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Local Circumstances (local + circumstance)
Selected AbstractsGuidelines for treatment of neonatal jaundice.ACTA PAEDIATRICA, Issue 3 2001Is there a place for evidence-based medicine? Treatment of neonatal jaundice continues to be a controversial issue. Arguments that traditional practice results in over-treatment have led to the adoption of more liberal guidelines in some countries. The importation of liberal guidelines from one country to the next, however, is fraught with danger, because differences in epidemiology, sociology and healthcare delivery systems between countries may not be adequately reflected. The unreflected extension of liberalization to non-target groups of patients can expose the latter to significant risk. It is not clear that the evidence on which guidelines for treatment of neonatal jaundice are based satisfy the requirements for evidence-based medicine. Evidence of adequate quality may be hard to obtain. Conclusions: Introduction of more liberal guidelines for the treatment of neonatal jaundice, if at all contemplated, must be adapted to local circumstances, and any available evidence pertaining to local epidemiology, sociology and healthcare organization has to be carefully weighed and incorporated. The time is ripe for a joint international effort to secure adequate funding for basic and applied research within the mechanisms of bilirubin encephalopathy in the newborn. [source] Prudential Regulation of Banks in Less Developed EconomiesDEVELOPMENT POLICY REVIEW, Issue 3 2002S. Mansoob Murshed This article argues that developing countries face inherent obstacles in setting up efficient financial regulation, and building up a sound banking sector: the presence of multiple tasks and multiple principals, poor institutions, lack of economies of scale in the banking sector as well as regulatory supervision, and the lack of reputation. Developing countries need a regulatory framework that rewards prudent risk-taking, but punishes misconduct. This is likely to involve a combination of input-based measures impacting on bankers' incentives, with a few direct controls on the output of the sector. The article concludes with a list of policy options whose appropriateness is judged by their ,friendliness' with local circumstances. [source] Role of meta-analysis of clinical trials for Alzheimer's diseaseDRUG DEVELOPMENT RESEARCH, Issue 3 2002Jesús M. López Arrieta Abstract Alzheimer's disease (AD) is a growing worldwide medical, social, and economic problem. In all countries, both prevalence and incidence of this disorder increase with age. The task of translating scientific clinical research into effective interventions for dementia has proved to be a difficult challenge. Data about the effects of therapeutic interventions come from several sources of evidence, ranging from studies with little potential for systematic bias and minimal random error, such as well-designed randomized controlled trials, through controlled but nonrandomized cohort and case-control studies, all the way to opinions based on laboratory evidence or theory. Although clinical trials are widespread in AD, there is increasing recognition that the results of studies do not necessarily apply to the type of patients that are seen by clinicians because of differences in patient characteristics, comorbidities, cotherapies, severity of disease, compliance, local circumstances, and patients preferences, which may differ sufficiently from those in the trial situation to attenuate or change the benefit-to-risk ratio. There are several methods to address those issues, like pragmatic trials and n-of-1 trials. When data from randomized clinical trials do not provide clear answers from sufficiently similar studies in the magnitude of effect sizes, lack of statistical significance, or identification of subgroups, systematic reviews and meta-analysis may help to provide a better summary of the data. A major difference between a traditional review and a systematic is the systematic nature in which studies are chosen and appraised. Traditional reviews are written by experts in the field who use differing and often subjective criteria to decide what studies to include and what weight to give them, and hence the conclusions are often very diverse, depending on the reviewer. Publication and selection bias is a major concern of traditional reviews. Systematic reviews and meta-analysis are being increasingly used in dementia, propelled by the Cochrane Dementia and Cognitive Improvement Group, to make decisions about treatment, management, and care and to guide future research. This narrative review describes the rationale for randomized clinical trials and systematic reviews in dementia, particularly AD. Drug Dev. Res. 56:401,411, 2002. © 2002 Wiley-Liss, Inc. [source] Hybrid Branch Plants: Japanese Lean Production in Poland's Automobile IndustryECONOMIC GEOGRAPHY, Issue 3 2008Tomasz Majek Abstract This article examines hybrid branch plants created by an interaction of the routines and conventions of the parent company with those of local institutions. We argue that hybridization is a search for an appropriate mix of practices that ensure viability in local circumstances, rather than necessarily the transfer of established "best" (parent-company) practices. Conceptually, hybridization is interpreted as learning-based (and bargaining) processes that are inherent in the evolution (internationalization) of firms in which alternative trajectories are possible. Empirically, the article examines the recent transfer of lean production to Poland's automobile industry and comparatively and qualitatively analyzes four hybrid branch plants in terms of six dimensions of shop-floor and factory management. Given the explosion of Japanese foreign direct investment in recent decades, its competitive strengths, and the importance that Japanese firms attach to learning processes, lean production is an important case study for hybridization. The four cases illustrate different types of hybrid behavior with different consequences for corporate and local performance. [source] The provincial social survey in Edwardian BritainHISTORICAL RESEARCH, Issue 187 2002Mark Freeman This article examines three social surveys carried out in English provincial towns after Seebohm Rowntree's study of York and before A. L. Bowley's sample surveys of five towns. The authors emphasized specific local circumstances and suggested local voluntary and municipal remedies for the social problems they described. Their focus was on the community, and although informed by the discourses of ,national efficiency' that also lay behind Rowntree's researches, the solutions to the problems of juvenile life and casual labour that compromised national efficiency were to be found in local endeavour. Poverty was viewed in the context of its impact on the community rather than on the individual. [source] Harnessing experience: exploring the gap between evidence-based medicine and clinical practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2008M. Cameron Hay PhD Abstract Rationale, aims and objectives, There is mounting evidence of a gap between Evidence-based Medicine (EBM) and physician clinical practice, in part because EBM is averaged global evidence gathered from exogenous populations which may not be relevant to local circumstances. Local endogenous evidence, collected in particular and ,real world' patient populations may be more relevant, convincing and timely for clinical practice. Evidence Farming (EF) is a concept to provide such local evidence through the systematic collection of clinical experience to guide more effective practice. Methods, We report on the findings of a pilot study of 29 individual and three focus group (n = 10) interviews exploring physicians' evaluations how they use multiple sources of information in clinical decision making and their thoughts on EF. Results, Physicians recognize a gap in translating EBM to practice. Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and EBM summarizing electronic clinical resources rather than refer directly to EBM literature. Confidence in making decisions based on clinical experience increases over time, yet few physicians reported having systems for tracking their clinical experience in designing treatment plans and patient outcomes. Most physicians saw EF as a promising way to track experience, thereby making scientific evidence more relevant to their own clinical practices. Conclusion, Clinical experience is relatively neglected by the EBM movement, but if that experience were systematically gathered through an approach such as EF, it would meet a need left unfulfilled by EBM. [source] Current practice of antifungal prophylaxis and treatment in immunocompromised children and adults with malignancies: a single centre approachMYCOSES, Issue 2 2009Thomas Lehrnbecher Summary Although various guidelines on antifungal prophylaxis and treatment have been published, the practical approach in the individual clinical setting might considerably differ because of special local circumstances. In addition, there are major differences between paediatric and adult patients regarding antifungal strategies and the use of antifungal compounds. We here present the antifungal approach in the Departments of Hematology and Oncology of the University Hospital of Frankfurt, where per year approximately 350 children and adults are diagnosed with cancer and an additional 100 patients undergo haematopoietic stem cell transplantation. The differences in the approach between the paediatric and adult setting are highlighted. [source] Biofuels , for better or worse?ANNALS OF APPLIED BIOLOGY, Issue 3 2010D.A. Walker The present world population is largely fed by ,industrialised agriculture'. This, in turn, depends on massive inputs of fossil fuels. While this energy expenditure is inescapable, it is an expensive way of ,converting oil into potatoes'. Arguably, in view of global climate change, ever increasing population, ever increasing oil prices, ever diminishing availability of water and arable land, this is not sustainable. Despite the fact that biofuels inevitably compete for resources that might otherwise be used to grow, store and distribute food, they are frequently held to be desirable and feasible ,green' substitutes for fossil fuels and even that they spare carbon emissions to the atmosphere. This article challenges the absurdity of such ,retro-agriculture' (i.e. except in a few local circumstances) incurring yet more energy expenditure. It seeks to illustrate the misinformation on which some of the advocacy of biofuels has been based. [source] End of life vehicle management in areas of low technology sophistication.BUSINESS STRATEGY AND THE ENVIRONMENT, Issue 5 2003A case study in Greece This paper was based on the findings of a study aimed at identifying and evaluating appropriate investment strategies in the area of end of life vehicle management (ELVM), especially against the emerging policy framework, as outlined by the recent EU legislation (2000/53 EG directive). The study was carried out for OMPM SA (Organisation for the Management of Public Material), a Greek organization, with many years' involvement in the management of ELVs. The departure point of the work was the critical review of available best practices, mostly compiled by means of a considerable number of on the spot visits to diverse ELVM processing facilities in the Northern EU. These experiences and practices were critically adapted to the very different local circumstances, characterized by an underdeveloped market and a low operational sophistication. In this way, the recommendations of the study, also reported in this work, are of a wider relevance to areas where the main priority is rather the development and rationalization of the ELVM business itself, before getting on to the subtler fine tuning and optimization issues that may be on the agenda in more mature environments. Copyright © 2003 John Wiley & Sons, Ltd and ERP Environment. [source] | |||||||||||||