Journal articles on the topic 'Resulting management recommendations'
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Hunter, Deirdre E. "Biosolids Management School of Hard Knocks: Lessons Learned and Resulting Recommendations." Proceedings of the Water Environment Federation 2005, no. 2 (January 1, 2005): 590–97. http://dx.doi.org/10.2175/193864705783967746.
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Dainiak, Nicholas, Robert Nicolas Gent, Zhanat Carr, Rita Schneider, Judith Bader, Elena Buglova, Nelson Chao, et al. "First Global Consensus for Evidence-Based Management of the Hematopoietic Syndrome Resulting From Exposure to Ionizing Radiation." Disaster Medicine and Public Health Preparedness 5, no. 3 (October 2011): 202–12. http://dx.doi.org/10.1001/dmp.2011.68.
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ABSTRACTObjective:Hematopoietic syndrome (HS) is a clinical diagnosis assigned to people who present with ≥1 new-onset cytopenias in the setting of acute radiation exposure. The World Health Organization convened a panel of experts to evaluate the evidence and develop recommendations for medical countermeasures for the management of HS in a hypothetical scenario involving the hospitalization of 100 to 200 individuals exposed to radiation. The objective of this consultancy was to develop recommendations for treatment of the HS based upon the quality of evidence.Methods:English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to panel members before the meeting and updated during the meeting. Published case series and case reports of individuals with HS, published randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases in which data were limited or incomplete, a narrative review of the observations was made. No randomized controlled trials of medical countermeasures have been completed for individuals with radiation-associated HS. The use of GRADE analysis of countermeasures for injury to hematopoietic tissue was restricted by the lack of comparator groups in humans. Reliance on data generated in nonirradiated humans and experimental animals was necessary.Results:Based upon GRADE analysis and narrative review, a strong recommendation was made for the administration of granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation.Conclusions:Assessment of therapeutic interventions for HS in humans exposed to nontherapeutic radiation is difficult because of the limits of the evidence.(Disaster Med Public Health Preparedness. 2011;5:202-212)
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Barczak, Anna, and Tomasz Gabryelewicz. "Diagnosis and management in dementia – recommendations." Aktualności Neurologiczne 21, no. 2 (December 17, 2021): 65–75. http://dx.doi.org/10.15557/an.2021.0008.
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The diagnosis of dementia and further management of patients are based on the latest recommendations developed by European and global organisations dealing with the diagnosis and standards of treatment of neurodegenerative diseases. Using useful and practical diagnostic methods, as well as the results of the latest additional tests and differential tools, a modern approach allows for a relatively quick diagnosis and implementation of recommended treatment. In addition to dementia in the course of Alzheimer’s disease, the paper presents recommendations for the diagnosis and treatment of other diseases including vascular dementia, dementia with Lewy bodies, dementia in Parkinson’s disease, frontotemporal dementia, and atypical parkinsonisms. Particular attention is given to the diagnosis of mild cognitive impairment due to Alzheimer’s disease and the possibilities of diagnosis and treatment of this phase, not only in a specialised medical practice. The article discusses the principles of procognitive pharmacological management in dementia and in the case of neuropsychiatric problems: psychotic, behavioural, and mood disorders. The importance of non-pharmacological management, primarily diet and cognitive stimulation, is also highlighted. Patient care requires close cooperation between the doctor and the caregiver, who is as important as the patient, and satisfying the caregiver’s needs is a guarantee of better care for the patient. Specifically, caregivers should be supported in handling their medical, legal, and psychological problems resulting from the burden of caring for the patient.
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Stricker, Carrie Tompkins, Linda A. Jacobs, SarahLena Panzer, and Steven C. Palmer. "Breast cancer survivorship visits: Presenting concerns and resulting recommendations." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e20553-e20553. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20553.
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e20553 Background: Survivorship care plans (SCPs) are mandated for cancer patients following initial cancer therapy. However, appropriate content, processes, and outcomes of survivorship visits are not yet defined. Neither the concerns that patients bring to these visits nor the degree to which they recall information given by providers is known. As part of a multicenter pilot study of breast cancer survivorship visits, we examined patient concerns at time of presentation for such visits, as well as patient and provider perceptions of resulting recommendations. Methods: We assessed post-treatment breast cancer survivors’ (BCSs’) survivorship concerns prior to a survivorship visit at 1 of 9 cancer centers associated with the LIVESTRONG Survivorship Center of Excellence Network. Following that visit we queried providers as to what referrals and recommendations were made during the visit. Three months later we asked patients to report what recommendations were made by providers. We then examined prevalence of patient concerns and agreement between patients and providers concerning survivorship visit recommendations for managing health. Results: 103 BCS at 9 centers participated. BCS most endorsed concerns were reducing risk of recurrence (81.4%), receipt of appropriate breast cancer follow up care (57.4%), weight loss (55.5%), risk for second cancers (54.9%), fatigue/sleep management (50.0%), and symptoms important to report to providers (50.0%). Although exercise was recommended to 63% of participants by providers, patients recalled this correctly only 79% of the time (Kappa = .16, ns). Moreover, there was a generally poor concordance between provider-reported and patient-recalled recommendations, with kappas ranging from 0.46 for recommendations about tobacco/alcohol to -0.11 for general health recommendations. Conclusions: Survivors report an array of concerns ranging from a risk of recurrence (81.4%) to concerns about peripheral neuropathy and lymphedema (51%). Survivors and providers, however, show little concordance concerning recommendations made visits. Provision of personalized survivorship care plans may improve agreement between survivors and providers concerning health recommendations.
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Benson, Helen, Cherie Lucas, Shalom I. Benrimoj, Walter Kmet, and Kylie A. Williams. "Pharmacists in general practice: recommendations resulting from team-based collaborative care." Australian Journal of Primary Health 24, no. 6 (2018): 448. http://dx.doi.org/10.1071/py18022.
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The Western Sydney Primary Health Network (PHN), WentWest, has been working to improve patient and health system outcomes by commissioning projects that enhance patient-focussed, team-based care. One such project is the WentWest General Practice Pharmacist Project, involving the integration of pharmacists within general practice sites. The aim of this study is to describe, classify and analyse recommendations made by pharmacists to GPs, resulting from patient consultations between pharmacists and patients in a general practice setting. This study was a multi-centre prospective observational study (April 2017–September 2017) investigating recommendations made by pharmacists integrated in a general practice setting. Thirteen general practice sites located in Western Sydney, NSW, Australia were involved in the study. The main outcome measures of this study include the classification of pharmacist recommendations and the percentage of those recommendations accepted by GPs. The pharmacists recorded the results from 618 patient consultations. These consultations resulted in 1601 recommendations of which 1404 (88%) were recorded as accepted. This study demonstrated that the recommendations made by pharmacists in general practice are well accepted by GPs and may lead to improvements in medication management and patient care.
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Mustian, Karen M., Calvin L. Cole, Po Ju Lin, Matt Asare, Chunkit Fung, Michelle C. Janelsins, Charles S. Kamen, Luke J. Peppone, and Allison Magnuson. "Exercise Recommendations for the Management of Symptoms Clusters Resulting From Cancer and Cancer Treatments." Seminars in Oncology Nursing 32, no. 4 (November 2016): 383–93. http://dx.doi.org/10.1016/j.soncn.2016.09.002.
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Chowdhury, Tasmiah P., Rebecca Starr, Maura Brennan, Alexander Knee, Mike Ehresman, Lalitha Velayutham, Alexander J. Malanowski, Heidi-Ann Courtney, and Mihaela S. Stefan. "A Quality Improvement Initiative to Improve Medication Management in an Acute Care for Elders Program Through Integration of a Clinical Pharmacist." Journal of Pharmacy Practice 33, no. 1 (July 4, 2018): 55–62. http://dx.doi.org/10.1177/0897190018786618.
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Purpose: To describe the implementation and impact of integrating a clinical pharmacist into interdisciplinary Acute Care for Elderly (ACE) rounds at a teaching hospital. Methods: Pre- and postanalyses were performed 6 months before and 12 months after the intervention. We report the total number, type, and frequency of recommendations made by the clinical pharmacist, the acceptance rate by the physician, and interventions on potentially inappropriate medications (PIM). Results: Among the 588 patients who met the ACE inclusion criteria, mean age was 81.2 years, 54.9% were female, and 79.8% were of white race. A total of 1243 pharmacy recommendations were recorded. The median number of recommendations per patient increased from a median of 1 (range: 1-7) in the preintervention to 2 (1-13) in the postintervention period, resulting in an incidence rate ratio of 1.25 (95% confidence interval [CI]: 1.10-1.40). The main categories of recommendations were dose adjustment, avoidance of inappropriate therapy, and prevention of adverse drug events. In the postintervention period, there was an increase in recommendations among analgesics (from 3.7% to 7.5%), PIMs (from 12% to 14%), and, in particular, antidepressant/antipsychotics (from 1.9% to 6.0%). The acceptance rate of the recommendations remained roughly the same (86.5% vs 84.4%). Conclusion: Proactive involvement of a clinical pharmacist in ACE rounds resulted in a substantial increase in recommendation for medication changes, most notably for PIMs. These recommendations generally were accepted by physicians. The integration of a clinical pharmacist requires significant dedicated time but leads to increased recognition of drug-related problems in the acute-care setting, resulting in improved patient outcomes.
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Ramadina, Risma Restu, Tacbir Hendro Pudjiantoro, and Irma Santikarama. "Sistem Customer Relationship Management (CRM) Menggunakan Metode Asosiasi Algoritma Apriori Untuk Menentukan Rekomendasi Produk." Jurnal ICT : Information Communication & Technology 19, no. 1 (September 9, 2020): 50–59. http://dx.doi.org/10.36054/jict-ikmi.v19i1.143.
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There are companies in the fashion sector that sell clothing for both women and men at affordable prices and quality. Currently, there are many competitors everywhere, especially in the Cimahi City area. The current SR Fashion Store boutique has a target of increasing the number of customers and retaining existing customers. However, because this fashion company has problems, namely delivery and determining recommendations that are directly in place, resulting in inconvenience for customers who make recommendations that are not in accordance with the tastes of these customers, because the services provided by the boutique have not been maximized causing customer loyalty to decline. Solutions to overcome these problems must be made a Customer Relationship Management System (CRM) that can be managed by a fashion company besides that the system to be built can also be accessed by customers. The system built will provide recommendations based on the customer's transaction history. To provide recommendations in a system by applying the association method using a priori algorithm, these recommendations are received by member subscribers via email messages. By looking at the transaction history of a customer who has made transactions more than five times, the recommendation will automatically be sent to the customer. The application of the association method using this a priori algorithm shows an attitude to determine product recommendations based on transaction history, by taking 5 product samples and 7 transaction histories in one member producing 2 recommendation rules with a support value of 42.8% and 75% trust.
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Nagib, Anthony, Chauniqua Kiffin, Eddy H. Carrillo, Andrew A. Rosenthal, Rachele J. Solomon, and Dafney L. Davare. "Necrotizing Fasciitis Resulting from an Anastomotic Leak after Colorectal Resection." Case Reports in Surgery 2018 (September 16, 2018): 1–3. http://dx.doi.org/10.1155/2018/8470471.
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One of the most feared complications in colorectal surgery is an anastomotic leak (AL) following a colorectal resection. While various recommendations have been proposed to prevent this potentially fatal complication, anastomotic leaks still occur. We present a case of an AL resulting in a complicated and fatal outcome. This case demonstrates the importance of high clinical suspicion, early recognition, and immediate management.
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Abbott, Lawrence J., Veena L. Brown, and Julia L. Higgs. "The Effects of Prior Manager-Auditor Affiliation and PCAOB Inspection Reports on Audit Committee Members' Auditor Recommendations." Behavioral Research in Accounting 28, no. 1 (October 1, 2015): 1–14. http://dx.doi.org/10.2308/bria-51314.
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ABSTRACT This study investigates (1) the extent to which audit committee members (ACM) of small publicly traded companies utilize Public Company Accounting Oversight Board (PCAOB) inspection reports in their auditor selection recommendations when management recommends hiring the auditor, and (2) whether the Sarbanes-Oxley Act's mandated one-year cooling-off period mitigates independence concerns of ACM resulting from a prior management-auditor affiliation in the same auditor selection context. We use financially literate professional participants as proxies for ACM who make a Likert-scale based recommendation for hiring the auditor. Our study manipulates a hypothetical, triennially inspected auditor's inspection results (favorable/unfavorable) as an auditor competence indicator and a prior management-auditor affiliation (present/absent) as an auditor independence indicator. We document that participants incorporate the inspection results into their selection recommendations, that prior affiliation negatively impacts ACMs' selection recommendations, and that auditor independence effects are contingent upon auditor competence. More specifically, auditor independence impacts auditor selection decisions only when auditor competence is favorable.
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Sohail, Rubina. "Latest Recommendations for Hormone Replacement Therapy." Journal of SAFOMS 1, no. 2 (2013): 82–83. http://dx.doi.org/10.5005/jp-journals-10032-1019.
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ABSTRACT Menopause is an area of increasing importance. Menopause management and hormone replacement therapy have had their share of popularity and downward trends. At the peak of its popularity came the WHI trial resulting in a lot of confusion and worry leading to the diuse of HRT. However the recent guidelines published by the British Menopause Society have put HRT in perspective. How to cite this article Sohail R. Latest Recommendations for Hormone Replacement Therapy. J South Asian Feder Menopause Soc 2013;1(2):82-83.
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Naraharisetti, Suresh Babu, Salma Srour, Yun Xu, David J. Lee, Sharon H. Hertz, and Chandrahas Sahajwalla. "Effects of Food on Bioavailability of Analgesics; Resulting Dosage and Administration Recommendations." Pain Medicine 21, no. 11 (April 10, 2020): 2877–92. http://dx.doi.org/10.1093/pm/pnaa046.
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Abstract Objectives To evaluate currently approved analgesics, that is, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and serotonin and norepinephrine reuptake inhibitors (SNRIs) used as analgesics, for 1) differences in pharmacokinetic parameters under fed vs fasting conditions and 2) factors involved in dosage recommendations in relation to food. Design Systematic review. Results Food effect on the rate, extent of absorption, or shape of concentration–time profile can alter the onset of action, duration of action, or tolerability of a medication. Based on 79 analgesic products reviewed, food effect dosage recommendations depend on whether an analgesic will be dosed on a regular interval around-the-clock vs on an as-needed basis, the shape of concentration–time profile, steady-state concentrations, the type of meals used in the pharmacokinetic study, and drug administration with regard to food in clinical trials. Overall, most opioids do not have food restriction and are taken without regard to food, with the exception of OPANA products and XTAMPZA ER. For many NSAIDs, food does not affect absorption characteristics, with the exception of ZORVOLEX and CELEBREX. Although NSAIDs are commonly to be taken without regard to food, prescribers recommend administering them with food to reduce their propensity for gastrointestinal adverse events. A larger percentage of anticonvulsants and SNRIs used as analgesics are taken with food to improve their tolerability. Of all analgesic products, seven NSAIDs and six opioids lack food effect information, maybe due to their approval before Food and Drug Administration food effect guidance. Conclusions Overall, because food effects could alter the onset and/or duration of pain relief, analgesic medication should be used as per labeled recommendations for proper pain management.
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Denby, Bruce, Steinar Larssen, Peter Builtjes, Menno Keuken, Ranjeet Sokhi, Nicolas Moussiopoulos, John Douros, Carlos Borrego, Ana Margarida Costa, and Thomas Pregger. "Recommendations for the spatial assessment of air quality resulting from the FP6 EU project Air4EU." International Journal of Environment and Pollution 44, no. 1/2/3/4 (2011): 128. http://dx.doi.org/10.1504/ijep.2011.038411.
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Karim, Sabina, Amin Islam, Shafquat Rafiq, and Ismail Laher. "The COVID-19 Pandemic: Disproportionate Thrombotic Tendency and Management Recommendations." Tropical Medicine and Infectious Disease 6, no. 1 (February 18, 2021): 26. http://dx.doi.org/10.3390/tropicalmed6010026.
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COVID-19 is an infectious disease caused by the SARS COV-2 virus. Patients with COVID-19 are susceptible to thrombosis due to excessive inflammation, platelet activation, endothelial dysfunction, and circulatory stasis, resulting in an increased risk of death due to associated coagulopathies. In addition, many patients receiving antithrombotic therapy for pre-existing thrombotic diseases can develop COVID-19, which can further complicate dose adjustment, choice and laboratory monitoring of antithrombotic treatment. This review summarizes the laboratory findings, the prohemostatic state, incidence of thromboembolic events and some potential therapeutic interventions of COVID-19 associated coagulopathy. We explore the roles of biomarkers of thrombosis and inflammation according to the severity of COVID-19. While therapeutic anticoagulation has been used empirically in some patients with severe COVID-19 but without thrombosis, it may be preferable to provide supportive care based on evidence-based randomized clinical trials. The likely lifting of travel restrictions will accelerate the spread of COVID-19, increasing morbidity and mortality across nations. Many individuals will continue to receive anticoagulation therapy regardless of their location, requiring on-going treatment with low-molecular weight heparin, vitamin K antagonist or direct-acting anticoagulants.
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Eastman, Kristin L., Marie C. Lutton, Gregory J. Raugi, Mandy R. Sakamoto, Jennifer A. McDowell, Lynne V. McFarland, and Gayle E. Reiber. "A teledermatology care management protocol for tracking completion of teledermatology recommendations." Journal of Telemedicine and Telecare 18, no. 7 (October 2012): 374–78. http://dx.doi.org/10.1258/jtt.2012.120417.
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In July 2009 we implemented a 3-year store-and-forward teledermatology project to provide dermatology care to veterans living in rural and underserved areas of the US Pacific Northwest. We also developed a follow-up protocol and tracking system. Information about all completed teledermatology consultations was entered into a database, and major procedures and select medications were tracked. In the first 21 months, 8202 dermatology conditions in 5232 veterans were treated and 3370 major procedures carried out. Ninety-five percent of conditions were associated with no more than two teledermatology consultations, and no condition required more than ten consultations. In total, 1454 conditions were reviewed for clinical pathological correlation, and in 310 (21%) there was a subsequent clinical pathological correlation conference, resulting in a change in final diagnosis for 93 conditions. The follow-up was important in ensuring high quality patient care.
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Rahman, MH, T. Jesmin, and G. Muinuddin. "An Update of Management of Idiopathic Nephrotic Syndrome: A Review Article." Bangladesh Journal of Child Health 37, no. 2 (December 4, 2013): 102–21. http://dx.doi.org/10.3329/bjch.v37i2.17268.
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Nephrotic syndrome (NS) is a common childhood kidney disease characterized by protein leakage from the blood to the urine through the glomeruli, resulting of proteinuria, hypoalbuminemia, generalized edema and hypercholesterolemia. The prevalence of minimal change nephrotic syndrome is higher in Indian subcontinent. Such incidence in Bangladesh is yet unknown. This review article discusses historical background, epidemiology, pathogenesis, pathophysiology and classification of nephrotic syndrome. In this review article focuses have been made on management of children aged between 1 to 18 years with idiopathic nephrotic syndrome. This article also provides information of different guideline recommendations and a brief review of relevant treatment trials related to each recommendation. DOI: http://dx.doi.org/10.3329/bjch.v37i2.17268 BANGLADESH J CHILD HEALTH 2013; VOL 37 (2) : 102-121
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Støen, Ole-Gunnar, Andrés Ordiz, Veronica Sahlén, Jon M. Arnemo, Solve Sæbø, Glenn Mattsing, Magnus Kristofferson, Sven Brunberg, Jonas Kindberg, and Jon E. Swenson. "Brown bear (Ursus arctos) attacks resulting in human casualties in Scandinavia 1977–2016; management implications and recommendations." PLOS ONE 13, no. 5 (May 23, 2018): e0196876. http://dx.doi.org/10.1371/journal.pone.0196876.
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Ewing, Lesley, and Costas E. Synolakis. "COMMUNITY RESILIENCE: LESSONS FROM RECENT DISASTERS." Coastal Engineering Proceedings 1, no. 32 (February 2, 2011): 7. http://dx.doi.org/10.9753/icce.v32.management.7.
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Resilience occurs at many levels, from global and national to family and individual. Community and local government efforts for resilience fit in the middle of this spectrum. Major community elements that are important both for minimizing vulnerability and hasten recovery include transportation, communication, water, energy, emergency services and housing. Coastal areas have some special concerns for vulnerabilities that can arise from coastal hazards such as tsunamis, hurricanes, storms, flooding, and erosion; lessons from recent coastal disasters provide recommendations for improved disaster management and community resilience. Resilience is not a one-time effort that can arise from a single approach; it is an ongoing community process, resulting from a combination of approaches. A Community Resilience Index (CRI) can help communities recognize their resilience strengths and opportunities for improvement. A “bare-bones” Community Resilience Index (CRI) has been developed based upon lessons learned from recent coastal disasters. The utility of the CRI is tested for recent community disasters at Galveston, Texas from Hurricane Ike, at American Samoa from the 2009 Samoan tsunami and at Pacifica, California from the 2009/2010 winter storms. Case studies will help identify additional CRI factors that will expand the focus of the CRI and improve overall community disaster management and coastal resilience.
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Khan, Aliya A., Bart Clarke, Lars Rejnmark, and Maria Luisa Brandi. "MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management." European Journal of Endocrinology 180, no. 2 (February 2019): R37—R44. http://dx.doi.org/10.1530/eje-18-0541.
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Purpose Review calcium homeostasis in pregnancy and provide evidence-based best practice recommendations for the management of hypoparathyroidism in pregnancy. Methods We searched MEDLINE, EMBASE and Cochrane databases from January 2000 to April 1, 2018. A total of 65 articles were included in the final review. Conclusions During pregnancy, calcitriol levels increase by two- to—three-fold resulting in enhanced intestinal calcium absorption. The renal filtered calcium load increases leading to hypercalciuria. PTHrP production by the placenta and breasts increases by three-fold, and this may lower the doses of calcium and calcitriol required during pregnancy in mothers with hypoparathyroidism. The literature however describes a wide variation in the required doses of calcium and calcitriol during pregnancy in hypoparathyroid mothers, with some women requiring higher doses of calcitriol, whereas others require lower doses. Close monitoring is necessary as hypercalcemia in the mother may suppress the fetal parathyroid gland development. Also hypocalcemia in the mother is harmful as it may result in secondary hyperparathyroidism in the fetus. This may be associated with demineralization of the fetal skeleton and the development of intrauterine fractures. Inadequate treatment of hypoparathyroidism may also result in uterine contractions and an increased risk of miscarriage. Treatment targets during pregnancy are to maintain a low normal serum calcium. Calcium, calcitriol and vitamin D supplements are safe during pregnancy. Close monitoring of the mother with a multidisciplinary team is advised for optimal care. If calcium homeostasis is well controlled during pregnancy, most women with hypoparathyroidism have an uncomplicated pregnancy and give birth to healthy babies.
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Stueve, Magnus, and Oliver Schnell. "Health Technology Assessments for Flash Glucose Monitoring and How to Use Them in Everyday Clinical Practice." Journal of Diabetes Science and Technology 13, no. 3 (August 22, 2018): 584–91. http://dx.doi.org/10.1177/1932296818794668.
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Background: Various health technology assessment (HTA) agencies review new medical devices worldwide, and their recommendations can be useful in guiding clinical decision making. However, different agencies use different processes and methodologies, resulting in variation in recommendations. Objectives: The objectives were to review full HTAs for a new technology for diabetes management, flash glucose monitoring (FGM), with the aim of summarizing similarities/differences in processes, methodologies, and recommendations from the perspective of everyday clinical practice. Methods: A literature review was conducted using online HTA resources. Results: Four full HTAs were identified (Canary Islands, France, Catalunya, and Norway); one issued a conditional recommendation for patients with type 1 diabetes mellitus (T1DM) with controlled glycated hemoglobin (HbA1c) (Spain; Canary Islands), one issued a broader recommendation for patients with T1DM and T2DM (France), and two reported that there was insufficient evidence to support a recommendation (Spain [Catalunya] and Norway). The most comprehensive and stringent of the available HTAs were those in the Canary Islands and Norway, which included systematic literature reviews (SLRs), consultation with patient groups and clinicians, GRADE evidence quality assessments, and full economic models. Comprehensive HTAs either did not recommend FGM (Norway) or restricted the recommendation to a small subpopulation of the overall diabetes population (Canary Islands). Conclusion: HTAs represent a valuable additional resource for clinicians to consider alongside clinical evidence, guidelines, and consensus papers; however, interpreting recommendations requires an understanding of the processes behind these recommendations. In this review, comprehensive HTAs either recommended for a selected subpopulation based on RCT evidence or found insufficient evidence for a recommendation.
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Benski, Caroline, Daria Di Filippo, Gianmarco Taraschi, and Michael R. Reich. "Guidelines for Pregnancy Management During the COVID-19 Pandemic: A Public Health Conundrum." International Journal of Environmental Research and Public Health 17, no. 21 (November 9, 2020): 8277. http://dx.doi.org/10.3390/ijerph17218277.
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Pregnant women seem to be at risk for developing complications from COVID-19. Given the limited knowledge about the impact of COVID-19 on pregnancy, management guidelines are fundamental. Our aim was to examine the obstetrics guidelines released from December 2019 to April 2020 to compare their recommendations and to assess how useful they could be to maternal health workers. We reviewed 11 guidelines on obstetrics management, assessing four domains: (1) timeliness: the time between the declaration of pandemics by WHO and a guideline release and update; (2) accessibility: the readiness to access a guideline by searching it on a common browser; (3) completeness: the amount of foundational topics covered; and (4) consistency: the agreement among different guidelines. In terms of timeliness, the Royal College of Obstetricians and Gynaecologists (RCOG) was the first organization to release their recommendation. Only four guidelines were accessible with one click, while only 6/11 guidelines covered more than 80% of the 30 foundational topics we identified. For consistency, the study highlights the existence of 10 points of conflict among the recommendations. The present research revealed a lack of uniformity and consistency, resulting in potentially challenging decisions for healthcare providers.
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Brown, Jacob T., Danielle MacDonald, Ann Yapel, Tiana Luczak, Anna Hanson, and David D. Stenehjem. "Integrating pharmacogenetic testing via medication therapy management in an outpatient family medicine clinic." Pharmacogenomics 22, no. 4 (March 2021): 203–12. http://dx.doi.org/10.2217/pgs-2020-0178.
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Introduction: Pharmacogenetic (PGx) implementation has lagged behind the development of drug/gene pair guidelines. Materials & methods: This was a prospective study assessing the integration of PGx through medication therapy management in an outpatient clinic. Variables collected included patient diagnosis, current medications, failed or discontinued medications, PGx results/recommendations, turnaround time and pre/post clinical ratings. Results: A total of 91 participants completed study procedures with an average enrollment of approximately one consult per week. Participants were referred for testing primarily for guidance for current and future medications. The average number of recommendations per participant was 0.93. Conclusion: Integrating PGx testing into medication therapy management is feasible with PGx results available in under a week resulting in clinical recommendations in over half of patients tested.
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Rubenstein, Lisa, Susanne Hempel, Margie Danz, Danielle Rose, Susan Stockdale, Idamay Curtis, and Susan Kirsh. "Eight Priorities for Improving Primary Care Access Management in Healthcare Organizations: Results of a Modified Delphi Stakeholder Panel." Journal of General Internal Medicine 35, no. 2 (November 14, 2019): 523–30. http://dx.doi.org/10.1007/s11606-019-05541-2.
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Abstract Objective To identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel. Background Studies on healthcare access show its importance for ensuring population health. Few studies show how healthcare organizations can improve access. Methods We conducted a modified Delphi stakeholder panel anchored by a systematic review. Panelists (N = 20) represented diverse stakeholder groups including patients, providers, policy makers, purchasers, and payers of healthcare services, predominantly from the Veterans Health Administration. A pre-panel survey addressed over 80 aspects of healthcare organization management of access, including defining access management. Panelists discussed survey-based ratings during a 2-day in-person meeting and re-voted afterward. A second panel process focused on each final priority and developed recommendations and suggestions for implementation. Results The panel achieved consensus on definitions of optimal access and access management on eight urgent and important priorities for guiding access management improvement, and on 1–3 recommendations per priority. Each recommendation is supported by referenced, panel-approved suggestions for implementation. Priorities address two organizational structure targets (interdisciplinary primary care site leadership; clearly identified group practice management structure); four process improvements (patient telephone access management; contingency staffing; nurse management of demand through care coordination; proactive demand management by optimizing provider visit schedules), and two outcomes (quality of patients’ experiences of access; provider and staff morale). Recommendations and suggestions for implementation, including literature references, are summarized in a panelist-approved, ready-to-use tool. Conclusions A stakeholder panel informed by a pre-panel systematic review identified eight action-oriented priorities for improving access and recommendations for implementing each priority. The resulting tool is suitable for guiding the VA and other integrated healthcare delivery organizations in assessing and initiating improvements in access management, and for supporting continued research.
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Espinel, Whitney, Marjan Champine, Heather Hampel, Joanne Jeter, Kevin Sweet, Robert Pilarski, Rachel Pearlman, et al. "Clinical Impact of Pathogenic Variants in DNA Damage Repair Genes beyond BRCA1 and BRCA2 in Breast and Ovarian Cancer Patients." Cancers 14, no. 10 (May 13, 2022): 2426. http://dx.doi.org/10.3390/cancers14102426.
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Consensus guidelines for hereditary breast and ovarian cancer include management recommendations for pathogenic/likely pathogenic (P/LP) variants in ATM, CHEK2, PALB2, and other DNA damage repair (DDR) genes beyond BRCA1 or BRCA2. We report on clinical management decisions across three academic medical centers resulting from P/LP findings in DDR genes in breast/ovarian cancer patients. Among 2184 patients, 156 (7.1%) carried a P/LP variant in a DDR gene. Clinical follow-up information was available for 101/156 (64.7%) patients. Genetic test result-based management recommendations were made for 57.8% (n = 59) of patients and for 64.7% (n = 66) of patients’ family members. Most recommendations were made for moderate-to-high risk genes and were consistent with guidelines. Sixty-six percent of patients (n = 39/59) implemented recommendations. This study suggests that P/LP variants in DDR genes beyond BRCA1 and BRCA2 can change clinical management recommendations for patients and their family members, facilitate identification of new at-risk carriers, and impact treatment decisions. Additional efforts are needed to improve the implementation rates of genetic-testing-based management recommendations for patients and their family members.
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Wenwen, Zhou. "Building an Urban Smart Community System Based on Association Rule Algorithms." Security and Communication Networks 2022 (July 19, 2022): 1–11. http://dx.doi.org/10.1155/2022/8773259.
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Intelligent system development is an integral component of smart community development and has a significant impact on the development of smart communities. Some cities continue to implement personalized smart community services, resulting in the formation of smart city communities with unique characteristics. Urban smart communities are based on the principle of owner-occupant convenience, integrating a wealth of community information and making it more relevant to each and every resident through intelligent management. Increasing information transmission rates have enhanced the ability of smart community systems to integrate information, but the smart community recommendation method is still based on traditional categorized recommendations. This paper addresses the deficiency of recommended information in smart urban communities. By analyzing user interaction and operation data, we can determine the interest and recognition of browsing attractions among users. Compared to conventional classification recommendations, weighted association rules can identify potentially very important rules applicable to small groups, thereby meeting the needs of various groups and enabling personalized services. Through continuous feedback from user behavior data, the system gradually identifies the community information that users are interested in during the specific recommendation process. After testing, the smart community system’s recommendation accuracy and real-time performance have vastly improved in comparison to categorical recommendations, and it can effectively meet the needs of tenants for community recommendations.
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Chruzik, Katarzyna, and Leszek Mindur. "INTEGRATION OF MANAGEMENT SYSTEMS IN RAILWAY TRANSPORT." Logistics and Transport 40, no. 4 (2018): 5–10. http://dx.doi.org/10.26411/83-1734-2015-4-40-1-18.
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The mandatory management systems implemented since 2008 in rail transport resulting from legal requirements [1-8], very often (especially in the first years of implementing the requirements) functioned independently of the optional procedural approach - ISO standard [9-10]. Currently, integration of requirements in both the mandatory and voluntary areas has become common practice. Legal requirements and recommendations do not define or recommend any specific form of extending the existing management systems. Regulation EC 402/2013 in Article 3 point 7 [8] defines only the obligation of interaction between systems (interfaces mean all interaction points during the system or subsystem life cycle). The publication describes the relationship between the requirements in the field of management systems currently used in the railway system resulting from legal requirements (Safety Management System - SMS) and voluntary implementations (Quality Management and Environmental Management System).
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Ha, Eun Jin. "Pediatric Severe Traumatic Brain Injury : Updated Management." Journal of Korean Neurosurgical Society 65, no. 3 (May 1, 2022): 354–60. http://dx.doi.org/10.3340/jkns.2021.0308.
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Traumatic brain injury (TBI) is the leading cause of death and disability in children. Survivors of severe TBI are more susceptible to functional deficits, resulting in disability, poor quality of life, cognitive decline, and mental health problems. Despite this, little is known about the pathophysiology of TBI in children and how to manage it most effectively. Internationally, efforts are being made to expand knowledge of pathophysiology and develop practical clinical treatment recommendations to improve outcomes. Here we discuss recently updated evidence and management of severe pediatric TBI.
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Thompson, Laura J., and Laila A. Puntel. "Transforming Unmanned Aerial Vehicle (UAV) and Multispectral Sensor into a Practical Decision Support System for Precision Nitrogen Management in Corn." Remote Sensing 12, no. 10 (May 17, 2020): 1597. http://dx.doi.org/10.3390/rs12101597.
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Determining the optimal nitrogen (N) rate in corn remains a critical issue, mainly due to unaccounted spatial (e.g., soil properties) and temporal (e.g., weather) variability. Unmanned aerial vehicles (UAVs) equipped with multispectral sensors may provide opportunities to improve N management by the timely informing of spatially variable, in-season N applications. Here, we developed a practical decision support system (DSS) to translate spatial field characteristics and normalized difference red edge (NDRE) values into an in-season N application recommendation. On-farm strip-trials were established at three sites over two years to compare farmer’s traditional N management to a split-application N management guided by our UAV sensor-based DSS. The proposed systems increased nitrogen use efficiency 18.3 ± 6.1 kg grain kg N−1 by reducing N rates by 31 ± 6.3 kg N ha−1 with no yield differences compared to the farmers’ traditional management. We identify five avenues for further improvement of the proposed DSS: definition of the initial base N rate, estimation of inputs for sensor algorithms, management zone delineation, high-resolution image normalization approach, and the threshold for triggering N application. Two virtual reference (VR) methods were compared with the high N (HN) reference strip method for normalizing high-resolution sensor data. The VR methods resulted in significantly lower sufficiency index values than those generated by the HN reference, resulting in N fertilization recommendations that were 31.4 ± 10.3 kg ha−1 higher than the HN reference N fertilization recommendation. The use of small HN reference blocks in contrasting management zones may be more appropriate to translate field-scale, high-resolution imagery into in-season N recommendations. In view of a growing interest in using UAVs in commercial fields and the need to improve crop NUE, further work is needed to refine approaches for translating imagery into in-season N recommendations.
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Harreiter, Jürgen, Karin Schindler, Dagmar Bancher-Todesca, Christian Göbl, Felix Langer, Gerhard Prager, Alois Gessl, et al. "Management of Pregnant Women after Bariatric Surgery." Journal of Obesity 2018 (June 3, 2018): 1–14. http://dx.doi.org/10.1155/2018/4587064.
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The prevalence of obesity is growing worldwide, and strategies to overcome this epidemic need to be developed urgently. Bariatric surgery is a very effective treatment option to reduce excess weight and often performed in women of reproductive age. Weight loss influences fertility positively and can resolve hormonal imbalance. So far, guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12–24 months after surgery. As limited data of these suggestions exist, further evidence is urgently needed as well for weight gain in pregnancy. Oral glucose tolerance tests for the diagnosis of gestational diabetes mellitus (GDM) should not be performed after bariatric procedures due to potential hypoglycaemic adverse events and high variability of glucose levels after glucose load. This challenges the utility of the usual diagnostic criteria for GDM in accurate prediction of complications. Furthermore, recommendations on essential nutrient supplementation in pregnancy and lactation in women after bariatric surgery are scarce. In addition, nutritional deficiencies or daily intake recommendations in pregnant women after bariatric surgery are not well investigated. This review summarizes current evidence, proposes clinical recommendations in pregnant women after bariatric surgery, and highlights areas of lack of evidence and the resulting urgent need for more clinical investigations.
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Allendorf, Fred W. "Ecological and Genetic Effects of Fish Introductions: Synthesis and Recommendations." Canadian Journal of Fisheries and Aquatic Sciences 48, S1 (December 19, 1991): 178–81. http://dx.doi.org/10.1139/f91-318.
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The papers resulting from this symposium review the ecological and genetic effects of fish introductions throughout the world. Purposeful introductions rarely have achieved their objectives. Moreover, both intentional and unintentional introductions usually have been harmful to native fishes and other taxa through predation, competition, hybridization, and the introduction of diseases. We must learn from the past in order to avoid mistakes in the future. Introductions should not be used as a management tool without sufficient prior information and understanding to predict their effects. Introductions are often made or permitted because of the demands of certain interests groups (e.g., anglers or aquaculturists). Education of the public to the potential dangers and costs of such introductions is essential. Cooperation among management agencies is necessary to regulate and control both the purposeful and accidental introductions of fishes.
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Dühnfort, Alexander, Christian Klein, and Niklas Lampenius. "Theoretical foundations of corporate governance revisited: A critical review." Corporate Ownership and Control 6, no. 2 (2008): 424–33. http://dx.doi.org/10.22495/cocv6i2c4p1.
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In this paper we review some of the initial ideologies regarding corporate governance, focusing in particular on the – in the literature dominating – Principal-Agent-Approach. We detail the implied assumptions and the thereof resulting consequences for corporate governance, including some resulting inconsistencies. Overall, we find that in the discussion about „Corporate Governance‟ the often referred to principal-agent-conflict is rarely defined with the necessary rigor, but find that the model seems to be applied to almost any situation loosely tied to the topic of corporate governance. We conclude that due to the missing theoretical rigor and the missed developments in the area of management theory the resulting corporate governance policy recommendations are often inconsistent and that the commonly applied theoretical framework for corporate governance discussions might not be the most suitable one for policy recommendations as well as for regulatory actions
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Mehta, Ranjana K., S. Camille Peres, Linsey M. Steege, Jim R. Potvin, Mike Wahl, Laura M. Stanley, and Thomas E. Nesthus. "Fatigue Monitoring and Management across Different Industries." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 60, no. 1 (September 2016): 993–96. http://dx.doi.org/10.1177/1541931213601230.
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Fatigue, often defined as a physiological state of reduced mental or physical performance capability resulting from sleep loss, circadian phase, or workload (physical or cognitive), has been implicated as a critical risk factor resulting in severe injuries and accidents. A great deal of research has been done into the identification, measurement, and management of fatigue, however it is still poorly understood. This may be due to the characteristics and variability of work conditions across different industries; for example, fatigue in manufacturing is largely related to physical demands, and in aviation fatigue is related to sleep and shift-work. This panel will comprise of academics and practitioners across manufacturing, healthcare, transportation, aviation, and oil and gas industries. Topics covered within each industry will include fatigue causes and consequences, existing fatigue monitoring/management practices, barriers to fatigue monitoring and management, and recommendations/discussions around improving the current state.
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SZKIEL, AGATA. "INTEGRATION OF RISK MANAGEMENT IN QUALITY MANAGEMENT SYSTEM AND MANAGEMENT CONTROL IN GDYNIA MARITIME UNIVERSITY." sj-economics scientific journal 26, no. 3 (November 30, 2017): 243–62. http://dx.doi.org/10.58246/sjeconomics.v26i3.173.
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The purpose of the article to analyse the solutions implemented in Gdynia Maritime University (GMU) in the area of risk management as part of management control system and their evaluation for the possibility of applying them during the process of designing, documenting, and implementing actions related to risk management as part of an adjustment of the quality management system implemented in GMU to the requirements of the ISO 9001:2015 standard. The article presents the requirements regarding risk management specified in the ISO 9001:2015 standard, as well as those resulting from legal provisions on management control. The risk management model implemented in GMU as part of management control system has also been described and the recommendations for GMU regarding changes which should be applied to this model, in order for it to meet the ISO 9001:2015 requirements and be used in the quality management system, have been presented.
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Babintseva, А. G., Yu D. Godovanets, Yu Yu Khodzinska, N. O. Popeliuk, and I. V. Koshurba. "International recommendations on neonatal management with congenital diaphragmatic hernia: literature review." Modern pediatrics. Ukraine, no. 3(115) (April 27, 2021): 51–60. http://dx.doi.org/10.15574/sp.2021.115.51.
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Congenital diaphragmatic hernia (CDH) is a defect of diaphragm development which is characterized by herniation of the abdominal content into the chest resulting in pulmonary hypoplasia and pulmonary hypertension of various degrees. Mortality and sickness rates among survived children with this pathology remain high all over the world. Prenatal diagnostics of high quality will help to find neonates with severe CDH and promote mobilization of human and material resources for optimal management at the tertiary level of giving medical aid. Attention of specialists in prenatal ultrasound diagnostics should be drawn to the necessity of measuring observed/expected lung(to(head ratio and location of the liver in fetus. Optimal treatment of neonates during preoperative period is focused on mild ventilation, avoidance of oxygen toxicity, baro/volutrauma of a hypoplastic lung and cardiac support. Administration of pulmonary vasodilator therapy including inhaled nitric oxide and extracorporal membrane oxygenation is pathogenetically substantiated for patients with pulmonary hypertension, and surgical correction should be delayed till stabilization of patient's condition. Echocardiography is a critically important diagnostic method. It enables to determine severity of pulmonary hypertension and myocardial functional disorders, to find targeted systemic methods of treatment that improve hemodynamic function or decrease pulmonary vascular resistance. Considering an insufficient level of evidence of the existing international recommendations, large(scale multi(center randomized studies on investigation of the best methods to prevent, diagnose and treat neonates with CDH are essential. No conflict of interest was declared by the authors. Key words: congenital diaphragmatic hernia; neonate; lung-to-head ratio; pulmonary hypertension; extracorporal membrane oxygenation.
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Smolle, Maria A., Sebastian P. Nischwitz, Martin Hutan, Primoz Trunk, David Lumenta, and Gerwin A. Bernhardt. "Closed-incision negative-pressure wound management in surgery—literature review and recommendations." European Surgery 52, no. 6 (August 24, 2020): 249–67. http://dx.doi.org/10.1007/s10353-020-00657-w.
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Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.
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Thompson, John A., Bryan J. Schneider, Julie Brahmer, Stephanie Andrews, Philippe Armand, Shailender Bhatia, Lihua E. Budde, et al. "Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network 17, no. 3 (March 11, 2019): 255–89. http://dx.doi.org/10.6004/jnccn.2019.0013.
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The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions and ASCO, consisting of medical and hematologic oncologists with expertise in a wide array of disease sites, and experts from the fields of dermatology, gastroenterology, neuro-oncology, nephrology, emergency medicine, cardiology, oncology nursing, and patient advocacy. Several panel representatives are members of the Society for Immunotherapy of Cancer (SITC). The initial version of the NCCN Guidelines was designed in general alignment with recommendations published by ASCO and SITC. The content featured in this issue is an excerpt of the recommendations for managing toxicity related to immune checkpoint blockade and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to chimeric antigen receptor T-cell therapy, visitNCCN.org.
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Thompson, John A., Bryan J. Schneider, Julie Brahmer, Amaka Achufusi, Philippe Armand, Meghan K. Berkenstock, Shailender Bhatia, et al. "Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network 20, no. 4 (April 2022): 387–405. http://dx.doi.org/10.6004/jnccn.2022.0020.
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The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions, consisting of medical and hematologic oncologists with expertise across a wide range of disease sites, and experts from the areas of dermatology, gastroenterology, endocrinology, neurooncology, nephrology, cardio-oncology, ophthalmology, pulmonary medicine, and oncology nursing. The content featured in this issue is an excerpt of the recommendations for managing toxicities related to CAR T-cell therapies and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to immune checkpoint inhibitors, visit NCCN.org.
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Hu, Die, and Le Fang. "Visualization Method of Key Knowledge Points of Nursing Teaching Management System Based on SOM Algorithm and Biomedical Diagnosis." Computational Intelligence and Neuroscience 2022 (October 11, 2022): 1–9. http://dx.doi.org/10.1155/2022/7057437.
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The traditional nursing teaching knowledge point recommendation algorithm based on collaborative filtering is difficult to deal with the problem of data sparsity, while the traditional recommendation algorithm based on matrix decomposition has poor scalability in dealing with high-dimensional data, and their recommendation results are only determined according to the prediction score, resulting in low recommendation accuracy. In view of this, a nursing teaching knowledge point recommendation method based on a SOM neural network and ranking factor decomposition machine is proposed. Firstly, the SOM neural network is used to cluster users based on users’ academic background information, then the partial order relationship of nursing teaching knowledge points is constructed by using users’ explicit and implicit web access behavior, and finally, the factor decomposition machine is used as the ranking function to classify users’ academic background web access behavior, borrowing nursing teaching introduction text, and other characteristic information were modeled, and the peer-to-peer ranking learning algorithm was used to accurately recommend nursing teaching knowledge points. Experimental results show that the proposed method can effectively alleviate the problem of data sparsity and improve the accuracy and efficiency of recommendations.
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Rogers, James, Alvina Acquaye, Ukeme Ikiddeh-Barnes, Kaitlyn Benson, Lisa Boris, Funto Akindona, Stephen Frederico, et al. "INNV-27. AN INNOVATIVE VIRTUAL MULTI-INSTITUTIONAL, MULTIDISCIPLINARY NEURO-ONCOLOGY TUMOR BOARD: THE NIH-NOB EXPERIENCE DURING THE COVID-19 PANDEMIC." Neuro-Oncology 23, Supplement_6 (November 2, 2021): vi111. http://dx.doi.org/10.1093/neuonc/noab196.438.
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Abstract BACKGROUND The American Academy of Neurology Institute and Society for Neuro-Oncology recommend multidisciplinary tumor board (MTB) meetings as a quality metric in neuro-oncology. With the COVID-19 pandemic resulting in travel restrictions, we expanded our existing MTB by transitioning to a virtual format that maintained our commitment to providing consultation for primary CNS tumor cases. This transition permitted participation by neuro-oncology teams from over 30 Brain Tumor Trials Collaborative (BTTC)/National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) centers across the United States. Here, we describe results from opening our MTB remotely to these teams. METHODS We retrospectively reviewed records from remote MTB meetings held between April 2020 and March 2021. To gauge the impact of our MTB on clinical management, we administered a brief survey querying BTTC members. RESULTS Twenty-eight providers presented 41 cases during 24 virtual MTB meetings (range: 1-4 cases per meeting). Two cases (5%) were presented only for educational value. Approximately half (54%) of the cases discussed dealt with diagnosis/management of an NCI-CONNECT rare CNS tumor. During MTB discussions of the 39 cases seeking diagnosis/management recommendations, 32% received clinical trial recommendations, 10% were suggested to enroll in the NCI Neuro-Oncology Branch (NOB) Natural History Study (NCT02851706), 17% received a recommendation to obtain central neuropathology review, and 100% received recommendations for further disease management. Most BTTC survey respondents (83%) found these recommendations impactful in the management/treatment of their presented case or generally useful/informative for their clinical practice. CONCLUSION We describe the feasibility and utility of an innovative virtual multi-institutional MTB. These novel remote meetings allowed for discussion of complex neuro-oncology cases and recommendations from experts, particularly important for those with rare CNS tumors. Our study’s findings during the COVID-19 pandemic of the value of providing remote access to MTBs should apply post-pandemic.
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Vasant, Dipesh H., Peter A. Paine, Christopher J. Black, Lesley A. Houghton, Hazel A. Everitt, Maura Corsetti, Anurag Agrawal, et al. "British Society of Gastroenterology guidelines on the management of irritable bowel syndrome." Gut 70, no. 7 (April 26, 2021): 1214–40. http://dx.doi.org/10.1136/gutjnl-2021-324598.
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Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.
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Tuomenvirta, Heikki, Hilppa Gregow, Atte Harjanne, Sanna Luhtala, Antti Mäkelä, Karoliina Pilli-Sihvola, Sirkku Juhola, et al. "Identifying Policy Actions Supporting Weather-Related Risk Management and Climate Change Adaptation in Finland." Sustainability 11, no. 13 (July 3, 2019): 3661. http://dx.doi.org/10.3390/su11133661.
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Climate change adaptation (CCA) policies require scientific input to focus on relevant risks and opportunities, to promote effective and efficient measures and ensure implementation. This calls for policy relevant research to formulate salient policy recommendations. This article examines how CCA research may contribute to policy recommendations in the light of idealized set of knowledge production attributes for policy development in Finland. Using general background information on the evolution of CCA research and a case study, we specifically examine how the set of attributes have been manifested in research serving CCA and discuss how they have affected the resulting policy recommendations. We conclude that research serving CCA can be improved by more explicit reflection on the attributes that pay attention to the context of application, the methods of teamwork and a variety of participating organizations, transdisciplinarity of the research, reflexivity based on the values and labour ethos of scientists and novel forms of extended peer review. Such attributes can provide a necessary, although not sufficient, condition for knowledge production that strives to bridge the gap between research and policy.
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Martin, Nyranne. "Enabling effective oversight: Enterprise risk management and board governance in healthcare." Healthcare Management Forum 33, no. 4 (April 6, 2020): 182–85. http://dx.doi.org/10.1177/0840470420907260.
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Lengthy emergency room wait times leaving patients waiting for essential care. Dwindling annual budgets putting core services at risk. Cyberattacks resulting in ransomed data. These are just some of the ever-present risks in the healthcare sector. Each of these risks has a potential for high likelihood of occurrence, impact, and velocity. Identifying, assessing, mitigating, and reporting risk are therefore crucial to Enterprise Risk Management (ERM), and should be built into healthcare institutional processes. This column provides some recommendations for health leaders on how to enable effective oversight through ERM.
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Rahaghi, Franck F., Hassan M. Alnuaimat, Rana L. A. Awdish, Vijay P. Balasubramanian, Robert C. Bourge, Charles D. Burger, John Butler, et al. "Recommendations for the clinical management of patients receiving macitentan for pulmonary arterial hypertension (PAH): A Delphi consensus document." Pulmonary Circulation 7, no. 3 (August 22, 2017): 702–11. http://dx.doi.org/10.1177/2045893217721695.
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In patients treated with macitentan (Opsumit®, Actelion Pharmaceuticals Ltd., Basel, Switzerland) for pulmonary arterial hypertension (PAH), prevention and/or effective management of treatment-related adverse events may improve adherence. However, management of these adverse events can be challenging and the base of evidence and clinical experience for macitentan is limited. In the absence of evidence, consensus recommendations from physicians experienced in using macitentan to treat PAH may benefit patients and physicians who are using macitentan. Consensus recommendations were developed by a panel of physicians experienced with macitentan and PAH using a modified Delphi process. Over three iterations, panelists developed and refined a series of statements on the use of macitentan in PAH and rated their agreement with each statement on a Likert scale. The panel of 18 physicians participated and developed a total of 118 statements on special populations, add-on therapy, drug–drug interactions, warnings and precautions, hospitalization and functional class, and adverse event management. The resulting consensus recommendations are intended to provide practical guidance on real-world issues in using macitentan to treat patients with PAH.
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Park, Kyung Seo (Elysia), Jason Pang, and Choigaon Park. "Digital Environmental Activism and its Effects on Canadian Politics, Education Institutions, ESG Corporate Management and Socially Responsible Investment." Korea Association for Public Value 3 (June 30, 2022): 35–42. http://dx.doi.org/10.53581/jopv.2022.3.1.35.
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Purpose: In this technology dense era, the methods of activism have progressed digitally, especially after the start of the COVID-19 pandemic. The developing generation of environmentally conscious individuals utilize digital electronics as the main method of advocacy, resulting in a positive shift in environmental public value worldwide.
Method: This paper will analyze the tangible effects of environmental digital activism in Canadian politics, British Columbia’s education institutions, Environmental, Social, Governance (ESG) corporate management, and socially responsible investments (SRI).
Conclusion: Conclusively, this paper will provide multidisciplinary recommendations for ongoing sustainable management that can ameliorate ESG practices and digital environmental activism.
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Munasinghe, BM, RN Perera, and SKWR Kumara. "Two lives at stake: Obstetric anaphylactic shock resulting in acute respiratory distress syndrome – A case report." SAGE Open Medical Case Reports 10 (January 2022): 2050313X2210848. http://dx.doi.org/10.1177/2050313x221084843.
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Maternal anaphylaxis is rare albeit life-threatening critical incident dreaded by many due to negative effects on not only the mother but the foetus as well. Antibiotics and anaesthetic agents still contribute to majority of the episodes. Consequences of anaphylaxis such as placental insufficiency and subsequent foetal neurocognitive deficits are devastating outcomes. Acute respiratory distress syndrome following anaphylaxis is even rarer among the normal population. The management of maternal anaphylaxis does not differ from routine recommendations even though close monitoring and preparedness for early delivery should be embedded in the protocols. This is a rare case report of a primi mother who developed anaphylactic shock following intravenous penicillin in the background of negative allergic history, resultant foetal distress requiring emergency lower segment caesarian section and delayed onset acute respiratory distress syndrome which was later attributed to anaphylaxis. Pertinent identification and management which included a multidisciplinary team culminated in favourable outcomes.
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Shankar, Roopa Kanakatti, and Philippe F. Backeljauw. "Current best practice in the management of Turner syndrome." Therapeutic Advances in Endocrinology and Metabolism 9, no. 1 (December 18, 2017): 33–40. http://dx.doi.org/10.1177/2042018817746291.
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Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population.
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Vogt, Lea, Timur Sellmann, Dietmar Wetzchewald, Heidrun Schwager, Sebastian Russo, and Stephan Marsch. "Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial." Journal of Clinical Medicine 9, no. 7 (June 29, 2020): 2045. http://dx.doi.org/10.3390/jcm9072045.
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The role of advanced airway management (AAM) in cardiopulmonary resuscitation (CPR) is currently debated as observational studies reported better outcomes after bag-mask ventilation (BMV), and the only prospective randomized trial was inconclusive. Adherence to CPR guidelines ventilation recommendations is unknown and difficult to assess in clinical trials. This study compared AAM and BMV with regard to adherence to ventilation recommendations and chest compression fractions in simulated cardiac arrests. A total of 154 teams of 3–4 physicians were randomized to perform CPR with resuscitation equipment restricting airway management to BMV only or equipment allowing for all forms of AAM. BMV teams ventilated 6 ± 6/min and AAM teams 19 ± 8/min (range 3–42/min; p < 0.0001 vs. BMV). 68/78 BMV teams and 23/71 AAM teams adhered to the ventilation recommendations (p < 0.0001). BMV teams had lower compression fractions than AAM teams (78 ± 7% vs. 86 ± 6%, p < 0.0001) resulting entirely from higher no-flow times for ventilation (9 ± 4% vs. 3 ± 3 %; p < 0.0001). Compared to BMV, AAM leads to significant hyperventilation and lower adherence to ventilation recommendations but favourable compression fractions. The cumulative effect of deviations from ventilation recommendations has the potential to blur findings in clinical trials.
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Darnata, Ni Putu Yasinta Oktavia, I. M. M. Arsana, and A. A. P. Suardani. "Management Audit to Evaluate the Economical, Efficiency, and Effectiveness of Purchasing Function in GK Hotel." Journal of Applied Sciences in Accounting, Finance, and Tax 4, no. 1 (April 15, 2021): 34–40. http://dx.doi.org/10.31940/jasafint.v4i1.2415.
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This research examines the economic, efficiency, and effectiveness of purchasing function and reveals findings obtained during the implementation of a management audit to give appropriate recommendations for better company performance in the future. The analytical techniques used in this research are quantitative and qualitative analytical techniques. The data analysis results in 2017-2019 show that the highest rate of economics occurred in 2019. The highest efficiency rate occurred in 2019 and declining the effectiveness rate in 2019. That is due to obstacles in the purchasing function resulting in wastage. These obstacles are the weaknesses in unauthorized purchase request activities, purchasing goods that did not comply with order specifications, and the delay of payment to the supplier due to a lack of funds from the head office. This research concludes that the economic rate in 2019 is uneconomical, the efficiency of purchase costs in 2019 is inefficient, and the effective rate in 2019 is quite effective. The recommendation is to make a payment agreement with the supplier, tighten the process of purchasing requests, and control in making the article description.
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Loh, R., M. Phua, and C.-K. L. Shaw. "Management of paediatric acute mastoiditis: systematic review." Journal of Laryngology & Otology 132, no. 2 (September 7, 2017): 96–104. http://dx.doi.org/10.1017/s0022215117001840.
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AbstractBackground:Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management.Objectives:To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes.Method:A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases.Results:Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively.Conclusion:Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.
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Medley, Tanya L., Christina Miteff, Ian Andrews, Tyson Ware, Michael Cheung, Paul Monagle, Simone Mandelstam, et al. "Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke." International Journal of Stroke 14, no. 1 (October 4, 2018): 94–106. http://dx.doi.org/10.1177/1747493018799958.
Full textAbstract:
Stroke is among the top 10 causes of death in children and survivors carry resulting disabilities for decades, at substantial cost to themselves and their families. Children are not currently able to access reperfusion therapies, due to limited evidence supporting safety and efficacy and long diagnostic delays. The Australian Clinical Consensus Guideline for the Diagnosis and Acute Management of Childhood Stroke was developed to minimize unwarranted variations in care and document best evidence on the risk factors, etiologies, and conditions mimicking stroke that differ from adults. Clinical questions were formulated to inform systematic database searches from 2007 to 2017, limited to English and pediatric studies. SIGN methodology and the National Health and Medical Research Council system were used to screen and classify the evidence. The Grades of Recommendation, Assessment, Development, and Evaluation system (GRADE) was used to grade evidence as strong or weak. The Guideline provides more than 60 evidence-based recommendations to assist prehospital and acute care clinicians in the rapid identification of childhood stroke, choice of initial investigation, to confirm diagnosis, determine etiology, selection of the most appropriate interventions to salvage brain at risk, and prevent recurrence. Recommendations include advice regarding the management of intracranial pressure and congenital heart disease. Implementation of the Guideline will require reorganization of prehospital and emergency care systems, including the development of regional stroke networks, pediatric Code Stroke, rapid magnetic resonance imaging and accreditation of primary pediatric stroke centers with the capacity to offer reperfusion therapies. The Guideline will allow auditing to benchmark timelines of care, access to acute interventions, and outcomes. It will also facilitate the development of an Australian childhood stroke registry, with data linkage to international registries, to allow for accurate data collection on stroke incidence, treatment, and outcomes.