterson, V. Beth; Kano, Miria; Sussman, Andrew L.; Williams, Robert; Neale, Anne Victoria

2015-01-01

Abstract Introduction Practice‐based research networks (PBRNs) conduct research in community settings, which poses quality control challenges to the integrity of research, such as study implementation and data collection. A foundation for improving research processes within PBRNs is needed to ensure research integrity. Methods Network directors and coordinators from seven U.S.‐based PBRNs worked with a professional team facilitator during semiannual in‐person meetings and monthly conference calls to produce content for a compendium of recommended research practices specific to the context of PBRNs. Participants were assigned to contribute content congruent with their expertise. Feedback on the draft document was obtained from attendees at the preconference workshop at the annual PBRN meeting in 2013. A revised document was circulated to additional PBRN peers prior to finalization. Results The PBRN Research Good Practices (PRGPs) document is organized into four chapters: (1) Building PBRN Infrastructure; (2) Study Development and Implementation; (3) Data Management, and (4) Dissemination Policies. Each chapter contains an introduction, detailed procedures for each section, and example resources with information links. Conclusion The PRGPs is a PBRN‐specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. PMID:26296309

Transcultural Diabetes Nutrition Algorithm: A Malaysian Application

PubMed Central

Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A.; Mechanick, Jeffrey I.

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations. PMID:24385984

Transcultural diabetes nutrition algorithm: a malaysian application.

PubMed

Hussein, Zanariah; Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Hussain, Husni; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A; Mechanick, Jeffrey I

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations.

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

PubMed

Pronk, Nicolaas P

2009-11-01

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

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

PubMed

Pronk, Nicolaas P

2009-11-01

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

Merging long range transportation planning with public health: a case study from Utah's Wasatch Front.

PubMed

Burbidge, Shaunna K

2010-01-01

US transportation systems have been identified as a problem for public health, as they often encourage automobile transportation and discourage physical activity. This paper provides a case study examination of the Public Health Component of the Wasatch Front Regional Council's Regional Transportation Plan. This plan provides an example of what transportation planners at Utah's largest metropolitan planning organization (MPO) are doing to encourage physical activity through transportation. Existing active living research was used to guide recommendations using a process that included a comprehensive literature review and a review of existing state programs, advisory group and stakeholder meetings, and policy recommendations based on existing local conditions. Stakeholders from a diversity of background and interests came together with one common goal: to improve public health. Based on this collaborative process, nine policy approaches were specifically recommended for approval and integration in the Wasatch Front Regional Transportation Plan. By using current research as a guide and integrating a variety of interests, the Wasatch Front Regional Council is setting a new standard for a collaborative multi-modal focus in transportation planning, which can be replicated nationwide.

Is carbohydrate needed to further stimulate muscle protein synthesis/hypertrophy following resistance exercise?

PubMed Central

2013-01-01

It is now well established that protein supplementation after resistance exercise promotes increased muscle protein synthesis, which ultimately results in greater net muscle accretion, relative to exercise alone or exercise with supplementary carbohydrate ingestion. However, it is not known whether combining carbohydrate with protein produces a greater anabolic response than protein alone. Recent recommendations have been made that the composition of the ideal supplement post-exercise would be a combination of a protein source with a high glycemic index carbohydrate. This is based on the hypothesis that insulin promotes protein synthesis, thus maximising insulin secretion will maximally potentiate this action. However, it is still controversial as to whether raising insulin level, within the physiological range, has any effect to further stimulate muscle protein synthesis. The present commentary will review the evidence underpinning the recommendation to consume carbohydrates in addition to a protein supplementation after resistance exercise for the specific purpose of increasing muscle mass. The paucity of data will be discussed, thus our conclusions are that further studies are necessary prior to any conclusions that enable evidence-based recommendations to be made. PMID:24066806

Research Data Alliance: Understanding Big Data Analytics Applications in Earth Science

NASA Astrophysics Data System (ADS)

Riedel, Morris; Ramachandran, Rahul; Baumann, Peter

2014-05-01

The Research Data Alliance (RDA) enables data to be shared across barriers through focused working groups and interest groups, formed of experts from around the world - from academia, industry and government. Its Big Data Analytics (BDA) interest groups seeks to develop community based recommendations on feasible data analytics approaches to address scientific community needs of utilizing large quantities of data. BDA seeks to analyze different scientific domain applications (e.g. earth science use cases) and their potential use of various big data analytics techniques. These techniques reach from hardware deployment models up to various different algorithms (e.g. machine learning algorithms such as support vector machines for classification). A systematic classification of feasible combinations of analysis algorithms, analytical tools, data and resource characteristics and scientific queries will be covered in these recommendations. This contribution will outline initial parts of such a classification and recommendations in the specific context of the field of Earth Sciences. Given lessons learned and experiences are based on a survey of use cases and also providing insights in a few use cases in detail.

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

Research Data Alliance: Understanding Big Data Analytics Applications in Earth Science

NASA Technical Reports Server (NTRS)

Riedel, Morris; Ramachandran, Rahul; Baumann, Peter

2014-01-01

The Research Data Alliance (RDA) enables data to be shared across barriers through focused working groups and interest groups, formed of experts from around the world - from academia, industry and government. Its Big Data Analytics (BDA) interest groups seeks to develop community based recommendations on feasible data analytics approaches to address scientific community needs of utilizing large quantities of data. BDA seeks to analyze different scientific domain applications (e.g. earth science use cases) and their potential use of various big data analytics techniques. These techniques reach from hardware deployment models up to various different algorithms (e.g. machine learning algorithms such as support vector machines for classification). A systematic classification of feasible combinations of analysis algorithms, analytical tools, data and resource characteristics and scientific queries will be covered in these recommendations. This contribution will outline initial parts of such a classification and recommendations in the specific context of the field of Earth Sciences. Given lessons learned and experiences are based on a survey of use cases and also providing insights in a few use cases in detail.

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

Hunsberger, Randolph; Tomberlin, Gregg; Gaul, Chris

As part of the Army Net-Zero Energy Installation program, the Fort Carson Army Base requested that NREL evaluate the feasibility of adding a biomass boiler to the district heating system served by Building 1860. We have also developed an Excel-spreadsheet-based decision support tool--specific to the historic loads served by Building 1860--with which users can perform what-if analysis on gas costs, biomass costs, and other parameters. For economic reasons, we do not recommend adding a biomass system at this time.

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey.

PubMed

Speerforck, Sven; Schomerus, Georg; Matschinger, Herbert; Angermeyer, Matthias C

2017-06-01

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.

[Pharmacological treatment of dementia: when, how and for how long. Recommendations of the Working Group on Dementia of the Catalan Society of Geriatrics and Gerontology].

PubMed

Rodríguez, Daniel; Formiga, Francesc; Fort, Isabel; Robles, María José; Barranco, Elena; Cubí, Dolors

2012-01-01

Dementia in general--and Alzheimer's disease (AD) in particular--are bound to loom large among the most acute healthcare, social, and public health problems of the 21st century. AD shows a degenerative progression that can be slowed down--yet not halted--by today's most widely accepted specific treatments (those based on cholinesterase inhibitors as well as those using memantine). There is enough evidence to consider these treatments advisable for the mild, moderate and severe phases of the illness. However, in the final stage of the disease, a decision has to be made on whether to withdraw such treatment or not. In this paper, the Working Group on Dementia for the Catalan Society of Geriatrics and Gerontology reviews the use of these specific pharmacological treatments for AD, and, drawing on the scientific evidence thus gathered, makes a series of recommendations on when, how, and for how long, the currently existing specific pharmacological treatments should be used. Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.

Health surveillance for occupational asthma.

PubMed

Fishwick, David; Forman, Steve

2018-04-01

The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma. The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance. Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate.

Water quality in Gaines Creek and Gaines Creek arm of Eufaula Lake, Oklahoma

USGS Publications Warehouse

Kurklin, J.K.

1990-01-01

Based on samples collected from May 1978 to May 1980 and analyzed for major anions, nitrogen, trace elements, phytoplankton, and bacteria, the water in Gaines Creek and the Gaines Creek arm of Eufaula Lake was similar with respect to suitability for municipal use. Water from Gaines Creek had a pH range of 5.7 to 7.6 and a maximum specific conductance of 97 microsiemens per centimeter at 25o Celsius, whereas water from the Gaines Creek arm of Eufaula Lake had a pH range of 6.0 to 9.2 and a maximum specific conductance of 260 microsiemens per centimeter at 25o Celsius. Dissolved oxygen, pH, temperature, and specific conductance values for the lake varied with depth. With the exceptions of cadmium, iron, lead, and manganese, trace-element determinations of samples were within recommended national primary and secondary drinking-water standards. When compared to the National Academy of Sciences water-quality criteria, phytoplankton and bacteria counts exceeded recommendations; however, water from either Gaines Creek or Eufaula Lake could be treated similarly and used as a municipal water supply.

Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil.

PubMed

Monteiro, Carlos Augusto; Cannon, Geoffrey; Moubarac, Jean-Claude; Martins, Ana Paula Bortoletto; Martins, Carla Adriano; Garzillo, Josefa; Canella, Daniela Silva; Baraldi, Larissa Galastri; Barciotte, Maluh; Louzada, Maria Laura da Costa; Levy, Renata Bertazzi; Claro, Rafael Moreira; Jaime, Patrícia Constante

2015-09-01

To present and discuss the dietary guidelines issued by the Brazilian government in 2014. The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socio-economic and environmental aspects of sustainability is discussed, and their application to other countries is considered. Brazil in the twenty-first century. All people in Brazil, now and in future. The food- and meal-based Brazilian Dietary Guidelines address dietary patterns as a whole and so are different from nutrient-based guidelines, even those with some recommendations on specific foods or food groups. The guidelines are based on explicit principles. They take mental and emotional well-being into account, as well as physical health and disease prevention. They identify diet as having cultural, socio-economic and environmental as well as biological and behavioural dimensions. They emphasize the benefits of dietary patterns based on a variety of natural or minimally processed foods, mostly plants, and freshly prepared meals eaten in company, for health, well-being and all relevant aspects of sustainability, as well as the multiple negative effects of ready-to-consume ultra-processed food and drink products. The guidelines' recommendations are designed to be sustainable personally, culturally, socially, economically and environmentally, and thus fit to face this century. They are for foods, meals and dietary patterns of types that are already established in Brazil, which can be adapted to suit the climate, terrain and customs of all countries.

Recommendations for the user-specific enhancement of flood maps

NASA Astrophysics Data System (ADS)

Meyer, V.; Kuhlicke, C.; Luther, J.; Fuchs, S.; Priest, S.; Dorner, W.; Serrhini, K.; Pardoe, J.; McCarthy, S.; Seidel, J.; Palka, G.; Unnerstall, H.; Viavattene, C.; Scheuer, S.

2012-05-01

The European Union Floods Directive requires the establishment of flood maps for high risk areas in all European member states by 2013. However, the current practice of flood mapping in Europe still shows some deficits. Firstly, flood maps are frequently seen as an information tool rather than a communication tool. This means that, for example, local stocks of knowledge are not incorporated. Secondly, the contents of flood maps often do not match the requirements of the end-users. Finally, flood maps are often designed and visualised in a way that cannot be easily understood by residents at risk and/or that is not suitable for the respective needs of public authorities in risk and event management. The RISK MAP project examined how end-user participation in the mapping process may be used to overcome these barriers and enhance the communicative power of flood maps, fundamentally increasing their effectiveness. Based on empirical findings from a participatory approach that incorporated interviews, workshops and eye-tracking tests, conducted in five European case studies, this paper outlines recommendations for user-specific enhancements of flood maps. More specific, recommendations are given with regard to (1) appropriate stakeholder participation processes, which allow incorporating local knowledge and preferences, (2) the improvement of the contents of flood maps by considering user-specific needs and (3) the improvement of the visualisation of risk maps in order to produce user-friendly and understandable risk maps for the user groups concerned. Furthermore, "idealised" maps for different user groups are presented: for strategic planning, emergency management and the public.

Development of emergency department load relief area--gauging benefits in empirical terms.

PubMed

Rasheed, Farrukh; Lee, Young Hoon; Kim, Seung Ho; Park, In Cheol

2012-12-01

The primary goal of this investigation was to develop a simulation model to evaluate the various internal and external factors affecting patient flow and crowding in the emergency department (ED). In addition, a few recommendations are proposed to reconfigure the patient flow to improve ED capacity while maintaining service quality. In this research, we present a simulation study conducted in the ED at the "S Hospital" located in Seoul. Based on patient flow data and process analysis, a simulation model of patient throughput in the ED has been developed. We evaluated simulations of diverting the specific patient load in the light of our proposed recommendations to a separately managed area named as the ED load relief area (ED-LRA) and analyzing potential effects on overall length of stay (LOS) and waiting time (WT). What-if analyses have been proposed to identify key issues and investigate the improvements as per our proposed recommendations. The simulation results suggest that specific patient load diversion is needed to ensure desired outcomes. With the diversion of specific patient load to ED-LRA, there is a reduction of 40.60% in mean LOS and 42.5% in WT with improved resource utilization. As a result, opening of an ED-LRA is justified. Real-world systems are often too intricate for analytical models and often too expensive to trial with directly. Simulation models allow the modeling of this intricacy and enable experimentation to make inferences about how the actual system might perform. Our simulation study modeled that diverting the specific patient load to ED-LRA produced an improvement in overall ED's LOS and WT.

Beta blockers in patients with end-stage renal disease-Evidence-based recommendations.

PubMed

Weir, Matthew A; Herzog, Charles A

2018-05-01

For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence. Despite these limitations, both trial and observational data exist that can help guide the use of these medications. In this review, we outline the reasons to consider beta blockers for patients receiving hemodialysis, discuss the barriers to their use, and provide specific evidence-based recommendations for beta blocker use in patients with heart failure, hypertension, ischemic heart disease and arrhythmia. © 2018 Wiley Periodicals, Inc.

Practice Guidelines for Cardiovascular Fitness and Strengthening Exercise Prescription After Burn Injury.

PubMed

Nedelec, Bernadette; Parry, Ingrid; Acharya, Hernish; Benavides, Lynne; Bills, Sara; Bucher, Janelle L; Cheal, Joanne; Chouinard, Annick; Crump, Donna; Duch, Sarah; Godleski, Matthew; Guenther, Jennifer; Knox, Catherine; LaBonte, Eric; Lorello, David; Lucio, J Xavier; Macdonald, Lori E; Kemp-Offenberg, Jennifer; Osborne, Candice; Pontius, Kara; Yelvington, Miranda; de Oliveira, Ana; Kloda, Lorie A

The objective of this review was to systematically evaluate the available clinical evidence for the prescription of strength training and cardiovascular endurance exercise programs for pediatric and adult burn survivors so that practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. Summary recommendations were made after the literature was retrieved by systematic review, was critically appraised by multiple authors and the level of evidence determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Although gaps in the literature persist and should be addressed in future research projects, currently, strong research evidence supports the prescription of strength training and aerobic conditioning exercise programs for both adult and pediatric burn survivors when in the presence of strength limitations and/or decreased cardiovascular endurance after evaluation.

A review of CDC's Web-based Injury Statistics Query and Reporting System (WISQARS™): Planning for the future of injury surveillance✩

PubMed Central

Ballesteros, Michael F.; Webb, Kevin; McClure, Roderick J.

2017-01-01

Introduction The Centers for Disease Control and Prevention (CDC) developed the Web-based Injury Statistics Query and Reporting System (WISQARSTM) to meet the data needs of injury practitioners. In 2015, CDC completed a Portfolio Review of this system to inform its future development. Methods Evaluation questions addressed utilization, technology and innovation, data sources, and tools and training. Data were collected through environmental scans, a review of peer-reviewed and grey literature, a web search, and stakeholder interviews. Results Review findings led to specific recommendations for each evaluation question. Response CDC reviewed each recommendation and initiated several enhancements that will improve the ability of injury prevention practitioners to leverage these data, better make sense of query results, and incorporate findings and key messages into prevention practices. PMID:28454867

Is a behavioral treatment for urinary incontinence beneficial to prostate cancer survivors as a follow-up care?

PubMed

Zhang, Amy Y; Fu, Alex Z; Moore, Shirley; Zhu, Hui; Strauss, Gerald; Kresevic, Denise; Klein, Eric; Ponsky, Lee; Bodner, Donald R

2017-02-01

The American Cancer Society (ACS) recommends a follow-up care plan for urinary incontinence of prostate cancer survivors that includes pelvic floor muscle exercise (PFME). We examined potential impacts and access barriers of this recommendation with consideration of patients who normally do not seek such care. We compared 267 participants of a clinical trial that tested a PFME-based treatment of urinary incontinence and 69 nonparticipants who declined the trial. All subjects were assessed at baseline, 3, and 6 months on leakage frequency, disease-specific quality of life (QOL), and physical well-being. The nonparticipants were interviewed to examine reasons for intervention refusal. The participating and nonparticipating groups did not differ in most baseline demographics and clinical variables except that the nonparticipants had lower baseline prostate-specific antigen (P ≤ 0.01), lower education levels, and higher likelihood of receiving surgery alone (both P ≤ 0.05). Nonparticipants exhibited significantly more frequent daily leakage, poorer urinary function and bother, and severer urinary problems at 3 and 6 months, as well as worse physical well-being at 6 months, relative to baseline, than the participants. The primary reason for refusal was economical, such as lacking transportation and time for participation. Urinary function and QOL can worsen without appropriate follow-up care. It is important to make a PFME-based follow-up care program available to all incontinent prostate cancer survivors as recommended by ACS guidelines. Seeking PFME-based treatment is crucial for long-term urinary health outcomes even if present leakage is minor or financial challenge is a concern.

Associations of Acculturation With Self-Report and Objective Physical Activity and Sedentary Behaviors Among Latinas

PubMed Central

Perez, Lilian G.; Chavez, Adrian; Marquez, David X.; Soto, Sandra C.; Haughton, Jessica; Arredondo, Elva M.

2017-01-01

Background Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas’ activity and sedentary levels are unclear. Aim To examine associations of acculturation with Latinas’ domain-specific and total PA as well as sedentary time. Method We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18–65 years) from a PA promotion intervention in San Diego, CA (Fe en Acción/Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Results Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Conclusions Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas’ PA and sedentary behaviors. PMID:27679665

Antimicrobial Prescribing Practices Following Publication of Guidelines for the Prevention of Infections Associated With Combat-Related Injuries

PubMed Central

Tribble, David R.; Lloyd, Bradley; Weintrob, Amy; Ganesan, Anuradha; Murray, Clinton K.; Li, Ping; Bradley, William; Fraser, Susan; Warkentien, Tyler; Gaskins, Lakisha J.; Seillier-Moiseiwitsch, Françoise; Millar, Eugene V.; Hospenthal, Duane R.

2018-01-01

Background Timely and limited antibiotic prophylaxis (postinjury antimicrobial therapy) targeting specific traumatic injuries is a well-recognized measure to lessen posttraumatic infection. Modern military combat injuries raise significant challenges because of complex multiple injuries and limited data derived directly from well-controlled trials to base recommendations. Expert consensus review of available evidence led to published guidance for selection and duration of antimicrobial therapy for combat-related trauma infection prevention. This analysis evaluates antibiotic-prescribing practices by military physicians in the operational theater relative to the published guidance. Methods Trauma history and infectious disease-specific inpatient care information is captured through the Joint Theater Trauma Registry along with a supplemental infectious disease module. Injury patterns are classified based on documented International Classification of Diseases-9th Revision codes with a composite assessment of each patient’s injury pattern. Antimicrobial use categorized as prophylaxis is prescribed within the first 48 hours postinjury. Adherence to published guidance is reported along with patient characteristics and injury severity to assess for potential explanations of nonadherence. Results During June to November 2009, 75% of the 610 eligible trauma patients received antimicrobial prophylaxis. Adherence to the recommended antibiotic agent on the day of injury was in the range of 46% to 50% for the most common extremity injury patterns and 10% in penetrating abdominal injuries. Antibiotics were given in 39% of patients sustaining injuries that are recommendations to not receive antimicrobial prophylaxis. Conclusions This first evaluation of combat trauma-related antibiotic prophylaxis shows adherence levels comparable or superior to reported rates in civilian settings despite the austere, frequently mass casualty environment. Areas for interval surveillance and education-based strategies for improved adherence to practice guidance are identified. PMID:21814096

Developing a Web-Based Mechanism for Assessing Teacher Science Content Knowledge

NASA Astrophysics Data System (ADS)

Byers, Al; Koba, Susan; Sherman, Greg; Scheppke, Joan; Bolus, Roger

2011-04-01

The National Science Teachers Association (NSTA) recently launched a comprehensive electronic professional development (e-PD) online portal, the NSTA Learning Center. This support site for educators currently includes over 6,000 e-PD resources and opportunities available on-demand, as well as various tools designed to help educators maximize the effectiveness of using NSTA resources. One tool, the PD Indexer, helps teachers identify their own areas of content strengths and weaknesses by selecting content-specific assessments. Individual NSTA resources are recommended based on assessment outcomes. This paper presents a detailed description of the procedures employed by NSTA to develop valid and reliable PD Indexer content-specific multiple-choice assessment items.

Assessment of the sunk-cost effect in clinical decision-making.

PubMed

Braverman, Jennifer A; Blumenthal-Barby, J S

2012-07-01

Despite the current push toward the practice of evidence-based medicine and comparative effectiveness research, clinicians' decisions may be influenced not only by evidence, but also by cognitive biases. A cognitive bias describes a tendency to make systematic errors in certain circumstances based on cognitive factors rather than evidence. Though health care providers have been shown in several studies to be susceptible to a variety of types of cognitive biases, research on the role of the sunk-cost bias in clinical decision-making is extremely limited. The sunk-cost bias is the tendency to pursue a course of action, even after it has proved to be suboptimal, because resources have been invested in that course of action. This study explores whether health care providers' medical treatment recommendations are affected by prior investments in a course of treatment. Specifically, we surveyed 389 health care providers in a large urban medical center in the United States during August 2009. We asked participants to make a treatment recommendation based on one of four hypothetical clinical scenarios that varied in the source and type of prior investment described. By comparing recommendations across scenarios, we found that providers did not demonstrate a sunk-cost effect; rather, they demonstrated a significant tendency to over-compensate for the effect. In addition, we found that more than one in ten health care providers recommended continuation of an ineffective treatment. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Bahramian, Z.; Abbaspour, R. Ali

2015-12-01

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

Evaluation of Alternative Refractory Materials for the Main Flame Deflectors at KSC Launch Complexes

NASA Technical Reports Server (NTRS)

Calle, Luz Marina; Trejo, David; Rutkowsky, Justin

2006-01-01

The deterioration of the refractory materials used to protect the KSC launch complex steel base structures from the high temperatures during launches results in frequent and costly repairs and safety hazards. KSC-SPEC-P-0012, Specification for Refractory Concrete, is ineffective in qualifying refractory materials. This study of the specification and of alternative refractory materials recommends a complete revision of the specification and further investigation of materials that were found to withstand the environment of the Solid Rocket Booster main flame deflector better than the refractory materials in current use in terms of compressive strength, tensile strength, modulus of rupture, shrinkage, and abrasion.

[Polish guidelines for the prevention and treatment of venous thromboembolism. 2012 update].

PubMed

Zawilska, Krystyna; Bała, Małgorzata M; Błędowski, Piotr; Chmielewski, Dariusz W; Dobrowolski, Zygmunt; Frączek, Mariusz; Frołow, Marzena; Gajewski, Piotr; Guzik, Tomasz; Jaeschke, Roman; Korman, Tomasz; Kotarski, Jan; Kozubski, Wojciech; Krawczyk, Marek; Kruszewski, Wiesław; Kulikowski, Jerzy; Kutaj-Wąsikowska, Halina; Mayzner-Zawadzka, Ewa; Mrozikiewicz, Przemysław M; Musiał, Jacek; Niżankowski, Rafał; Pasierski, Tomasz; Poręba, Ryszard; Tomkowski, Witold; Torbicki, Adam; Undas, Anetta; Urbanek, Tomasz; Wojtukiewicz, Marek Z; Woroń, Jarosław; Wroński, Jacek

2012-01-01

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We chose to update the existing Polish guidelines with the use of the most recent high-quality international guidelines that we identified and adjusted the final product to Polish cultural and organizational setting. We based our recommendations primarily on the 9th edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy and Prevention of Thrombosis, the European Society of Cardiology Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism, the 3rd edition of the American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines on Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy, the ACOG practice bulletin on thromboembolism in pregnancy (Number 123), and Guidance from the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis on the Duration of Anticoagulant Therapy after a First Episode of Unprovoked Pulmonary Embolus or Deep Vein Thrombosis, as well as two other Polish practice guidelines on the prophylaxis and treatment of venous thromboembolism and the management of patients treated with oral direct inhibitors of factor X or factor II. To make recommendations regarding specific management issues that had not been addressed in other guidelines, or whenever the panel members felt they needed additional information to reach the decision, we also consulted the authors of guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each adapted recommendation, we explicitly assessed its relevance and applicability in the context of the healthcare system in Poland. When necessary, we explicitly stated the rationale for modification of the previously published recommendations and judgements about the values and preferences we assumed. The information regarding reimbursement of drugs mentioned in the recommendations was added in chapters 6-9 and 13 and approved by the National Health Fund. The final version of the practice guidelines was officially approved by the scientific societies and institutions listed at the beginning of the document.  

Comparison of ACC/AHA and ESC Guideline Recommendations Following Trial Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: Results From the Population-Based Rotterdam Study.

PubMed

Pavlovic, Jelena; Greenland, Philip; Deckers, Jaap W; Brugts, Jasper J; Kavousi, Maryam; Dhana, Klodian; Ikram, M Arfan; Hofman, Albert; Stricker, Bruno H; Franco, Oscar H; Leening, Maarten J G

2016-09-01

The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) guidelines both recommend lipid-lowering treatment for primary prevention based on global risk for cardiovascular disease (CVD). However, randomized clinical trials (RCTs) for statin use have included participants with specific risk-factor profiles. To evaluate the overlap between the ACC/AHA and ESC guideline recommendations and available evidence from RCTs for statin use in primary prevention of CVD. We calculated the 10-year risk for hard atherosclerotic CVD (ASCVD) following the ACC/AHA guideline, 10-year risk of CVD mortality following the ESC guideline, and we determined eligibility for each of 10 major RCTs for primary prevention of CVD. Conducted from July 2014 to August 2015, this study included 7279 individuals free of CVD, aged 45 to 75 years, examined between 1997 and 2008 for the Rotterdam Study, a prospective population-based cohort. Proportions of individuals qualifying for lipid-lowering treatment per guidelines, proportions of individuals eligible for any of the 10 RCTs, overlap between these groups, and corresponding ASCVD incidence rates. Of the 7279 individuals included in the study, 58.2% were women (n = 4238) and had a mean (SD) age of 61.1 (6.9) years. The ACC/AHA guidelines would recommend statin initiation in 4284 participants (58.9%), while the ESC guidelines would in 2399 participants (33.0%) (overlapping by 95.8% with ACC/AHA). A total of 3857 participants (53.0%) met eligibility criteria for at least 1 RCT. Recommendations from both guidelines and trial evidence overlapped for 1546 participants (21.2%), who were at high risk for ASCVD (21.5 per 1000 person-years). A further 1703 participants (23.4%) would be recommended for statins by the guidelines in the absence of direct trial evidence, while 1176 (16.2%) would have been eligible for at least 1 trial without being recommended statin treatment by any guideline. Finally, 1719 participants (23.6%) would not be recommended a statin, nor would qualify for any of the trials. These individuals had low incidence of ASCVD (3.3 per 1000 person-years). Based on this European population study, ACC/AHA and ESC prevention guidelines often did not align at the individual level. However, for one-fifth of the general population, guidelines on both sides of the Atlantic recommend statin initiation, with trial data supporting the efficacy. There should be no controversy about providing optimal preventive medication to these individuals.

The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA

PubMed Central

Fleshner, Katherine; Carlsson, Sigrid V.; Roobol, Monique J.

2017-01-01

Guidelines conflict regarding recommendations for prostate-specific antigen (PSA) screening for early detection of prostate cancer. The United States Preventive Services Task Force (USPSTF) assigned a grade of D (recommending against screening) for men 75 and older in 2008 and for men of all ages in 2012. We reviewed temporal trends in rates of screening before and after the 2012 recommendation based on a literature search for studies published between 2011/01/01–2016/10/03 on PSA utilization patterns, changes in prostate cancer incidence and biopsy patterns, and how the recommendation has shaped physician and patient attitudes about PSA screening and subsequent ordering of other screening tests. Rates of PSA screening decreased by 3–10 percentage points among all age groups and within most U.S. geographic regions. Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a notable shift towards higher grade, stage and risk upon detection. Despite the recommendation, some physicians reported ongoing willingness to screen appropriately selected men, and men largely reported intending to continue to ask for the PSA test. In the coming years, we expect to have a better picture of whether these decreased rates of screening will impact prostate cancer metastasis and mortality. PMID:27995937

Specific physiological and biomechanical performance in elite, sub-elite and in non-elite male team handball players.

PubMed

Wagner, Herbert; Fuchs, Philip X; von Duvillard, Serge P

2018-01-01

Team handball is a dynamic sport game that is played professionally in numerous countries. However, knowledge about training and competition is based mostly on practical experience due to limited scientific studies. Consequently, the aims of our study were to compare specific physiological and biomechanical performance in elite, sub-elite and in non-elite male team handball players. Thirty-six elite, sub-elite and non-elite male team handball players performed a game based performance test, upper-body and lower-body strength tests, 30-m sprint test, counter movement jump test and an incremental treadmill running test. Significant differences (P<0.05) were found for the peak oxygen uptake, heart rate, offense and defense time, jump height and ball velocity during the jump throw in the game based performance test, maximal oxygen uptake in the incremental treadmill running test as well as in maximal leg strength and leg explosive strength in the isometric strength test. Elite male players have an enhanced specific agility, a better throwing performance, a higher team handball specific oxygen uptake and higher leg strength compared to sub-elite and non-elite players. Based on these results we recommend that training in team handball should focus on game based training methods to improve performance in specific agility, endurance and technique.

Reporting results from whole-genome and whole-exome sequencing in clinical practice: a proposal for Canada?

PubMed

Zawati, Ma'n H; Parry, David; Thorogood, Adrian; Nguyen, Minh Thu; Boycott, Kym M; Rosenblatt, David; Knoppers, Bartha Maria

2014-01-01

This article proposes recommendations for the use of whole-genome and whole-exome (WGS/WES) sequencing in clinical practice, endorsed by the board of directors of the Canadian College of Medical Geneticists. The publication of statements and recommendations by several international and national organisations on clinical WGS/WES has prompted a need for Canadian-specific guidance. A multi-disciplinary group consisting of lawyers, ethicists, genetic researchers, and clinical geneticists was assembled to review existing guidelines on WGS/WES and identify provisions relevant to the Canadian context. Definitions were provided to orient the recommendations and to minimize confusion with other recommendations. Recommendations include the following: WGS/WES should be used in a judicious and cost-efficient manner; WGS/WES should be used to answer a clinical question; and physicians need to explain to adult patients the nature of the results that could arise, so as to allow them to make informed choices over whether to take the test and which results they wish to receive. Recommendations are also provided for WGS/WES in the pediatric context, and for when results implicate patients' family members. These recommendations are only a proposal to be developed into comprehensive Canadian-based guidelines. They aim to promote discussion about the reporting of WGS/WES results, and to encourage the ethical implementation of these new technologies in the clinical setting.

Implementing Evidence-Based Practices for People With Schizophrenia

PubMed Central

Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

2009-01-01

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

Tobacco cessation with patients recovering from alcohol and other substance abuse.

PubMed

McIlvain, H E; Bobo, J K

1999-09-01

This article focuses on the problem of tobacco cessation in the patient recovering from alcohol or other substance abuse. The authors review the epidemiology of the problem, specific health risks to this population from continued tobacco use, and recent research findings that address previous treatment concerns. Recommendations for counseling by physicians are made. These include an algorithm for determining the patient's stage of readiness for making a quit attempt, specific counseling tasks based on the patients stage, and motivational counseling strategies aimed at increasing the patients motivation to quit.