Good Practice Criteria Research Articles

Innovative Approaches in Environmental Medicine: Redox/Detoxification Biomarkers in Environmental Intolerances

Innovative Approaches in Environmental Medicine: Redox/Detoxification Biomarkers in Environmental Intolerances

Analysis and evaluation of good practices in the design of internet sites dedicated to electromagnetic fields and health

PurposeThe purpose of this paper is to apply a dedicated checklist for the evaluation of good practice information in the design of Italian internet sites on electromagnetic fields (emf) and health.Design/methodology/approachThe “Guidelines on the collection, evaluation and dissemination of good practice information on the Internet” by European Occupational Safety and Health Agency (EU‐OSHA) and the criteria of effective health communication, by the American National Institute of Health (NIH), have been reoriented to the issue “emf and health”. In total, 100 Italian internet sites, provided by the search engine GoogleItalia, have been analysed.FindingsThe results show how Italian official sources of information on “emf and health”, mainly affiliated to public institutions, apply good practice criteria in the design of internet sites, in terms of Identity card of the provider, quality of information, usability, interactivity and content of the sites.Practical implicationsIn recent years, the internet has become a powerful tool for information, especially concerning health issues. Internet users need to find a trusted source providing accurate, balanced, evidence‐based, reliable, understandable information. This research provides practical criteria for selecting good practice information in the internet sites dedicated to “emf and health”.Originality/valueThe authors' effort in collecting and evaluating main criteria for an ergonomic design of internet sites dedicated to “emf and health”, confirms the need to implement usability of the internet sites and enhance the quality of information provided in the web in terms of “good practice”.

Variability in the detection and monitoring of chronic patients in primary care according to what is registered in the electronic health record

The electronic health record (EHR) allows a detailed study of the primary care consultations and assessment of variability among physicians regarding the implementation of practices for prevention, detection and monitoring of chronic diseases. To describe the variability in the detection and surveillance of chronic conditions in primary care. Review of the medical records maintained by 1685 primary care physicians in the Basque Health Service. Estimation of age and sex standardized rates of compliance with evidence-based recommendations and the systematic component of variation (SCV). Compliance with screening recommendations varied from 14.2% for chronic obstructive pulmonary disease (COPD) to 37.2% for hypercholesterolaemia of the at-risk populations. Variability between Primary Care Units (PCUs) was low (SCV(5) (-95) < 0.10) for high blood pressure, hypercholesterolaemia and diabetes and high (SCV(5) (-95) ≥ 0.20) for COPD. Based on the EHR registries, recommendations were followed to in at least 50% of relevant patients according to only 10 of the 44 good care practice (GCP) criteria. For 16 of the GCP criteria, the EHR data indicated compliance to the recommendations in <25% of patients diagnosed. EHR data indicate that some of the preventative care practices recommended to detect chronic problems in primary care are unevenly implemented across PCUs. Notably, there is less variation in the case of conditions for which evidence-based clinical practice guidelines have been published. The level of monitoring is inadequate for all the conditions studied; particularly in those in which it is less evident that primary care is the right level of the health service to provide this care.

Computerized tomography in pediatric oncology

Computerized tomography (CT) is an extremely powerful imaging modality, which provides extremely valuable information for the diagnosis, staging, and management of pediatric solid tumors. In recent years, the concern of potential risks associated with ionizing radiation from diagnostic imaging – especially from CT – has greatly increased. In children with cancer the radiation burden from CT studies can easily accumulate because of repeated studies for disease staging, assessment of response to therapy, and follow up.The purpose of this article is to review the role of CT and its imaging key points for diagnosis, staging and planning surgical excision of common extracranial pediatric tumors, according to protocol specific imaging guidelines. The issue of the radiation burden from CT in children with cancer, and criteria of good practice to reduce it, will also be discussed.

QUESTÕES CONCEITUAIS E METODOLÓGICAS RELACIONADAS AO MONITORAMENTO EM AVALIAÇÃO AMBIENTAL ESTRATÉGICA

A Avaliação Ambiental Estratégica (AAE) emerge como um instrumento de apoio à tomada de decisão para garantir a consideração das questões ambientais em situações estratégicas como Políticas, Planos e Programas (PPP). Entretanto, a AAE não termina com a adoção das políticas, mas requer, como uma de suas etapas, a adoção do monitoramento, que tem como objetivo acompanhar os efeitos ambientais significativos da implantação dos PPPs; identificar, no estágio inicial, os efeitos adversos não previstos e auxiliar a adoção de medidas de correção adequadas. Este estudo tem como objetivo discutir e explorar conceitos e metodologias sobre monitoramento em AAE. As questões conceituais e teóricas são discutidas e relacionadas com as questões práticas de monitoramento por meio da análise de duas experiências, ambas na Inglaterra, uma no âmbito regional (Sustainability Appraisal of the Draft East Midlands Regional Plan) e outra no âmbito local (Sustainability Appraisal of the North Hertfordshire Local Development Framework). Para as análises das experiências selecionadas foram considerados os critérios de boas práticas identificados na literatura bem como as diretrizes estabelecidas pela Diretiva Européia de AAE. Verificou-se, ainda, que mesmo na Inglaterra, região considerada como referência em termos de pesquisa e prática no campo da AAE, ainda há uma série de ajustes e falhas a serem melhorados nas ações de monitoramento, principalmente no que diz respeito à identificação de medidas de correção de impactos ambientais negativos. Desta maneira, para o alcance dos objetivos traçados na AAE há a necessidade clara de garantir a retroalimentação do processo com informações identificadas no monitoramento.

Learning together: designing effective e-classrooms

This paper reports on the innovative development of e-learning in criminology and criminal justice programmes that were designed in line with the current ethos of learning and teaching in the Higher Education Academy. The criteria for best practice, the advantages and potential barriers to implementing or adopting such an approach to teaching are highlighted. The paper then discusses the experiences of our students who have participated in virtual collaborative work with students in other jurisdictions and geographical locations in the UK and the US. It concludes that while there are many beneficial outcomes for students and staff in this learning and teaching experience it does need to be supported in the academy if it is to continue to be viable.

Benefits of ecological engineering practices

With the intention to further promote the field of ecological engineering and the solutions it provides, a workshop on “Benefits of Ecological Engineering Practices” was held 3 Dec 2009. It was conducted by the International Ecological Engineering Society in Paris at the conference “Ecological Engineering: from Concepts to Application” organized by the Ecological Engineering Applications Group GAIE. This paper presents the results of the workshop related to three key questions: (1) what are the benefits of ecological engineering practices to human and ecosystem well-being, (2) which concepts are used or useful to identify, reference, and measure the benefits of ecological engineering practices, and (3) how and to whom shall benefits of ecological engineering practices be promoted. While benefits of ecological engineering practices are diverse, general conclusions can be derived to facilitate communication. Identifying benefits requires valuation frameworks reaching beyond the scope of ecology and engineering. A distinction between human and ecosystem well-being in this regard may not be easy or useful, but instead humans embedded in ecosystems should be addressed as a whole. The concepts of resource efficiency, ecosystem services, ecosystem health, and multifunctional land use could serve as suitable references to frame ecological engineering benefits, as well as referring to international political goals such as biodiversity protection, climate change mitigation and poverty reduction. Sector and application specific criteria of good practice could be worked out. Regional, area specific reference systems for sustainable development could provide comparative advantages for ecologically engineered solutions. Besides people with high decision making power and people with high motivation for change are good target groups to be addressed.

Combining rigour with relevance: A novel methodology for testing Chinese herbal medicine

There is a need to develop an evidence base for Chinese herbal medicine (CHM) that is both rigorous and reflective of good practice. This paper proposes a novel methodology to test individualised herbal decoctions using a randomised, double blinded, placebo controlled clinical trial. A feasibility study was conducted to explore the role of CHM in the treatment of endometriosis. Herbal formulae were pre-cooked and dispensed as individual doses in sealed plastic sachets. This permitted the development and testing of a plausible placebo decoction. Participants were randomised at a distant pharmacy to receive either an individualised herbal prescription or a placebo. The trial met the predetermined criteria for good practice. Neither the participants nor the practitioner-researcher could reliably identify group allocation. Of the 28 women who completed the trial, in the placebo group (n=15) 3 women (20%) correctly guessed they were on placebo, 8 (53%) thought they were on herbs and 4 (27%) did not know which group they had been allocated to. In the active group (n=13) 2 (15%) though they were on placebo, 8 (62%) thought they were on herbs and 3 (23%) did not know. Randomisation, double blinding and allocation concealment were successful and the study model appeared to be feasible and effective. It is now possible to subject CHM to rigorous scientific scrutiny without compromising model validity. Improvement in the design of the placebo using food colourings and flavourings instead of dried food will help guarantee the therapeutic inertia of the placebo decoction.

Quality colonoscopy: assumptions and expectations

Colonoscopy has become accepted as the most effective method of screening of the colon for neoplasia. Evidences prove that utilization of colonoscopy has increased dramatically in the past few years, largely because of increased rates of CRC screening. Effectiveness and safety of colonoscopy depend on the quality of examination, and growing body of evidence suggests that the quality of colonoscopy varies in clinical practice. Quality assurance of colonoscopy could be expected to contribute significantly to improved patient care. There is a clear need for evidence-based quality measures to ensure the quality of colonoscopy. In this review we present an overview of literature concerning criteria for best practice and important quality indicators for colonoscopy.

Good radiographic practice: The Nigerian experience and the CEC recommendations

A survey of 25 hospitals in Nigeria has been conducted to assess the level of compliance to the Commission for European Communities (CEC) criteria for good radiographic practice in four adult radiographic examinations. Chest, skull, abdominal and lumbar spine radiographic examinations were assessed. Using a simple scoring system of ‘0’ for unfulfilled and ‘1’ for fulfilled criteria, the results show an average compliance level of 50 ± 8% for chest, 57 ± 8% for skull, 56 ± 10% for abdomen and 51 ± 7% for lumbar spine radiography. Findings show that the level of compliance could be corrected by the adoption of quality control programmes in the country.

What accounts for good practice? Assessment of obesity prevention projects for kindergarten children in Germany

Objective Up to now, no guideline has been set up that provides criteria for good practice in universal and selective childhood obesity prevention projects for children aged 3 to 6 in the kindergarten setting. Hence, based on guidelines for targeted prevention, the present study not only aims at assessing the current state of German universal and selective childhood obesity prevention projects in kindergartens, but also at deriving criteria of good practice in order to help fill this gap.

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

BackgroundPeople with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions.Methods and designHELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities.Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems.DiscussionA general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities.

How does the quality of surveys for nutrient intake adequacy assessment compare across Europe? A scoring system to rate the quality of data in such surveys

Research was conducted within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence, to find the best practice in assessing nutrient intakes. Objectives include: to search for and use data on individual nutrient intake adequacy (NIA) assessment collected in twenty-eight European countries and the four European Free Trade Association countries; to design and test innovative tools for data quality analysis. The information was obtained using the method described by Blanquer et al. in the present issue. The best-practice criteria were devised to select the most appropriate survey in each country. Then a survey quality scoring system was developed in consultation with experts and tested on these surveys. Weights were allocated according to a variable priority order agreed by consultation. The thirty-two countries yielded twenty-four national surveys (eight countries excluded). Data collection techniques: eleven countries/surveys used personal interviews only; six used combinations of techniques. Dietary assessment methods: two used repeated 24 h recalls only; eleven used combinations. NIA assessment methods: two used probabilistic approach and sd/Z-scores only; eleven used comparison with estimated average requirements/RDA only. Countries were ranked according to the survey quality scoring, but careful interpretation is needed because of incomplete data from some surveys; bearing this in mind, the information quality is high in 37.5 % countries, medium in 50.0 % and low in 12.5 %. Although there is room for improvement and caution should be taken when drawing conclusions and recommendations from these results, the lessons learned and tools developed at this first attempt form the basis for future work within the EURRECA framework for aligning European micronutrient recommendations.

Using Quality Improvement Science to Implement a Multidisciplinary Behavioral Intervention Targeting Pediatric Inpatient Airway Clearance

The objective of this study was to use quality improvement science methodology to develop a multidisciplinary intervention improving occurrence of best-practice airway clearance therapy (ACT) in inpatient adolescents with cystic fibrosis during routine clinical care. The model for improvement was used to develop and implement interventions. Primary outcomes were quality of ACT (% ACT meeting criteria for best practice) and quantity of ACT (% of hospital days patients received ACT four times/day). Annotated control charts were used to document the impact of the interventions. Quality of ACT significantly improved from 21% best practice ACT at baseline to 73%. Quantity of ACT significantly improved from 41% days with ACT four times/day at baseline to 64%. A multidisciplinary, evidence-based intervention was effective for improving occurrence of best-practice ACT. Pediatric psychology can make valuable contributions to improving the quality of care provided in the medical setting.

A small world on feet of clay? A comparison of empirical small-world studies against best-practice criteria

Small-world studies were introduced by Milgram and others in the 1960s and 1970s. These studies, and a majority of variants conducted by others, display a number of methodological weaknesses that bias their results. While no explicit methodological standard exists for these studies, here I derive a number of best-practice criteria for small-world studies by pointing out mistakes of previous studies, and by applying methodological standards from other empirical research areas. Improving the methodology of letter referral studies is important, because such studies could still be useful in a number of contexts today, especially for the exploration of factors affecting targeted search processes.

Cytomegalovirus vaccination of leukemia and lymphoma patients after allogeneic stem cell transplantation — Validation of a peptide vaccine

Peptide vaccination constitutes a novel immunotherapeutical approach for the treatment of patients with solid tumors, lymphoma and leukemia. Moreover it might be of use in hematooncological patients for the prevention and therapy of infections like cytomegalovirus (CMV) reactivation due to immunosuppression. To meet good manufacturing practice (GMP) criteria, we introduce here a bio-assay to validate peptide vaccines for peptide content and bio-activity. As a paradigm for peptide vaccine preparation the immunogenic CMV peptide 495–503 NLVPMVATV lyophilisate was resolubilized in dimethyl sulfoxide, phosphate buffered saline and admixed with Montanide™. Addition of different amounts of peptide (10–80 µg) to a mixed lymphocyte peptide culture (MLPC) resulted in the generation of interferon (IFN) gamma and granzyme B releasing CD8 + CMV tetramer + T cells in a dose dependent manner. The combination of FACS and ELISPOT results allowed the definition of the peptide amount in a vaccine preparation. Storage at ± 4 °C over 24 h did not result in a significant change of the immunogenicity of the vaccine. In contrast, cryopreservation of the vaccine at − 20 °C resulted in a loss of immunogenicity. Quantitation of tumor/viral antigen peptides admixed with adjuvants, such as incomplete Freund's adjuvant (IFA), is feasible through bio-assays as the modified ELISPOT/FACS assay described here, meeting GMP criteria for multi-center trials.

Peptide Vaccine Preparation and Validation with a Bio-Assay

Introduction: Peptide vaccination constitutes a novel immunotherapeutical approach for the treatment of patients with solid tumors, lymphoma and leukemia. Moreover it might be of use in hematooncological patients for the prevention and therapy of infections like cytomegalovirus (CMV) reactivation due to immunosuppression. To meet good manufacturing practice (GMP) criteria, we introduce here a bio-assay to validate peptide vaccines for peptide content and bio-activity.Methods: As a paradigm for peptide vaccine preparation the immunogenic CMV peptide (pp65, pos.: 495–503 NLVPMVATV) lyophilisate was resolubilized in dimethyl sulfoxide (DMSO), phosphate buffered saline (PBS) and admixed with Montanide™ (ISA51: incomplete Freund's adjuvant [IFA]). This mixture freshly prepared, stored at +4°C and cryopreserved at −20°C was subjected to lymphocyte peptide cultures (MLPC) followed by enzyme linked immunospot (ELISPOT) assays and flow cytometry (FACS) as bio-assay.Results: Addition of different amounts of peptide (10–80 μg) to a MLPC resulted in the generation of interferon (IFN) gamma and granzyme B releasing CD8+ CMV tetramer+ T cells in a dose dependent manner. The combination of FACS and ELISPOT results allowed the definition of the peptide amount in a vaccine preparation. Storage at ±4°C over 24 hrs did not result in a significant change of the immunogenicity of the vaccine, as assessed by ELISPOT and FACS. In contrast, cryopreservation of the vaccine at −20°C resulted in a loss of immunogenicity.Conclusion: Quantitation of tumor/viral antigen peptides admixed with adjuvants, such as IFA, is feasible through bio-assays as the modified ELISPOT/FACS assay described here, meeting GMP criteria for multi-center trials.

Legal aspects of end-of-life decisions in Italy

The interruption of life support poses different problems for he who interrogates himself regarding the possible juridical role of omissible behaviour or activities by part of the physician when dealing with end-of-life interventions within the boundary of life and death. The present contribution proposes to trace the coordinates necessary to answer the main query regarding the obligations which may be incumbent on the physician. For this reason, the necessity to interpret the legal sanctions in a technical key is highlighted. This is performed in sight of a progressive and inevitable adaptation to problems which are the result of a social evolution, and to the conception of values which constitute an object responsibility, as renewed by the constitution. The laws that discipline crimes against life and individual integrity must be interpreted while keeping in mind that the objective of maintaining the patient in life must be integrated with the control of suffering and the guarantee of a dignified death. When identifying the principles which have to inspire the decisions during 'borderline or boundary situations', it is highlighted the way the physician has to resort to a just equilibrium between benefit, which can be reasonably expected, and sacrifice, which should be imposed, taking into consideration the criteria of good clinical practice, among which attention to the patient's will must be taken into consideration.

Retronectin®-assisted retroviral transduction of primary human T lymphocytes under good manufacturing practice conditions: tissue culture bag critically determines cell yield

For our clinical immunogene therapy study for the treatment of renal cell carcinoma (RCC) patients, we had developed a protocol for gene transduction and expansion of human T cells in compliance with good manufacturing practice (GMP) criteria. Critical to our successful clinical-scale transductions of patient T cells was the use of Retronectin in combination with Lifecell X-foldtrade mark cell culture bags. In our current study, we evaluated two alternative types of bags for the Retronectin-mediated retroviral transduction of human T cells: the Miltenyi DC-generation bag and the Takara CultiLife Spin bag. In static transductions, but not in spinoculation, the DC-generation bags and CultiLife Spin bags performed as well as Lifecell X-foldtrade mark bags in Retronectin-assisted retroviral transduction of human T cells with respect to transduction efficiency, lymphocyte subset composition and lymphocyte function. However, both types of bags performed less well than Lifecell X-foldtrade mark cell culture bags in terms of cell yield. Adjusted numbers of cells at the start of transduction should be used when using the Miltenyi or Takara bags in order to compensate for the lower cell yield following transduction.

Verification of Medical Guidelines Using Background Knowledge in Task Networks

The application of a medical guideline to the treatment of a patient's disease can be seen as the execution of tasks, sequentially or in parallel, in the face of patient data. It has been shown that many of such guidelines can be represented as a network of tasks,? that is, as a sequence of steps that have a specific function or goal. In this paper, a novel methodology for verifying the quality of such guidelines is introduced. To investigate the quality of such guidelines, we propose to include medical background knowledge to task networks and to formalize criteria for good medical practice that a guideline should comply with. This framework was successfully applied to a guideline dealing with the management of diabetes mellitus type 2 by using KIV.