Management Guidelines (management + guideline)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Role of Pap Test terminology and age in the detection of carcinoma invasive and carcinoma in situ in medically underserved California women

Lydia P. Howell M.D.
Abstract Our goals were to evaluate Pap Test findings classified by the Bethesda system, and follow up biopsies from participants in the California Breast and Cervical Cancer Control Program (Ca-BCCCP) for: 1) correlation in the detection of carcinoma in situ (CIS) and carcinoma invasive (CI), and 2) age-related trends, with discussion in the context of the 2001 ASCCP Management Guidelines. Women (n = 52,339) who had their initial screening Pap Tests with Ca-BCCCP between January 1995,December 1999 were followed for diagnostic services through December 2000. Descriptive and analytical methods were used in the analysis. Of the Pap results, 81.9% were negative, 10.6% showed infection, 4.7% showed an epithelial abnormality as defined by the Bethesda system (atypical squamous cells of undertermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL)), 0.1% showed squamous-cell cancer (SCC), and 2.7% showed other or unsatisfactory. Subsequent to the initial Pap Test, follow-up results of carcinoma in situ (CIS) and carcinoma invasive (CI) accounted for 0.36% and 0.05% of the population, respectively. Among HSIL Pap Tests (n = 285), 40.7% had follow-up showing CIS. Among SCC Pap Tests, 17.9% had follow-up results of CIS and 28.6% CI. Of the 191 patients with CIS as a follow-up finding, the initial Pap smear showed: HSIL 60.7%, SCC 2.6%, LSIL 10.5%, ASCUS 13.6%, and negative or infection 9.9%. Of the 27 patients with CI, the initial Pap Test showed: HSIL 40.7%, SCC 29.6%, LSIL 7.4%, ASCUS 7.4%, and negative or infection 11.1%. Pap diagnoses of other or unsatisfactory accounted for 2.6% of the Pap results from patients with CIS and 3.7% of Pap results from patients with CI. Except for LSIL, there was an increasing age trend in the number of cases in each of Pap results, with the exception of age 65+ yr. However, the ratio of LSIL and ASCUS to negative cases decreased with age. (P < 0.0001 and 0.0293, respectively). HSIL Pap results indicate a reasonably high probability of CIS and CI. However, approximately 1/3 of patients with CIS and 1/4 of patients with CI presented with Pap diagnoses of less severity than HSIL. When a negative Pap Test result is chosen as reference group, there is a negative age trend for LSIL and ASCUS, and no age trend for other results. These findings all have important implications in the design of follow-up strategies, and support the 2001 ASCCP Consensus Guidelines for the Management of Women with Cervical Abnormalities. Diagn. Cytopathol. 2004;30:227,234. © 2004 Wiley-Liss, Inc. [source]

Anaphylaxis: Clinical concepts and research priorities

Simon GA Brown
Abstract Anaphylaxis is a severe immediate-type hypersensitivity reaction characterized by life-threatening upper airway obstruction bronchospasm and hypotension. Although many episodes are easy to diagnose by the combination of characteristic skin features with other organ effects, this is not always the case and a workable clinical definition of anaphylaxis and useful biomarkers of the condition have been elusive. A recently proposed consensus definition is ready for prospective validation. The cornerstones of management are the supine position, adrenaline and volume resuscitation. An intramuscular dose of adrenaline is generally recommended to initiate treatment. If additional adrenaline is required, then a controlled intravenous infusion might be more efficacious and safer than intravenous bolus administration. Additional bronchodilator treatment with continuous salbutamol and corticosteroids are used for severe and/or refractory bronchospasm. Aggressive volume resuscitation, selective vasopressors, atropine (for bradycardia), inotropes that bypass the ,-adrenoreceptor and bedside echocardiographic assessment should be considered for hypotension that is refractory to treatment. Management guidelines continue to be opinion- and consensus-based, with retrospective studies accounting for the vast majority of clinical research papers on the topic. The clinical spectrum of anaphylaxis including major disease subgroups requires clarification, and validated scoring systems and outcome measures are needed to enable good-quality prospective observational studies and randomized controlled trials. A systematic approach with multicentre collaboration is required to improve our understanding and management of this disease. [source]

Insulin intensification , the rationale and the target

A. Liebl
Summary Aims:, To review the key evidence supporting targets for glycaemic control in people with type 2 diabetes and the implications for management in primary care. Method:, Literature review. Results:, Achieving early glycaemic control may reduce long-term risk by minimising the ,metabolic memory' effect of hyperglycaemia. Several large studies have failed to confirm expectations that intensive treatment would offer greater reductions in risk. This may reflect the failure to achieve control blood glucose early in the course of diabetes. Management guidelines emphasise the importance of targets for glycaemic control, but differ in the strategies they recommend for dose intensification. All, however, acknowledge the importance of individualising treatment. Conclusion:, Early achievement of targets for glycaemic control may be important to reduce long-term risk in people with diabetes, but treatment should be tailored to individual need. [source]

Osteosarcoma of the testis

Abstract, This report describes a case of primary osteosarcoma of the testis in a 60-year-old man. Treatment consisted of an inguinal orchiectomy with no adjuvant therapy. The patient is alive and doing well without recurrent disease at 18 months after diagnosis. Only three reports have been published on primary osteosarcoma of the testis. The origin of this tumor from undifferentiated mesenchymal cells or from a malignant transformation of pre-existing teratomatous elements is still unclear. Management guidelines are difficult to establish due to the rarity of such tumors, but inguinal orchiectomy with careful follow up appears to be sufficient treatment. [source]

A survey of provision of dietetic services for coeliac disease in the UK

M. Nelson
Abstract Background, Management guidelines for care of coeliac patients published by the British Society of Gastroenterology (BSG), 2002 recommend that patients should see a dietitian at diagnosis and at least at annual review. In the absence of information on dietetic provision in coeliac disease management in the UK and with surveys in other countries suggesting that patients with coeliac disease gain most information from coeliac support groups (Green et al., 2001), Coeliac UK set out to investigate dietetic services for coeliac patients in the UK. Methods, Questionnaires were sent to dietetic departments in the UK via the Regional Managers Group of the British Dietetic Association (BDA) by email. The questionnaires were in two parts, the first was completed by the dietetic manager and the second by the dietitian with the main responsibility for the management of coeliac patients within the department. Results, Over one-quarter of departments reported allocating a maximum of 1 h of dietitians' time per month per 100 000 population to seeing coeliac patients. More hours were allocated to coeliac patients in departments where dietitians had attended coeliac disease training, where dietitians were professional members of Coeliac UK or where coeliac patient care was undertaken by a multi-disciplinary team. Conclusion, There is wide variation in dietetic provision for diagnosed coeliac patients in the UK. The Coeliac UK survey suggests that the current level of dietetic provision is in the region of one-third of what is required according to the BSG management guidelines (British Society of Gastroenterology (BSG), 2002) to provide diagnosed coeliacs with only basic support and annual review. [source]

Impact of introducing a sedation management guideline in intensive care

ANAESTHESIA, Issue 3 2006
C. Adam
Summary To ensure that sedative agents in the intensive care unit are used for maximum benefit, a guideline that promotes the accurate and continuous assessment of patients' needs is indicated. This observational 24-month prospective study investigated the effect of introducing a sedation management guideline into a 10-bedded multidisciplinary intensive care unit on length of stay, severity of illness, mortality and the number of bed days provided. Costs for all sedative drugs were calculated as cost per bed day. Intensive care unit mortality remained constant before and after guideline introduction. The length of stay of non-cardiac surgery patients was mean (SD) 4.6 (4.4) and 5.1 (4.3) days, respectively (p = 0.2). Monthly sedative cost before guideline introduction was £6285 compared to £3629 afterwards (p,0.0001), representing a real saving of £63 759 in sedative costs over the 2 years following introduction of the guideline. Guideline-directed management for sedation significantly reduces the cost of sedative drugs per bed day without any negative effect on length of ICU stay and outcome. [source]

Geological controls on the formation of alluvial meanders and floodplain wetlands: the example of the Klip River, eastern Free State, South Africa

S. Tooth
Abstract Floodplain wetlands are common features of rivers in southern Africa, but they have been little studied from a geological or geomorphological perspective. Study of the upper Klip River, eastern Free State, South Africa, indicates strong geological controls on the formation of alluvial meanders and associated floodplain wetlands. Along this river, pronounced and abrupt changes in valley width are strongly linked to lithological variations. Where weakly cemented sandstone crops out, the Klip has laterally eroded bedrock and carved valleys up to 1500 m wide. In these valleys, the river meanders (sinuosity up to ,1·75) on moderate gradients (<0·001) within extensive floodplains marked by numerous oxbow lakes, backswamps and abandoned channels, many of which host substantial wetlands. In contrast, where highly resistant dolerite crops out, lateral erosion of bedrock is restricted, with the Klip tending instead to erode vertically along joints or fractures. Here, valleys are narrower (<200 m), channel-bed gradients are steeper (>0·003), the river follows a much straighter course (sinuosity ,1·10,1·34), and floodplains are restricted in width. Long-term landscape development in the Klip and numerous similar catchments depends on the interaction between fluvial processes in the sandstone and dolerite valleys. In the sandstone valleys, vertical erosion rates are controlled by erosion rates of the more resistant dolerites downstream. Hence, in the short- to medium-term (decades to tens of thousands of years), lateral erosion dominates over vertical erosion, with the river concomitantly planing sandstone in the channel floor and reworking floodplain sediments. The thickness of alluvial fill in the sandstone valleys is limited (<4 m), but the resultant meanders are naturally dynamic, with processes such as point bar deposition, cutoff formation and channel avulsion resulting in an assemblage of fluvial landforms. In the longer term (greater than tens of thousands of years), however, vertical erosion will occur in the sandstone valleys as the downstream dolerites are lowered by erosion, resulting in channel incision, floodplain abandonment, and desiccation of the wetlands. Identification of the geological controls on meander and wetland formation provides information vital for the design of effective management guidelines for these ecologically rich habitats, and also contributes to a better understanding of rivers that are intermediate between fully alluvial and fully bedrock. Copyright © 2002 John Wiley & Sons, Ltd. [source]

The promise and the potential consequences of the global transport of mycorrhizal fungal inoculum

Mark W. Schwartz
Abstract Advances in ecology during the past decade have led to a much more detailed understanding of the potential negative consequences of species' introductions. Moreover, recent studies of mycorrhizal symbionts have led to an increased knowledge of the potential utility of fungal inoculations in agricultural, horticultural and ecological management. The intentional movement of mycorrhizal fungal species is growing, but the concomitant potential for negative ecological consequences of invasions by mycorrhizal fungi is poorly understood. We assess the degree to which introductions of mycorrhizal fungi may lead to unintended negative, and potentially costly, consequences. Our purpose is to make recommendations regarding appropriate management guidelines and highlight top priority research needs. Given the difficulty in discerning invasive species problems associated with mycorrhizal inoculations, we recommend the following. First, careful assessment documenting the need for inoculation, and the likelihood of success, should be conducted prior to inoculation because inoculations are not universally beneficial. Second, invasive species problems are costly and often impossible to control by the time they are recognized. We recommend using local inoculum sources whenever possible. Third, non-sterile cultures of inoculum can result in the movement of saprobes and pathogens as well as mutualists. We recommend using material that has been produced through sterile culture when local inoculum is not available. Finally, life-history characteristics of inoculated fungi may provide general guidelines relative to the likelihood of establishment and spread. We recommend that, when using non-local fungi, managers choose fungal taxa that carry life-history traits that may minimize the likelihood of deleterious invasive species problems. Additional research is needed on the potential of mycorrhizal fungi to spread to non-target areas and cause ecological damage. [source]

Practice nurses' role and knowledge about diabetes management within rural and remote Australian general practices

District Nurse, MRCNA, R Livingston RN
Abstract Background: The increasing prevalence of diabetes and obesity represents a significant disease burden in Australia. Practice nurses (PNs) play an important role in diabetes education and management. Aim: To explore PNs' roles, knowledge and beliefs about diabetes education and management in rural and remote general practice in Australia. Method: Exploratory study undertaken in three phases: 1) Pilot study to test the performance of the questionnaire; 2) One-shot cross-sectional survey using self-complete questionnaires; 3) Individual interviews. Results: Ten PNs completed the pilot test; the draft questionnaire was deemed appropriate to the study purpose. Then, 65 questionnaires were distributed to PNs and 21 responded. Fourteen respondents had worked in the role <5 years, and most PNs attended diabetes education programmes in their workplace. A minority (40%) used diabetes management guidelines regularly. Most knew obesity to be the most common risk factor for diabetes but only 50% knew that glycosylated haemoglobin indicates blood glucose levels over the preceding three months. Self-reported competency to assess patients' self-care practices and medication management practices varied. Conclusion: PNs' diabetes management was self-reported; their knowledge varied and their perceived benefits of diabetes education differed from those of patients. Copyright © 2010 FEND [source]

The impact of salinity pulses on the emergence of plant and zooplankton from wetland seed and egg banks

Summary 1. In this study we compared the emergence of aquatic biota from sediments under 14-day pulses of high (5000 mg L,1) and low (1000 mg L,1) salinity with emergence under freshwater and equivalent constant salinity levels. We tested the hypothesis that pulses of high salinity and short duration have no impact on the emergence of aquatic plants and zooplankton from wetland sediment. 2. The way salt is moved through the landscape may alter the response of biota to increases in salinity. Under natural hydrological regimes in rivers and floodplains salinity pulses occur often at concentrations that exceed predicted tolerance levels for aquatic biota. The impacts of natural pulses of high salinity followed by rapid return to fresh conditions may be used to inform management guidelines for the potential release of non-natural saline water into river systems with minimal impact. 3. For both aquatic plants and zooplankton the abundance and richness of the emerging taxa decreased at higher salinities kept at constant levels. In contrast, pulses of salinity followed by return to freshwater conditions did not have a negative impact on the emergence of aquatic plants or zooplankton. For many taxa of zooplankton a positive impact was demonstrated with higher emergence following the salinity pulse. 4. The responses of aquatic plant and zooplankton taxa are grouped into five response types. Type 1: negatively impacted by all salt regimes. Type 2: preference for constant salinities. Type 3: no difference between fresh and either pulse regime. Type 4: preference for high concentration pulses. Type 5: emergence higher under a low concentration pulse. 5. Although previous studies indicate that constant high-level salinity in rivers and wetlands can decrease the species richness of aquatic communities, this current study shows pulses may not have the same impact. Our results support the hypothesis that pulses of high salinity and short duration do not impact on the emergence of aquatic plants and zooplankton from wetland sediments. For zooplankton, pulses of salt may trigger emergence. 6. These trends may be used to explore the potential to use managed water releases to move salt through the landscape with minimal impact of salinity on aquatic biota. However, before such preliminary results are applied in management of saline water releases we need to determine the implications for interacting processes in natural ecosystems. [source]

Identification and management of women with inherited bleeding disorders: a survey of obstetricians and gynaecologists in the United Kingdom

HAEMOPHILIA, Issue 4 2006
Summary., A mail survey of members and fellows of Royal College of Obstetricians and Gynaecologists was carried out to determine current practices of obstetricians and gynaecologists in the United Kingdom in the management of women with inherited bleeding disorders. In total, 3929 questionnaires were sent, 707 returned and analysis was limited to 545 valid questionnaires. In the past 5 years, 91% have managed women with inherited bleeding disorders. The majority (83%) considered inherited bleeding disorders to be under diagnosed in obstetrics and gynaecology. More than 80% considered the prevalence of von Willebrand's disease (VWD) to be <0.2% in the general population and <1% in women with menorrhagia and no gynaecological pathology, although the reported prevalence is 1% and 5,25% respectively. Twelve percent of the respondents would arrange testing for VWD when reviewing an 18-year-old with menorrhagia and no pelvic pathology, while only 2% would do the same for a 35-year-old with the same presentation. Twenty-one percent thought elective caesarean section is indicated in all fetuses known to be at risk of being affected by haemophilia. Eighty-four percent considered vacuum extraction unsafe in these cases, but 76% would consider the use of low forceps. In conclusion, obstetricians and gynaecologists underestimate inherited bleeding disorders as an underlying cause for menorrhagia. Increased awareness and management guidelines are essential in minimizing haemorrhagic complications and improving quality of care of these women. [source]

Modelling habitat selection of Common Cranes Grus grus wintering in Portugal using multiple logistic regression

IBIS, Issue 3 2000
Predictive models of habitat suitability for the Common Crane Grus grus in a wintering area of southern Portugal were derived using logistic multiple regression and Geographic Information Systems. The study area was characterized by landscape variables and surveyed uniformly for the presence of cranes. The most important variables were distance to roosts, to open Holm Oak woods and to villages, and the occurrence of unpaved roads, shrubby vegetation, slope and orchards. Two models were built, the second having one variable fewer than the first. The selection of the best model was based on statistical and biological criteria. Crane distribution was negatively related to: distance to open Holm Oak Quercus rotundifolia woods and roosts. Additionally, unsuitable vegetation and orchard areas are avoided. In these areas movement is difficult, food availability is reduced and the risk of predation increased. We also found that villages and roads were avoided; disturbance is a significant factor for this species. Some management guidelines are proposed for the area: (1) maintenance of open Holm Oak woodlands, (2) incentives to avoid the abandonment of traditional agriculture and pastoral use of the area, which would lead to an increase of shrubby vegetation areas, (3) preservation of suitable roosting places and (4) management of new patches of forest and orchards. [source]

Orthodontic considerations for gingival health during pregnancy: a review

PM Mukherjee
Abstract:, Gingivitis is caused by several known systemic and local factors. Among systemic factors, the role of hormonal changes during pregnancy is well established. While presence of fixed orthodontic appliances alone may not cause gingivitis, factors such as pregnancy and poor oral hygiene combined together could precipitate acute gingival inflammation that may progress to a periodontal condition in a patient receiving orthodontic therapy. There has been an increase in the number of adult patients who are receiving orthodontic treatment. Orthodontic appliances could act as a potential plaque retentive source and aggravate inflammatory reactions that are seen during pregnancy. There is a lack of awareness regarding oral healthcare issues among patients who are pregnant and choose to seek orthodontic treatment. In addition, there is a need in the literature to outline management guidelines for patients who want to receive orthodontic treatment during pregnancy, with or without pre-existing gingival conditions. This review focuses on the aetiology of pregnancy gingivitis and the management of orthodontic patients during pregnancy. Our emphasis is on patient education, oral hygiene maintenance, preventive and treatment strategies for the management of gingival health in orthodontic patients during pregnancy. We also highlight some of the possible complications of initiating orthodontic treatment during pregnancy. [source]

Water resource hazard management system: assessing sustainable practices at the farm and catchment scales,

W. O. Ochola
qualité de l'eau; gestion des risques; pratique de la gestion des eaux; système d'aide a la decision Abstract Water quality is a pivotal environmental indicator of sustainable land management and environmental ,health'. Hazards to water resource use at the farm and catchment scales have far-reaching physical, biological, environmental and socio-economic impacts. These impacts are exacerbated by on-site and off-site agricultural and non-agricultural activities. A prototype water hazard management decision support system that uses an integrated framework to identify, by origin, hazards and related best water management practices guidelines is proposed. The system recommends best management guidelines with respect to the inherent water resource use mitigations. The system has been calibrated by and applied to expert knowledge and experimental and survey data from Kiumbu Catchment in central Kenya. Suggestions are made for the inclusion of GIS capabilities for the production of water resource assessment maps and other spatial water quality indicators. Copyright © 2002 John Wiley & Sons, Ltd. RÉSUMÉ La qualité de l'eau est un indice fondamental pour l'estimation de l'aménagement territorial et de la ,santé' environnementale. Les risques dus à l'utilisation des ressources hydriques au niveau des exploitations agricoles et des bassins versants ont de grands impacts physiques, biologiques, environnementaux et socio-économiques. Ces impacts sont de plus en plus accentuées par des activités aussi bien agricoles que non-agricoles. On propose ici un prototype de système d'aide à la décision pour la gestion des risques qui, utilisant une structure integrée, permettra d'identifier les risques selon leur origine et de proposer les grands axes d'une meilleure gestion des ressources hydriques. Le système recommande des directives en rapport avec les mesures environnementales inhérentes au site. Le système a été calibré par des données provenant d'une connaisaance théorique et expérimentale dans le bassin versant Kiumbu du Kenya central. Des suggestions ont été faites afin d'inclure des capacités GIS pour la production des cartes d'estimation des ressources hydriques mais aussi d'autres indicateurs de la qualité de l'eau. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Pre-hospital airway management guidelines: we need more!

P. P. Bredmose
No abstract is available for this article. [source]

Emerging Insights in the First-Step Use of Antihypertensive Combination Therapy

Keith Norris MD
The blood pressure (BP) goals set by hypertension management guidelines (<140/90 mm Hg in uncomplicated hypertension; <130/80 mm Hg in type 2 diabetes or kidney disease) are not being achieved in a high proportion of patients, partly because monotherapy is insufficient in many patients. In particular, patients with uncontrolled moderate or severe hypertension and/or associated cardiovascular risk factors remain at high risk for cardiovascular events and hypertensive emergency. In recognition of the urgency of treating moderate and severe hypertension, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) advocates the initial use of 2-drug therapies in patients with systolic BP levels >20 mm Hg above goal or diastolic BP level >10 mm Hg above goal. Regimens should usually include a thiazide diuretic and, for patients with diabetes or kidney disease, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Recently, clinical trial data have shown that first-step antihypertensive treatment of moderate and severe hypertension with carefully chosen fixed-dose combinations provides a high rate of BP goal achievement, a simplified dosing regimen, and superior tolerability compared with monotherapy. [source]

Risk management with suicidal patients

Alan L. Berman
The patient who is at-risk for suicide is complex and is difficult to evaluate and treat effectively. Should suicidal behavior occur, the clinician faces the potential wrath of bereaved survivors and their externalized blame exercised through a malpractice suit. The clinician's duty of care to a patient is to act affirmatively to protect a patient from violent acts against self. A finding of malpractice is established if the court finds that this duty was breached, through an act of omission or commission relative to the standard of care, and that this breach was proximately related to the patient's suicidal behavior. This article discusses the standard of care and factors that determine liability in a suicide death of a patient. An extensive list of recommendations for competent caregiving for the at-risk patient and risk management guidelines are then presented. © 2005 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 171,184, 2006. [source]

Wood-feeding beetles and soil nutrient cycling in burned forests: implications of post-fire salvage logging

Tyler P. Cobb
1Rising economic demands for boreal forest resources along with current and predicted increases in wildfire activity have increased salvage logging of burned forests. Currently, the ecological consequences of post-fire salvage logging are insufficiently understood to develop effective management guidelines or to adequately inform policy decision-makers. 2We used both field and laboratory studies to examine the effects of post-fire salvage logging on populations of the white-spotted sawyer Monochamus scutellatus scutellatus (Say) (Coleoptera: Cerambycidae) and its ecological function in boreal forest. 3Monochamus s. scutellatus adults were relatively abundant in both burned and clear-cut logged sites but were absent from salvage logged sites. 4An in situ mesocosm experiment showed that the abundance of M. s. scutellatus larvae in burned white spruce bolts was linked to changes in total organic nitrogen and carbon in mineral soil. 5Organic nutrient inputs in the form of M. s. scutellatus frass increased mineral soil microbial respiration rates by more than three-fold and altered the availability of nitrogen. Changes in nitrogen availability corresponded with decreased germination and growth of Epilobium angustifolium and Populus spp. but not Calamagrostis canadensis. 6Although the present study focused on local scale effects, the reported findings suggest that continued economic emphasis on post-fire salvage logging may have implications beyond the local scale for biodiversity conservation, nutrient cycling and plant community composition in forest ecosystems recovering from wildfire. [source]

Management of refractory ascites and hepatorenal syndrome

Anuchit Chutaputti
Abstract, Refractory ascites and hepatorenal syndrome (HRS) are the late complications of the terminal stages of cirrhosis. The definitions of refractory ascites and HRS proposed by the International Ascites Club in 1996 are now widely accepted, and are useful in diagnosis, treatment and research in this field. In both conditions, the only treatment of proven value for improved survival is liver transplantation. However, because of better understanding about the pathophysiology of HRS, including the roles of portal hypertension, ascites formation and hemodynamic derangements, treatments such as transjugular intrahepatic portasystemic shunt (TIPS) and new pharmacological agents may be considered to alleviate the problem prior to transplantation. Symptomatic treatment of refractory ascites includes TIPS and repeated large volume paracentesis. Transjugular intrahepatic portasystemic shunt can improve survival while waiting for liver transplantation. Practical management guidelines for TIPS and large volume paracentesis, including the prevention and management of further complications, are considered in this review. © 2002 Blackwell Publishing Asia Pty Ltd [source]

A survey of provision of dietetic services for coeliac disease in the UK

M. Nelson
Abstract Background, Management guidelines for care of coeliac patients published by the British Society of Gastroenterology (BSG), 2002 recommend that patients should see a dietitian at diagnosis and at least at annual review. In the absence of information on dietetic provision in coeliac disease management in the UK and with surveys in other countries suggesting that patients with coeliac disease gain most information from coeliac support groups (Green et al., 2001), Coeliac UK set out to investigate dietetic services for coeliac patients in the UK. Methods, Questionnaires were sent to dietetic departments in the UK via the Regional Managers Group of the British Dietetic Association (BDA) by email. The questionnaires were in two parts, the first was completed by the dietetic manager and the second by the dietitian with the main responsibility for the management of coeliac patients within the department. Results, Over one-quarter of departments reported allocating a maximum of 1 h of dietitians' time per month per 100 000 population to seeing coeliac patients. More hours were allocated to coeliac patients in departments where dietitians had attended coeliac disease training, where dietitians were professional members of Coeliac UK or where coeliac patient care was undertaken by a multi-disciplinary team. Conclusion, There is wide variation in dietetic provision for diagnosed coeliac patients in the UK. The Coeliac UK survey suggests that the current level of dietetic provision is in the region of one-third of what is required according to the BSG management guidelines (British Society of Gastroenterology (BSG), 2002) to provide diagnosed coeliacs with only basic support and annual review. [source]

Breastfeeding the Late Preterm Infant

Marsha Walker
ABSTRACT Late preterm infants comprise the fastest growing segment of babies born prematurely. They arrive with disadvantages relative to feeding skills, stamina, and risk for conditions such as hypoglycemia, hyperbilirubinemia, and slow weight gain. Breastfeeding these babies can be difficult and frustrating. Individualized feeding plans include special considerations to compensate for immature feeding skills and inadequate breast stimulation. Breastfeeding management guidelines are described that operate within the late preterm infant's special vulnerabilities. [source]

Intrapartum management guidelines based on fetal heart rate pattern classification

Takashi Okai
First page of article [source]

Pregnancy following renal transplantation

John M. Davison
Abstract Pregnancy is not contraindicated in renal transplant recipients with stable renal function, and a successful and healthy obstetric outcome can be expected in 95% of such cases. The incidence of both maternal and fetal complications is related to the degree of graft dysfunction and/or hypertension prior to pregnancy. Poorer prognosis is associated with poorer renal function. If complications (usually hypertension, renal deterioration, and/or rejection) occur before 28 weeks, then successful obstetric outcome is reduced by 20%. More information is needed about the intrauterine effects and neonatal consequences of maternal immunosuppression, which appears harmless at maintenance levels. From the data available it seems that pregnancy does not compromise long-term transplant prognosis. In the absence of prospective controlled studies transplant pregnancy registries are the only viable means of providing clinicians with timely and relevant information on pregnancy outcomes on which to base management guidelines. [source]

Multidisciplinary Teaming to Promote Effective Management of Type 1 Diabetes for Adolescents

MaryAnn Tapper Strawhacker BSN, RN Special Education Nursing Consultant
ABSTRACT: Intensive diabetes therapy can reduce the long-term microvascular complications of Type 1 diabetes and improve glucose control. Managing the demands of intensive therapy however, often poses a burden on adolescents and their families. Through multidisciplinary teaming, the school health office can facilitate active participation in treatment, coordinate services, and maximize use of community resources. This paper presents a general overview of intensive diabetes therapy, psychosocial implications of chronic illness in adolescence, effects of chronic illness on the family, and behavior change strategies to improve adherence with disease management guidelines. [source]

Pregnancy after liver transplantation

Vincent T. Armenti
The first known posttransplantation pregnancy was in 1958 in a renal transplant recipient who had received a kidney from her identical twin sister. The first known posttransplantation pregnancy in a liver transplant recipient was in 1978. Information available from female kidney transplant recipients helped in the decision making involved in the management of this case, as well as those that followed. Over the last 20 years, issues specific to liver transplantation and pregnancy have been identified. Similar to the kidney transplant recipient population, when prepregnancy recipient graft function is stable and adequate, pregnancy appears to be well tolerated. Also similar to kidney transplant recipients, there has been no evidence of a specific malformation pattern among the children, and although prematurity and low birth weight occur, overall newborn outcomes have been favorable. Pregnancy in the setting of recurrent liver disease, such as recurrent hepatitis C, poses a potential problem among liver transplant recipients, as well as the possible adverse effects of immunosuppression on maternal kidney function. Also of significance, peripartum graft deterioration has more severe consequences in this transplant recipient population. Therefore, pregnancy must be considered carefully in this transplant recipient group. Since 1991, the National Transplantation Pregnancy Registry (NTPR) has studied the safety of pregnancy outcomes in solid-organ transplant recipients. The purpose of this review is to catalog studies in the literature, as well as to present current data from the registry with management guidelines. [source]

Time trends in prevalence and severity of childhood asthma and allergies from 1995 to 2002 in France

ALLERGY, Issue 5 2009
I. Annesi-Maesano
Objective:, To assess time trends in symptoms of asthma, allergic rhinitis and atopic eczema among adolescents in Languedoc Roussillon, France. Methods:, Two cross-sectional surveys were conducted 7 years apart using the same protocol. School-based samples of 3383 participants in the 1995 survey and 1642 participants in the 2002 survey respectively were recruited. Results:, There was a tendency towards stagnation in current symptoms of asthma, rhinoconjunctivitis and eczema. Indices related to lifetime diagnosis of asthma, hay fever and eczema increased. For all the conditions, indices of severity also showed a decrease in the 7-year study period. Conclusions:, Our study shows that symptoms of asthma, allergic rhinitis and eczema were stable, supporting the effectiveness of national asthma prevention and management guidelines for such diseases. The increase in indices related to lifetime diagnosis could be the result of increased public and professional awareness of the diseases and changes in diagnostic labelling in recent years. [source]

Health economics of asthma: assessing the value of asthma interventions

ALLERGY, Issue 12 2008
J. D. Campbell
The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0,100). Six studies (15%) had quality category 2, 26 studies (65%) achieved quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. [source]

Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis

Nicola E. Walsh MSc MCSP
Abstract Objectives:,To document physiotherapy provision for patients with knee osteoarthritis (OA) in relation to the United Kingdom (UK) recently published National Institute of health and Clinical Excellence (NICE) guidelines for osteoarthritis. Design:,Questionnaire survey of chartered physiotherapists. Method:,300 postal questionnaires were distributed to Physiotherapy Departments requesting information regarding source of referrals, treatment aims, preferred methods of treatment and service delivery. Results:,Responses were received from 83 physiotherapists (28 %), predominantly working in the UK National Health Service. Approximately equal numbers of referrals came from primary and secondary care. Aims of physiotherapy management were to; encourage self-management; increase strength and range of movement; reduce pain; and improve function. To achieve these, exercise was utilised by 100% of practitioners, often supplemented with electrotherapeutic modalities (66%), manual therapy (64%) and acupuncture (60%). The majority of patients received individual treatment for a total contact time of 1,2 hours, whilst most group interventions lasted 5,6 hours. Approximately half (54%) of respondents reported using outcome measures to determine treatment efficacy. Conclusions:,Although knee OA is usually managed in primary care, the similar number of referrals from primary and secondary care may suggest a deviation from evidence-based management guidelines. The guidelines' recommendations of exercise, patient education and self-management are observed by physiotherapists, but other modalities are often used despite poor or no research evidence supporting their efficacy. Whether any of these interventions are clinically beneficial is speculative as treatment outcomes were frequently under-evaluated. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Accessibility for parents of weight management information on the Internet

Abstract Objective:, The aim of the present study was to describe the accessibility, quality and readability of web base content on the Internet for childhood obesity management from a parental viewpoint. As more than 25% of Australian children are overweight or obese, it is likely that parents access the Internet for advice on obesity management for their child. Design:, Links to websites were generated using three search engines and three phrases. The first 10 website links were selected from each of nine searches. Ten aspects of obesity management were identified for the analysis of childhood obesity and related websites. The Fry readability graph was used to assess content readability. Data analysis:, The data were analysed using spss Version 10, Minitab and Microsoft Excel 2000. anova was used to compare clinical criteria between website type. Results:, A total of 90 links were generated with 60 relevant for analysis. In total, 30 were specific to childhood obesity and 47 websites were either obesity-specific or weight-related. Childhood obesity websites were community-based or commercial. Most websites relevant to childhood obesity management came at no cost, in comparison with general weight-related sites. Childhood obesity websites scored generally high on accuracy of content. Overall, website readability was at an undergraduate level. Conclusions:, There appears to be a paucity of accessible information on the Internet related to childhood weight management, which parents could access. Childhood obesity management websites should ideally include clinically approved management guidelines and follow e-health codes of ethical practice. [source]

Updates on bisphosphonates and potential pathobiology of bisphosphonate-induced jaw osteonecrosis

ORAL DISEASES, Issue 3 2008
J Sarin
Osteonecrosis of the jaws is a major complication associated with long-term use of bisphosphonates. While osteonecrosis can arise from other precipitating conditions, bisphosphonate-induced jaw osteonecrosis (BJON) is highly associated with long-term administration of pamidronate (Aredia®) and zoledronic acid (Zometa®), which are two intravenous bisphosphonate formulations. The underlying pathogenesis of BJON and its site-specific presentation still remain to be fully elucidated. This review will discuss clinically available bisphosphonates, current opinions, pathogenesis, and management guidelines for bisphosphonate-induced jaw osteonecrosis. [source]