Practical Guidelines (practical + guideline)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Atlas of Neuromuscular Diseases: A Practical Guideline

Richard A. C. Hughes MD

Protein intake, growth and lung function of infants with chronic lung disease

E. Cillié
Background:, The increased survival rate of extremely preterm infants has not improved the incidence or outcome of infants diagnosed with chronic lung disease (CLD) (Riley, 2008). The relationship between optimal nutrition (particularly protein intake) and chronic lung disease has not been established. The aim of this study was to investigate the association between protein intake, growth and lung function in infants with CLD. Methods:, A CLD database, maintained for the past 10 years, was used to select participants that had reached 1 year of corrected age. Infants who were born during 2001,2006 with a birth weight of <1500 g, and who subsequently had a diagnosis of CLD, were included. Infants with evidence of intra-uterine growth restriction and abnormal cerebral pathology were excluded. Demographic, mean weight gain, protein intake and respiratory support data were collected retrospectively from the medical notes. Growth parameters and need for oxygen and inhalers up to 1 year of corrected age were collected from the CLD follow-up database. SPSS, version 15 (SPSS Inc., Chicago, IL, USA) were used for Pearson's or Spearmans correlation analysis and analysis of variance or the Wilcoxon test, as appropriate. Results:, Sixty infants were studied: 25 females and 35 males. The median (range) post-menstrual age at birth was 26 (22,31) weeks. The most common feed was breast milk; fortified breast milk was used for 37% of the total days studied. The mean (SD) protein intake was 2.28 (0.33) g kg,1 day,1 and the mean (SD) weight gain was 11.67 (1.77) g kg,1 day,1. There was a positive correlation between protein intake and weight gain (r = 0.32, P = 0.013), which was stronger in females (r = 0.51, P = 0.009). Protein intake was significantly associated with head circumference growth in females only (r = 0.47, P = 0.038). Protein intake was inversely related to the number of days spent mechanically ventilated (r = ,0.32, P = 0.015). There was no relationship between protein intake and growth at 1 year corrected age, time spent on continuous positive airway pressure, age weaned off oxygen, or the use of inhalers. There was an inverse correlation between total weeks of oxygen dependence and head circumference at 1 year (r = ,0.35, P = 0.022). Discussion:, The mean protein intake was <3 g kg,1 day,1, which is the minimum requirement for preterm infants (Tsang et al., 2005). This was associated with a sub-optimal weight gain in our participants of <15 g kg,1 day,1 (Steward & Pridham, 2002). The study demonstrates the known association between low protein intake and poor growth with ventilator dependence (Loui et al., 2008). Conclusions:, Low birth weight and low gestational age infants at risk of CLD should receive special attention to optimise their protein intake because sub-optimal protein intake potentially leads to poor growth when on a neonatal intensive care unit. References Loui, A., Tsalikaki, E., Maier, K., Walch, E., Kamarianakis, Y. & Obladen, M. (2008) Growth in high risk infants <1500 g birth weight during the first 5 weeks. Early Hum. Dev. 84, 645,650, Doi: 10.1016/j.earlhumdev.2008.04.005. Riley, K., Roth, S., Sellwood, M. & Wyatt, J.S. (2008) Survival and neurodevelopmental morbidity at 1 year of age following extremely preterm delivery over a 20-year period: a single centre cohort study. Acta Paediatr.97, 159,165. Steward, D.K. & Pridham, K.F. (2002) Growth patterns of extremely low-birth-weight hospitalised preterm infants. JOGN Nurs31, 57,65. Tsang, R.C., Uauy, R., Koletzko, B. & Zlotkin, S.H., eds. (2005) Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. Cincinnati: Digital Educational Publishing. [source]

Distribution of Aggregate Utility Using Stochastic Elements of Additive Multiattribute Utility Models

Herbert Moskowitz
ABSTRACT Conventionally, elements of a multiattribute utility model characterizing a decision maker's preferences, such as attribute weights and attribute utilities, are treated as deterministic, which may be unrealistic because assessment of such elements can be imprecise and erroneous, or differ among a group of individuals. Moreover, attempting to make precise assessments can be time consuming and cognitively demanding. We propose to treat such elements as stochastic variables to account for inconsistency and imprecision in such assessments. Under these assumptions, we develop procedures for computing the probability distribution of aggregate utility for an additive multiattribute utility function (MAUF), based on the Edgeworth expansion. When the distributions of aggregate utility for all alternatives in a decision problem are known, stochastic dominance can then be invoked to filter inferior alternatives. We show that, under certain mild conditions, the aggregate utility distribution approaches normality as the number of attributes increases. Thus, only a few terms from the Edgeworth expansion with a standard normal density as the base function will be sufficient for approximating an aggregate utility distribution in practice. Moreover, the more symmetric the attribute utility distributions, the fewer the attributes to achieve normality. The Edgeworth expansion thus can provide a basis for a computationally viable approach for representing an aggregate utility distribution with imprecisely specified attribute weights and utilities assessments (or differing weights and utilities across individuals). Practical guidelines for using the Edgeworth approximation are given. The proposed methodology is illustrated using a vendor selection problem. [source]

Diabetes management in the new millennium using insulin pump therapy

Bruce W. Bode
Abstract Current goals of therapy of type 1 and 2 diabetes are to achieve near normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain, improve quality of life and delay or prevent late vascular complications. As discussed in this review, insulin pump or continuous subcutaneous insulin infusion (CSII) therapy provides a treatment option that can dramatically aid in achieving all of these goals. In comparison to multiple daily injections (MDI), CSII uses only rapid-acting insulin, provides greater flexibility in timing of meals and snacks, has programmable basal rates to optimize overnight glycemic control, can reduce the risk of exercise-induced hypoglycemia, and enhances patients' ability to control their own diabetes. Most important, in adults and adolescents with type 1 diabetes, CSII has been shown to lower HbA1c levels, reduce the frequency of severe hypoglycemia and limit excessive weight gain versus MDI without increasing the risk of diabetic ketoacidosis. Similarly positive results are being seen with CSII in adults with type 2 diabetes. The effectiveness of CSII and improvements in pump technology have fueled a dramatic increase in the use of this therapy. Practical guidelines are presented for selection of patients, initiation of treatment, patient education, follow-up assessments and troubleshooting. The recent introduction of methods for continuous glucose monitoring provides a new means to optimize the basal and bolus capabilities of CSII and offers the hope of the development of a feedback-controlled artificial pancreas. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Practical guidelines for treating inflammatory bowel disease safely with anti-tumour necrosis factor therapy in Australia

W. Connell
Abstract Anti-tumour necrosis factor (TNF) therapy is an effective but expensive option for treating inflammatory bowel disease (IBD). Its use is generally reserved for patients with severe refractory disease, often involving long-term administration. Anti-TNF therapy has the potential to be associated with various adverse effects, such as infection, malignancy and immunogenicity. Clinicians and patients should be familiar with these possibilities and adopt appropriate precautions prior to and during treatment to minimize risk. Guidelines have been developed for Australian prescribers intending to use anti-TNF therapy in IBD by a Working Party commissioned by IBD-Australia, a Special Interest Group affiliated with the Gastroenterology Society of Australia. [source]

Predictors and Effects of Training on an Online Health Education and Support System for Women with Breast Cancer

Helene McDowell
Many breast cancer patients currently turn to Internet-based education and support to help them cope with their illness. This study explores the role of training in influencing how patients use a particular Interactive Cancer Communication System (ICCS) over time and also examines what pre-test characteristics predict which people are most likely to opt in or out of training in the first place. With use of pre-test survey and unobtrusive individual records of ICCS system use data (N = 216), nonparametric tests revealed that only having a later stage of cancer predicted whether or not patients participated in training. Results indicated that participating in training was a significant predictor of higher levels of using the CHESS system. In particular, the repeated measures analysis of covariance found the significant interaction as well as main effect of group (i.e., training vs. no training) and time (i.e., individual's CHESS usages at different times) in interactive and information CHESS services, suggesting that 1) the training group has a higher level of usage than the no training group, 2) both of the groups' usage decreased over time, and 3) these joint patterns hold over time. Practical guidelines for future ICCS campaign implementation are discussed. [source]

Practical guidelines for the management of interferon-,-2b side effects in patients receiving adjuvant treatment for melanoma

CANCER, Issue 5 2008
Expert opinion
Abstract Interferon-,-2b (IFN,2b) is the only effective adjuvant therapy for melanoma patients at high risk of recurrence that has been approved by regulatory authorities worldwide. However, IFN toxicities increase the risk of poor treatment compliance and impair the potential for benefit from this agent. A review of the literature demonstrated little recent attention to supportive care in the management of IFN toxicities. An international group of experts with extensive personal experience in the use of IFNs worked together to develop practical guidelines for the use of IFNs. Practical recommendations were developed for patient education on the use of IFN; initial patient assessment and monitoring, including contraindications to the use of IFN, monitoring and managing adverse events, and IFN dose modification and discontinuation; IFN injection procedures; treatment of elderly patients; and use during pregnancy and nursing. Successful adjuvant therapy of melanoma with high-dose IFN requires close compliance with the treatment regimen. Recommendations for the recognition and management of adverse events are designed to enable more patients to complete the full planned course of treatment. Cancer 2008. © 2008 American Cancer Society. [source]

The management of heparin-induced thrombocytopenia

David Keeling
Abstract The Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology has produced a concise practical guideline to highlight the key issues in the management of heparin-induced thrombocytopenia (HIT) for the practicing physician in the UK. The guideline is evidence-based and levels of evidence are included in the body of the article. All patients who are to receive heparin of any sort should have a platelet count on the day of starting treatment. For patients who have been exposed to heparin in the last 100 d, a baseline platelet count and a platelet count 24 h after starting heparin should be obtained. For all patients receiving unfractionated heparin (UFH), alternate day platelet counts should be performed from days 4 to 14. For surgical and medical patients receiving low-molecular-weight heparin (LMWH) platelet counts should be performed every 2,4 d from days 4 to 14. Obstetric patients receiving treatment doses of LMWH should have platelet counts performed every 2,4 d from days 4 to 14. Obstetric patients receiving prophylactic LMWH are at low risk and do not need routine platelet monitoring. If the platelet count falls by 50% or more, or falls below the laboratory normal range and/or the patient develops new thrombosis or skin allergy between days 4 and 14 of heparin administration HIT should be considered and a clinical assessment made. If the pretest probability of HIT is high, heparin should be stopped and an alternative anticoagulant started at full dosage unless there are significant contraindications while laboratory tests are performed. Platelet activation assays using washed platelets have a higher sensitivity than platelet aggregation assays but are technically demanding and their use should be restricted to laboratories experienced in the technique. Non-expert laboratories should use an antigen-based assay of high sensitivity. Only IgG class antibodies need to be measured. Useful information is gained by reporting the actual optical density, inhibition by high concentrations of heparin, and the cut-off value for a positive test rather than simply reporting the test as positive or negative. In making a diagnosis of HIT the clinician's estimate of the pretest probability of HIT together with the type of assay used and its quantitative result (enzyme-linked immunosorbent assay, ELISA, only) should be used to determine the overall probability of HIT. Clinical decisions should be made following consideration of the risks and benefits of treatment with an alternative anticoagulant. For patients with strongly suspected or confirmed HIT, heparin should be stopped and full-dose anticoagulation with an alternative, such as lepirudin or danaparoid, commenced (in the absence of a significant contraindication). Warfarin should not be used until the platelet count has recovered. When introduced in combination with warfarin, an alternative anticoagulant must be continued until the International Normalised Ratio (INR) is therapeutic for two consecutive days. Platelets should not be given for prophylaxis. Lepirudin, at doses adjusted to achieve an activated partial thromboplastin time (APTT) ratio of 1·5,2·5, reduces the risk of reaching the composite endpoint of limb amputation, death or new thrombosis in patients with HIT and HIT with thrombosis (HITT). The risk of major haemorrhage is directly related to the APTT ratio, lepirudin levels and serum creatinine levels. The patient's renal function needs to be taken into careful consideration before treatment with lepirudin is commenced. Severe anaphylaxis occurs rarely in recipients of lepirudin and is more common in previously exposed patients. Danaparoid in a high-dose regimen is equivalent to lepirudin in the treatment of HIT and HITT. Danaparoid at prophylactic doses is not recommended for the treatment of HIT or HITT. Patients with previous HIT who are antibody negative (usually so after >100 d) who require cardiac surgery should receive intraoperative UFH in preference to other anticoagulants that are less validated for this purpose. Pre- and postoperative anticoagulation should be with an anticoagulant other than UFH or LMWH. Patients with recent or active HIT should have the need for surgery reviewed and delayed until the patient is antibody negative if possible. They should then proceed as above. If deemed appropriate early surgery should be carried out with an alternative anticoagulant. We recommend discussion of these complex cases requiring surgery with an experienced centre. The diagnosis must be clearly recorded in the patient's medical record. [source]

State of Research in High-consequence Hospital Surge Capacity

Carl H. Schultz MD
High-consequence surge research involves a systems approach that includes elements such as healthcare facilities, out-of-hospital systems, mortuary services, public health, and sheltering. This article focuses on one aspect of this research, hospital surge capacity, and discusses a definition for such capacity, its components, and future considerations. While conceptual definitions of surge capacity exist, evidence-based practical guidelines for hospitals require enhancement. The Health Resources and Services Administration's (HRSA) definition and benchmarks are extrapolated from those of other countries and rely mainly on trauma data. The most significant part of the HRSA target, the need to care for 500 victims stricken with an infectious disease per one million population in 24 hours, was not developed using a biological model. If HRSA's recommendation is applied to a sample metropolitan area such as Orange County, California, this translates to a goal of expanding hospital capacity by 20%,25% in the first 24 hours. Literature supporting this target is largely consensus based or anecdotal. There are no current objective measures defining hospital surge capacity. The literature identifying the components of surge capacity is fairly consistent and lists them as personnel, supplies and equipment, facilities, and a management system. Studies identifying strategies for hospitals to enhance these components and estimates of how long it will take are lacking. One system for augmenting hospital staff, the Emergency System for Advance Registration of Volunteer Health Professionals, is a consensus-derived plan that has never been tested. Future challenges include developing strategies to handle the two different types of high-consequence surge events: 1) a focal, time-limited event (such as an earthquake) where outside resources exist and can be mobilized to assist those in need and 2) a widespread, prolonged event (such as pandemic influenza) where all resources will be in use and rationing or triage is needed. [source]

Schizophrenia and physical health problems

Y. Von Hausswolff-Juhlin
Objective:, To estimate the prevalence of physical health problems in patients with schizophrenia, and to appraise the impact on mortality rates and quality of life (QoL) in such patients. Method:, A selective review of clinical articles relating to physical health such as cardiovascular disease, metabolic syndrome and QoL. In addition, current guidelines and recommendations for the monitoring of physical health in schizophrenia were reviewed. Results:, Cardiovascular events contribute most strongly to the excess mortality observed in schizophrenia. Other factors that contribute significantly include obesity, metabolic aberrations, smoking, alcohol, lack of exercise and poor diet , all of which might be targets for health promoting activities. Conclusion:, Physical health problems in patients with schizophrenia are common, and contribute to the excess mortality rate, as well as decreasing QoL. Many adverse physical factors are malleable in such patients, and physical benefit may be gained by following practical guidelines for their monitoring and improvement. [source]

Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?

A critique of diabetes CPGs
Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source]

VegTrack: A structured vegetation restoration activity database

Andre Zerger
Summary, Information about on-ground vegetation restoration activities (e.g. fencing and revegetation) is critical if natural resource management (NRM) groups are to monitor progress towards restoration targets, assess the efficacy of their interventions and adaptively learn from different actions. However, in Australia, there are few practical guidelines for recording data, making it difficult to consistently compare actions between sites and through time. Records of primary information are particularly important given the ongoing national investment in vegetation restoration activities. With the aid of six-case study areas in different landscapes, robust guidelines and tools were developed and incorporated into VegTrack, a methodology, which allows groups to develop their own vegetation restoration activity database. VegTrack differentiates spatial data from attribute data storing each in different databases (a GIS and a relational database management system respectively). We describe the process which enables NRM groups to develop their own database, and provide a Microsoft Access 2003 version of VegTrack to allow NRM groups to commence activity recording. To demonstrate the utility of the VegTrack method in different situations and to encourage consistency across study areas, we describe the application of the guidelines for several scenarios including riparian revegetation, corridors disrupted by roads and infill plantings. [source]

Learning to Manage the University: Tales of Training and Experience

Rachel Johnson
The paper draws on interviews with ,manager-academics' (Pro-Vice Chancellors, Deputy Vice Chancellors and Heads of Department) in UK universities to examine their views on their preparation, training and support for their roles. Following a brief description of the ESRC-funded study, the paper describes manager-academics' reported career trajectories, motivations and initial experiences, and the training they received: their views both of training and of less formal learning are ambivalent and often hesitant. However, the interviews reveal processes and contexts that manager-academics consider beneficial to their own learning and development, and this analysis suggests both theoretical understanding and practical guidelines. Manager-academics' learning occurs through engagement in practice and through social interaction, and is context-specific. Institutions can foster learning and good management by acknowledging these characteristics and promoting opportunities for self-critical reflection, peer feedback and collective articulation and sharing of experience. [source]

Research to practice: Effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment,critical appraisal and meta-analysis

Setenay Tuncel
Previous studies on the effectiveness of interventions in reducing musculoskeletal disorders (MSD) in manufacturing facilities had contradictory results, indicating a need for a quality assessment of these studies followed by a quantitative assessment of the overall effectiveness of the interventions. These assessments may also provide suggestions for practical implementations. The first objective of this study is to assess the effectiveness of controlled workplace interventions to reduce the occurrence of MSD in the manufacturing environment by utilizing meta-analysis integrated with the study quality score. The second objective is to translate the research findings into practical guidelines. Two hypotheses were tested pertinent to the first objective: (1) Controlled workplace interventions are effective in reducing the occurrence of MSD in different body regions among manufacturing workers and (2) the study quality scores do not depend on the evaluator. The study quality was assessed for all articles, however, meta effect size (meta-OR) was calculated only for the articles that reported prevalence of low back disorders (LBDs), using the Mantel,Haenszel method. The effect of study quality was included into meta-OR. The chi-square test of independence was employed to test the second hypothesis. Seven articles were identified. Study quality was poor (0.39 out of 2) to moderate (0.97). Insignificant reduction in LBDs prevalence (meta-OR = 0.925; 95% CI: 0.566,1.512) was found. Integration of the study quality did not have a substantial effect on the meta-OR (meta-OR = 0.933; 95% CI: 0.571,1.525). Each evaluator's study quality scores were not independent from the agreed quality scores (p < 0.01). The results suggested that practitioners should consider scientific evidence during design and implementation of an intervention, especially in terms of study duration, confounders, outcome measures, and data analysis. The articles reviewed exhibited the following: (1) the statistical insignificance of the meta-OR; (2) the relatively low methodological quality of studies; and (3) the small number of studies included in the meta-OR. The extent of the generalizability of meta-OR for LBD to other body regions was also in question. Future research should consider the following: (1) the physical and nonphysical work environment should be assessed to determine the workplace-specific needs, and the intervention should be structured around these needs; (2) group comparability, participation rate, subject loss, and randomization of subjects should be taken into account; (3) exposure and outcome measurement methods should be reported, as well as blinding of the observers and subjects, when applicable, to ensure reliability and validity; and (4) data analysis should be conducted adjusting for covariates and confounders, different lengths of follow-up, and level of exposure. © 2008 Wiley Periodicals, Inc. [source]

The Assessment of Basic Learning Abilities Test for Persons with Intellectual Disability: A Valuable Clinical Tool

Tricia Vause
The Assessment of Basic Learning Abilities (ABLA) test requires a tester to attempt to teach to a person, using standard prompting and reinforcement procedures, six tasks that are hierarchically ordered in difficulty. Performance on the test provides valuable information for teachers and rehabilitation workers to match the difficulty of training tasks with the learning ability of persons with profound, severe and moderate intellectual disabilities. This paper summarizes the characteristics of the test, outlines the testing procedures, and reviews supporting data and practical guidelines for clinicians. [source]

Skin biopsy for inflammatory and common neoplastic skin diseases: optimum time, best location and preferred techniques.

A critical review
The diagnosis of skin diseases, particularly inflammatory dermatoses, is based primarily on clinical information. Pathologic examination of the biopsied specimen often serves as a complementary or confirmative part of the diagnosis. However, the clinical diagnosis of skin diseases may be challenging, as the clinical information and appearance of skin lesions invariably overlap. Evidence for a correct diagnosis may be lacking without histopathologic examination of skin biopsies. It is well known that the histologic diagnosis of inflammatory and other skin diseases requires clinicopathologic correlation, and there is evolution of skin lesions into different stages as the diseases progress. Other factors important for accurate dermatopathologic diagnosis are optimum time, best location and preferred techniques of skin biopsy. In searching for available information concerning when, where and how to take skin biopsies, it is noted that there are only limited practical guidelines currently available. We present this review article in hopes that our collective dermatopathologic and dermatologic experience can provide a quick reference for accurate diagnosis and proper management of skin diseases. [source]

Lessons learned by participants of distributed software development

Seija Komi-Sirviö
The maturation of the technical infrastructure has enabled the emergence and growth of distributed software development. This has created tempting opportunities for companies to distribute their software development, for example, to economically favourable countries so as to gain needed expertise or to get closer to customers. Nonetheless, such distribution potentially creates problems that need to be understood and addressed in order to make possible the gains offered. To clarify and understand the most difficult problems and their nature, a survey of individuals engaged in distributed software development was conducted. The purpose of this survey was to gather and share lessons learned in order to better understand the nature of the software development process when operating in a distributed software development environment and the problems that may be associated with such distributed processes. Through a clear appreciation of the risks associated with distributed development it becomes possible to develop approaches for the mitigation of these risks. This paper presents the results of the survey, focusing on the most serious problems raised by the respondents. Some practical guidelines that have been developed by industry to overcome these problems are also briefly summarized. Copyright © 2005 John Wiley & Sons, Ltd. [source]

GINA guidelines on asthma and beyond,

ALLERGY, Issue 2 2007
J. Bousquet
,Clinical guidelines are systematically developed statements designed to help practitioners and patients make decisions regarding the appropriate health care for specific circumstances. Guidelines are based on the scientific evidence on therapeutic interventions. The first asthma guidelines were published in the mid 1980s when asthma became a recognized public health problem in many countries. The Global Initiative on Asthma (GINA) was launched in 1995 as a collaborative effort between the NHLBI and the World Health Organization (WHO). The first edition was opinion-based but updates were evidence-based. A new update of the GINA guidelines was recently available and it is based on the control of the disease. Asthma guidelines are prepared to stimulate the implementation of practical guidelines in order to reduce the global burden of asthma. Although asthma guidelines may not be perfect, they appear to be the best vehicle available to assist primary care physicians and patients to receive the best possible care of asthma. [source]

Designing and conducting grief workshops for college students

Craig J. Vickio
This chapter offers practical guidelines for conducting grief workshops on college campuses. [source]

Dietary Therapy in Idiopathic Nephrolithiasis

Loris Borghi MD
Like other diseases striking predominantly the affluent societies, idiopathic nephrolithiasis is increasing in rich countries and appears to be closely related to dietary habits. In this review we summarize the latest evidence about the efficacy of dietary treatment for idiopathic calcium and uric acid stones, dealing especially with its effect on the urinary stone risk factors, stone recurrences, and clinical limitations. After a short introduction on epidemiology and pathogene-sis, we review the role of the most important foods and nutrients in stone formation and protection: water and other fluids, proteins, carbohydrates, fats, salt, milk and dairy products, fruits and vegetables, and vitamins. The final part of the paper will provide practical guidelines for pursuing an anti-lithogenic diet in idiopathic calcium and uric acid stones. [source]

Enforcing Emissions Trading Programs

Performance, Practice, Theory
Combining an analysis of the compliance incentives faced by firms in an emissions trading program, a comprehensive review of the enforcement strategies employed in Sulfur Dioxide Allowance and the Regional Clean Air Incentives Market (RECLAIM) programs, and a review of the compliance performance of these programs thus far, we are able to propose several practical guidelines for enforcing emissions trading programs. We stress the importance of prevailing market prices for emissions permits in determining compliance incentives, the importance of accurately measuring firms' emissions, and the importance of implementing enforcement strategies that remove the incentives firms may have to falsify emissions reports. [source]

Control of polyaniline conductivity and contact angles by partial protonation

Natalia V Blinova
Abstract Many studies require a specific value of conductivity when investigating conducting polymers. The conductivity of polyaniline can efficiently be controlled by partial protonation of the polyaniline base. Although this is a simple task in principle, practical guidelines are missing. In the present study, the changes in the conductivity of polyaniline base after immersion in aqueous solutions of various acids are reported. Polyaniline base has been reprotonated in aqueous solutions of picric, camphorsulfonic and phosphoric acids. The conductivity of partially reprotonated polyaniline varied between 10,9 and 100 S cm,1. The relation between the pH of a phosphoric acid solution, which was in equilibrium with polyaniline, and the conductivity , is pH = 0.77 , 0.64 log(, [S cm,1]). The wettability, i.e. water contact angles, can similarly be set by partial protonation to between 78° for polyaniline base and 44° for polyaniline reprotonated in 1 mol L,1 phosphoric acid. In solutions of picric acid, the transition from the non-conducting to the conducting state occurs over a narrow range of acid concentrations, and the tuning of conductivity is consequently difficult. Phosphoric acid is well suited for the control of conductivity of polyaniline because of the moderate dependence of the conductivity on the acid concentration or pH. Copyright © 2007 Society of Chemical Industry [source]

Definition of hospital-acquired pneumonia and characteristics of guidelines in Japan

Article first published online: 19 OCT 200
SUMMARY ,,Hospital-acquired pneumonia is defined as pneumonia that appears for the first time within 48 h of hospital admission. Special care is needed in treatment because of poor patient conditions, including the underlying disorder, immunocompetence and general status. ,,The 2002 hospital-acquired pneumonia guidelines were reviewed, and the current revisions were made based on those findings with the aim of producing simple and practical guidelines. ,,Differences are seen between hospital-acquired pneumonia in the USA and Japan, and hospital-acquired pneumonia treatment guidelines matched to circumstances in Japan were considered necessary. [source]

Breast Cancer in Reduction Mammaplasty Specimens: Case Reports and Guidelines

Angela J. Keleher MD
Abstract: Increasing numbers of women of all ages are electing to have reduction mammaplasty for very large breasts. Breast cancer can be an incidental finding in reduction mammaplasty specimens. We report here the discovery of breast cancer in specimens from four patients who underwent elective breast reduction, three of whom had not had recent mammograms. All four patients underwent modified radical mastectomy. The role of mammography, surgical options, specimen evaluation, and practical guidelines are discussed., [source]

Reducing Ongoing Product Design Decision-Making Bias,

Michael Antioco
The objective of this exploratory study is to add to our understanding of ongoing product design decision-making to reduce eventual decision-making bias. Six research questions are formulated with the aim to establish if and how functional membership and informal patterns of communication within an organization influence whether and why employees are willing to engage in product design modifications. We selected as a field site for our study an industrial company that had an internal research and product development operations and where the employees were located on the same site. A three-step approach within the manufacturing case company was designed: (1) In-depth interviews were carried out with managers and employees; (2) a survey questionnaire was sent out to all employees involved with a specific product that is subject to potential design modifications; and (3) a post hoc group feedback session was organized to further discuss our findings with the management. First, analysis of the nine in-depth interviews establishes a taxonomy of product design decisions involving four types of criteria; product-related, service-related, market-related, and feasibility-related criteria explain why employees would engage or not in product design modifications. Second, it is demonstrated that functional membership has a significant influence on the concern for these decision-making criteria as well as on the decision to proceed or not with product design modifications. In other words, functional membership influences whether and why employees are more or less willing to make product design modifications. In this manufacturing company, a global industrial player, the differences in concern appear especially for service- and market-related criteria and pertain particularly to the research and development (R&D) and service function. Overall, even though the perceived performance of the specific product under study did not differ significantly among the different departments, it is observed that R&D employees were significantly less in favor of proceeding with product design modifications than other employees were. Third, using UCINET VI software, we provide some explanations for this finding. It is shown that informal patterns of communication (i.e., employee degree centrality) operate a situational opportunity to make modifications to an existing product and a cognitive opportunity influencing the decision to modify product design following an inverted U-shaped function. Ultimately, we derive practical guidelines for an ideal product,team composition to reduce product design decision-making bias. [source]

Emotional Intelligence in the Workplace: A Critical Review

Moshe Zeidner
Cet article est une revue critique des théories et résultats empiriques favorables à l'intelligence émotionelle (I.E.) et à son prétendu rôle dans l'environnement professionnel. On s'intéresse au statut supposé de l'I.E. dans la performance au travail, la satisfaction et l'évaluation de la carrière et des compétences (surtout dans la domaine de la sélection et de l'orientation). Globalement, cette revue de questions prouve que les recherches récentes ont fait de grands pas dans la comprehénsion de l'utilité de l'I.E. au travail. Les preuves strictement scientifiques sont cependant insuffisantes, la littérature accordant une confiance excessive aux avis d'experts, aux anecdotes, aux études de cas et aux enquêtes privées non publiées. On propose, à la fin de l'article, quelques directives pratiques pour favoriser le développement et l'utilisation de mesures de l'I.E. dans les situations professionnelles. This paper critically reviews conceptualisations and empirical evidence in support of emotional intelligence (EI) and its claimed role in the occupational environment. Consideration is given to the purported status of EI in occupational and career assessment (with particular emphasis on personnel selection and placement), job performance, and satisfaction. Overall, this review demonstrates that recent research has made important strides towards understanding the usefulness of EI in the workplace. However, the ratio of hyperbole to hard evidence is high, with over-reliance in the literature on expert opinion, anecdote, case studies, and unpublished proprietary surveys. The review concludes by providing a number of practical guidelines for the development and implementation of EI measures within occupational settings. [source]

Effects of impurities on membrane-protein crystallization in different systems

Christopher A. Kors
When starting a protein-crystallization project, scientists are faced with several unknowns. Amongst them are these questions: (i) is the purity of the starting material sufficient? and (ii) which type of crystallization experiment is the most promising to conduct? The difficulty in purifying active membrane-protein samples for crystallization trials and the high costs associated with producing such samples require an extremely pragmatic approach. Additionally, practical guidelines are needed to increase the efficiency of membrane-protein crystallization. In order to address these conundrums, the effects of commonly encountered impurities on various membrane-protein crystallization regimes have been investigated and it was found that the lipidic cubic phase (LCP) based crystallization methodology is more robust than crystallization in detergent environments using vapor diffusion or microbatch approaches in its ability to tolerate contamination in the forms of protein, lipid or other general membrane components. LCP-based crystallizations produced crystals of the photosynthetic reaction center (RC) of Rhodobacter sphaeroides from samples with substantial levels of residual impurities. Crystals were obtained with protein contamination levels of up to 50% and the addition of lipid material and membrane fragments to pure samples of RC had little effect on the number or on the quality of crystals obtained in LCP-based crystallization screens. If generally applicable, this tolerance for impurities may avoid the need for samples of ultrahigh purity when undertaking initial crystallization screening trials to determine preliminary crystallization conditions that can be optimized for a given target protein. [source]

Fauna habitat modelling and mapping: A review and case study in the Lower Hunter Central Coast region of NSW

Abstract Habitat models are now broadly used in conservation planning on public lands. If implemented correctly, habitat modelling is a transparent and repeatable technique for describing and mapping biodiversity values, and its application in peri-urban and agricultural landscape planning is likely to expand rapidly. Conservation planning in such landscapes must be robust to the scrutiny that arises when biodiversity constraints are placed on developers and private landholders. A standardized modelling and model evaluation method based on widely accepted techniques will improve the robustness of conservation plans. We review current habitat modelling and model evaluation methods and provide a habitat modelling case study in the New South Wales central coast region that we hope will serve as a methodological template for conservation planners. We make recommendations on modelling methods that are appropriate when presence-absence and presence-only survey data are available and provide methodological details and a website with data and training material for modellers. Our aim is to provide practical guidelines that preserve methodological rigour and result in defendable habitat models and maps. The case study was undertaken in a rapidly developing area with substantial biodiversity values under urbanization pressure. Habitat maps for seven priority fauna species were developed using logistic regression models of species-habitat relationships and a bootstrapping methodology was used to evaluate model predictions. The modelled species were the koala, tiger quoll, squirrel glider, yellow-bellied glider, masked owl, powerful owl and sooty owl. Models ranked sites adequately in terms of habitat suitability and provided predictions of sufficient reliability for the purpose of identifying preliminary conservation priority areas. However, they are subject to multiple uncertainties and should not be viewed as a completely accurate representation of the distribution of species habitat. We recommend the use of model prediction in an adaptive framework whereby models are iteratively updated and refined as new data become available. [source]

Engaging with Aboriginal communities in an urban context: some practical suggestions for public health researchers

Priscilla Pyett
Objective: In this paper, one Indigenous and two non-Indigenous public health researchers reflect on our combined experience of over thirty years in Aboriginal health, in order to develop some practical guidelines, particularly for researchers working with urban Indigenous population groups. Approach: Public health research is important not only to address the health inequities experienced by Australia's Indigenous populations, but also to build knowledge and confidence and to inform practice in Aboriginal community-controlled health organisations. Ethical guidelines and previous research experience demonstrate that researchers need to engage with the communities that may be involved in or affected by the research they propose. Although more than half of Australia's Aboriginal and Torres Strait Islander population live in urban and regional centres, most research and commentaries address the health and social issues of remote communities. Researchers often do not know how to engage with urban Aboriginal communities and how to approach the particular research challenges within this context. Conclusion and Implications: The practical guidelines suggested in this paper may assist public health researchers to conduct ethical health research that is planned and carried out in a culturally appropriate way and that will benefit urban Aboriginal people. While not intended to be prescriptive, we believe that the lessons learned in Victoria will be applicable to other urban Indigenous contexts around Australia. [source]

Emergency Medicine in the Developing World: A Delphi Study

Peter W. Hodkinson MPhil(EM)
ACADEMIC EMERGENCY MEDICINE 2010; 17:765,774 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Emergency medicine (EM) as a specialty has developed rapidly in the western world, but remains largely immature in developing nations. There is an urgent need for emergency services, but no clear guidelines are available on the priorities for establishing EM in the developing world. This study seeks to establish consensus on key areas of EM development in developing world settings, with respect to scope of EM, staffing needs, training requirements, and research priorities. Methods:, A three-round Delphi study was conducted via e-mail. A panel was convened of 50 EM specialists or equivalent, with experience in or interest in EM in the developing world. In the first round, panelists provided free-text statements on scope, staffing, training, and research priorities for EM in the developing world. A five-point Likert scale was used to rate agreement with the statements in Rounds 2 and 3. Consensus statements are presented as a series of synopsis statements for each of the four major themes. Results:, A total of 168 of 208 statements (81%) had reached consensus at the end of the study. Key areas in which consensus was reached included EM being a specialist-driven service, with substantial role for nonphysicians. International training courses should be adapted to local needs. EM research in developing countries should be clinically driven and focus on local issues of importance. Conclusions:, The scope and function of EM and relationships with other specialties are defined. Unambiguous principles are laid out for the development of the specialty in developing world environments. The next step required in this process is translation into practical guidelines for the development of EM in developing world settings where they may be used to drive policy, protocols, and research. [source]