Final Guidelines Research Articles

Singapore ministry of health clinical practice guidelines on stroke and transient ischemic attacks.

The primary aim of these guidelines is to assist individual clinicians, hospital departments, and hospital administrators to produce local protocols for the: • assessment, investigation and immediate management of individuals with a transient ischemic attack or acute stroke (other than sub-arachnoid hemorrhage), and • secondary prevention and risk factor management following a transient ischemic attack or acute stroke. The secondary aim of these guidelines is to suggest methods for implementation and clinical audit. The workgroup preparing these guidelines was formed by the Ministry of Health, Singapore. It comprised healthcare workers from relevant specialties, family medicine, nursing, occupational therapy, and a lay patient advocate. The Scottish Intercollegiate Guidelines Network's Clinical Practice Guidelines on the Management of Patients with Stroke were reviewed, updated, and modified to meet local needs. The final guidelines are made up of evidence-based recommendations covering the following areas - assessment, investigation, immediate management, secondary prevention, rehabilitation, and implications for service delivery. The guidelines were sent to professional organizations for comments and endorsements. The final version was circulated to all medical practitioners in Singapore. It is hoped that the guidelines will improve the care of patients with stroke and transient ischemic attack. Clinical quality improvement measures are proposed.

Consumer involvement in topic and outcome selection in the development of clinical practice guidelines

Consumer involvement in guideline development is advocated, but minimal participation, such as a nominated consumer representative on a guideline working group, can inhibit their decision-making power and contribution. Little is known about how to involve consumers more effectively in guideline development. To describe a targeted approach for involving consumers actively in guideline development, by focusing on topic and outcome selection, and to discuss the impact on content and structure of the final guideline. Descriptive study. Patients and carers (n = 24) from a tertiary hospital in Sydney attended three structured peer-facilitated workshops to complete group-based exercises on topic and outcome selection for guidelines for early stage chronic kidney disease. These workshops were run in parallel with the guideline-writing group. For each exercise, participants formed small groups and facilitated their own discussion, recorded their responses and presented them to the wider group. The topics and outcomes identified were fed back to the guideline writers. The participants actively engaged in the workshop discussions and articulated topics and outcomes they perceived should be included in clinical guidelines. Four main changes to guideline-related outputs were observed. A new guideline subtopic was introduced, guidelines were consumer-endorsed, guideline recommendations and suggestions for clinical care were augmented with consumer-focused issues, and plain English guidelines were developed. Consumer workshops in parallel and feeding into guideline development can be a feasible and effective approach for active consumer contribution. This process can inform the development of both consumer-focused guidelines for clinicians and specific versions for consumers.

Credit Default Swaps (CDS): Theory Emerging into Practice (Initiated by Reserve Bank of India)

India is all set to launch credit Default Swaps which are expected to ignite the spark which will flourish the corporate bond market. Considering the caution nature of RBI and the havoc created by CDS in global market the move by RBI is significant. From the move of RBI one can say as the knife itself is not harmful but it depends whether it’s in a doctor’s hand or a robber’s hand. Similarly CDS as a product is certainly not harmful but its utility will depend on the judicial use of the same. RBI has given clear indications about the launch of CDS. Reserve Bank of India has placed its draft report of the Internal Group on Introduction of Credit Default Swaps (CDS) for Corporate Bonds on 4th August, 2010. RBI has published draft guidelines on the introduction to CDS in 2003 and in 2007 and these were again introduced in the Second Quarter Review of Monetary Policy of 2009-10 wherein RBI proposed the introduction of plain vanilla OTC single-name CDS for corporate bonds for resident entities subject to appropriate safeguards. However, taking into account the status of risk management practices then prevailing in the banking system and also the experiences relating to the financial crisis, the issuance of final guidelines was deferred. This research paper aims to examine the scope of the guidelines issue by the RBI so far with respect to introducing CDS in India. As a part of the endeavour the authors also seek to identify need for CDS and analyse the Credit Derivative Market of India.

AAD publish final guidelines for psoriasis and psoriatic arthritis

AAD publish final guidelines for psoriasis and psoriatic arthritis

조망 및 지형특성에 따른 경관고도 도출과 적용 방안 - 북한산 국립공원 인근의 최고고도지구를 중심으로 -

서울의 도시경관은 경제성장과 함께 급속하게 성장하고 변화하였다. 서울시는 건축물 난립으로 인하여 경관이 훼손되는 것을 보호하기 위하여 고도지구를 지정하여 도시경관을 보전 관리하기 시작하였다. 도시경관을 보전하기 위한 최고고도지구 지정은 그 목적이 명확하고 규제가 단순하여 시행 및 관리가 용이하지만, 규제 높이에 대한 객관적인 근거가 부족하여 설득력이 부족하다. 또한 일률적인 규제로 인하여 획일적인 경관을 형성하고 재산권 제약 및 지역발전 저해 등으로 인하여 주민으로부터 민원을 발생시키고 있다. 이러한 문제를 해결하기 위하여 많은 연구가 진행되고 있으나, 여전히 일률적인 기준에 의하여 규제되고 있어 보다 객관적이고 합리적인 경관고도 기준 도출이 필요하다. 따라서 본 연구는 국립공원의 자연경관을 보호하기 위한 목적으로 지정되어 있는 북한산 인근의 최고고도지구를 사례 대상지로 선정하여 자연경관의 훼손을 최소화하면서 인공경관과 자연경관이 조화를 이룰 수 있는 경관고도를 제시하고자 하였다. 이를 위하여 문헌조사를 통한 경관고도 기준의 유형 중 절대높이 기준, 조망선 기준, 사선제한 기준에 대하여 파악하고, 경관고도 설정 기본 원칙을 수립하였으며, 북한산 인근의 최고고도지구의 현황 및 문제점을 파악한 후 강북구를 적용 대상지로 선정하여 설문조사를 통하여 우수 조망점과 조망축을 파악하였다. 문헌조사를 통하여 파악한 경관고도 기준의 유형을 기초로 하여 강북구 최고고도지구의 구역을 세분화함으로써 각 구역에 적합한 경관고도 기준을 도출하였다. 도출된 기준은 3차원 시뮬레이션을 통하여 적용해 봄으로써 최종 경관고도를 제시하였다. The landscape of Seoul was dynamically changed and developed with the rapid post-war economic growth. Seoul city designated a height regulation district to preserve and manage the city landscape and protect it from haphazard construction. The designation of a maximum height regulation district has obvious purpose and simple regulations which makes the implementation and management easy to apply yet the altitude restriction lacks an objective basis for its enforcement. Many studies have been done and the current uniform height regulation requires more objective and logical guidelines. This study selected the Bukhan Mountain area, a National Park designated to protect the environment, to present a new landscape height guideline to minimize environmental degradation and to harmonize the artificial and natural landscapes of the area. Document research was done to identify the regulation types(absolute height regulation, view line regulation, oblique line restriction regulation) and principles for height regulation district establishment, acknowledge the current status and issues of the Bukhan Mountain area's maximum height regulation district. Gangbuk-Gu was chosen as the site and survey was conducted on outstanding view points and view corridors of residents. From document research, an appropriate landscape height guideline was selected and applied to Gangbuk-Gu. According to the guideline, suitable heights for buildings were suggested. These were then applied to three-dimensional simulations and a final guideline was suggested.

Guidelines for the Management of the Foot Health Problems Associated with Rheumatoid Arthritis

Rheumatoid arthritis (RA) as a chronic systemic disease, commonly affects the feet, impacting negatively on patients' quality of life. Specialist podiatrists have a prime role to play in the assessment and management of foot and ankle problems within this patient group. However, it has been identified that in many areas there is no specialist podiatry service, with many patients being managed by non-specialist podiatrists. Therefore, the North West Clinical Effectiveness Group for the Foot in Rheumatic Diseases (NWCEG) identified the need to develop 'practitioner facing' guidelines for the management of specific foot health problems associated with RA. Members of a guideline development group from the NWCEG each reviewed the evidence for specific aspects of the assessment and management of foot problems. Where evidence was lacking, 'expert opinion' was obtained from the members of the NWCEG and added as a consensus on current and best practice. An iterative approach was employed, with the results being reviewed and revised by all members of the group and external reviewers before the final guideline document was produced. The management of specific foot problems (callus, nail pathology, ulceration) and the use of specific interventions (foot orthoses, footwear, patient education, steroid injection therapy) are detailed and standards in relation to each are provided. A diagrammatic screening pathway is presented, with the aim of guiding non-specialist podiatrists through the complexity of assessing and managing those patients with problems requiring input from a specialist podiatrist and other members of the rheumatology multidisciplinary team. This pragmatic approach ensured that the guidelines were relevant and applicable to current practice as 'best practice', based on the available evidence from the literature and consensus expert opinion. These guidelines provide both specialist and non-specialist podiatrists with the essential and 'gold standard' aspects of managing people with RA-related foot problems.

OECD Guidelines on Business Restructuring and German Transfer of Function Regulations: Do Both Jeopardize the Existing Arm’s Length Principle?

With the finalization of Chap. IX of the OECD Guidelines and the publication of the final German administration principles dealing with the transfer of functions, on the OECD level as well as in Germany, comprehensive final guidelines and regulations are available for cross-border business relocations between related parties. This article analyses the extent to which the new guidance is in line with the existing interpretation of the arm’s length principle.

Canadian Sedentary Behaviour Guidelines for Children and Youth

The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children's Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5-11years) and Youth (aged 12-17years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5-11years) and youth (aged 12-17years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2h per day- lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence.

Development of a Clinical Guideline to Predict Undiagnosed Diabetes in Dental Patients

In 2007, 17.9 million people in the United States had diagnosed diabetes, and 5.7 million had undiagnosed diabetes. The authors developed a clinical guideline to help dentists identify patients with undiagnosed diabetes. The authors used classification and regression tree (CART) methods to generate different prediction models using data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988-1994) and data from NHANES 2003-2004 for external validation. They classified participants who answered "No" to the question "Have you ever been told by a physician that you have diabetes?" and who had a fasting plasma glucose level greater than or equal to 126 milligrams per deciliter as having undiagnosed diabetes. The authors used oral examination data regarding the presence or absence of periodontitis and waist circumference, as well as data on participants' self-reported oral health status, weight, age, family history and race or ethnicity. The authors chose the best prediction model by means of 10-fold cross-validation, as well as internal and external validation methods, which evaluated each prediction model by comparing sensitivity, specificity, area under the receiver operating characteristic curve and ease of use criteria (N = 7,545). The authors' final clinical guideline for predicting undiagnosed diabetes in dental patients had a sensitivity of 82.4 percent, a specificity of 52.8 percent and a receiver operating characteristic area under the curve of 0.72. They found that waist circumference, age, self-reported oral health status, self-reported race or ethnicity and self-reported weight information could be used to predict the risk of having undiagnosed diabetes (range, 0.1 to 9.1 percent). Dental care providers should consider using a clinical guideline that includes the following predictors: waist circumference, age, self-reported oral health, self-reported weight and self-reported race or ethnicity, as well as any additional information on periodontal status and family history of diabetes. This clinical guideline could help dentists identify patients with undiagnosed diabetes, resulting in the early identification of dental patients who require treatment for diabetes and, thus, reduce morbidity and health care costs.

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference.

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection Based on the Expert Consensus

Purpose: This study was conducted to develop a guideline for HIV testing in South Korea where the HIV prevalence is very low. It is necessary to make the recommendations presented here based on the epidemiology of opportunistic infection and cancer in the community. Methods: The development of a guideline for HIV testing was conducted using literature reviews and the agreement of Korean experts for HIV patients using a two-round Delphi consensus technique. Each expert was asked to independently answer to each item related to HIV risk. Ten experts participated in the two-round survey. Results: The individual items were determined based on the following categories: high risk behavior, symptom and diseases, colo-rectal diseases, uro-genital diseases and gynecology, skin and oral diseases. The final guideline consisted of 4-scale agreement rating (strongly recommended, recommended, not routinely recommended, no recommendation for routine provision). Discussion: We have developed the guideline for HIV testing in a country where the HIV prevalence is low based on a systematic investigation and expert consensus.

New Canadian Physical Activity Guidelines

The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stakeholders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5-11years), Youth (aged 12-17years), Adults (aged 18-64years), and Older Adults (aged >=65years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evidence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines represents the most current synthesis, interpretation, and application of the scientific evidence to date.

Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report

Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report

C-B3-03: Development and Pilot Testing of Guidelines to Monitor High-Risk Medications in the Ambulatory Setting

Background: Inadequate laboratory monitoring of high-risk medications contributes to preventable adverse drug events. One barrier to appropriate monitoring is lack of standardized monitoring guidelines. The study aims were to develop guidelines to monitor high-risk medications and to assess the prevalence of laboratory testing for these medications in a multispecialty group practice. Methods: We developed guidelines for laboratory monitoring of high-risk medications as part of a patient safety intervention trial. An advisory committee of national experts and local leaders (clinicians, pharmacists, pharmacoepidemiologists, and patient safety experts) used a two-round, internet-based Delphi process to select guideline medications based on the importance of monitoring for efficacy, safety, and drug-drug interactions. Test frequency recommendations were developed by academic pharmacists based on literature review and local interdisciplinary consensus. To estimate the potential impact of the intervention, we determined the prevalence of high-risk drug dispensings and laboratory testing for guideline medications between January 1, 2008 and July 31, 2008. Results: Consensus on medications to include in the guidelines was achieved in two rounds. Final guidelines included 35 drugs/drug classes and 61 laboratory tests. The prevalence of monitoring ranged from 90%, with infrequently prescribed drugs having a lower prevalence of recommended testing. When more than one test was recommended for a selected medication, monitoring within a medication sometimes differed by > 50%. Conclusions: Even among drugs where there is general consensus that laboratory monitoring is important, prevalence of monitoring is highly variable. Further, infrequently prescribed medications are at higher risk for poor monitoring.

Identifying Problems in Students’ Final Projects Based on Scientific Writing Guidelines

Article analyzed student’s difficulties and abilities in writing their final projects, which were undergraduate theses and undergraduate paper conducted by some students at the English Department, Bina Nusantara University. This was a preliminary study to support an appropriate student guideline in writing their final project. The study was conducted by applying qualitative methods that was by analyzing the four theses and one paper in terms of their format: titles, introduction, theoretical background, analysis, conclusion, bibliography, and paper rubric to analyze the contents. It can be concluded that generally, students, guided by their mentor/lecturer, understand the final paper guidelines and they are able to apply it in their thesis and paper. But, there are still lack of clarity and relevancy in expressing their ideas properly, and their ability in writing in both English and Bahasa Indonesia must be improved. These problems can be overcome by socializing the writing guidelines to both students and lecturers, providing them with critical thinking skills, cooperation with library that will guide them in information literacy skills, and language center that will improve their writing skills.

A systematic approach for uptake of evidence on sex‐specific issues in guidelines – a pilot study

Increasing evidence indicates that sex-specific issues may have impact on prevention, diagnosis, or treatment. These issues are not systematically considered during the development of Dutch clinical practice guidelines. The aim of this study is to identify how members of guideline development groups discuss sex-specific evidence, and whether and how the outcomes of these discussions are reflected in the guideline. Six guideline development committees (GDCs) were studied. Each committee was supported by a staff member from the guideline organization who was trained and received feedback to facilitate uptake of evidence on sex differences in the process of guideline development. Non-participant observation and transcription of audio recordings from 22 GDC meetings were performed. Content analysis of meeting transcripts and guidelines were studied to analyse characteristics of discussion episodes on sex-specific research data-based issues (subject matter, initiator and group approach towards the topic and themes) and whether or not conclusions on evidence were reflected in the final guideline text. Of the 87 identified discussion episodes, 68 dealt with sex-specific research evidence potentially relevant to guidelines. Respectively 51%, 28% and 21% of the latter episodes were initiated by committee members, staff members and chairpersons. Group approaches towards the subject matter were generally positive. Data from 60% of those episodes were reflected in the final guideline text. Sex-specific data on reproductive issues were more often discussed and reflected in guideline texts than data on other health issues. Discussion episodes on sex-specific evidence initiated by chairpersons were most often reflected in the guidelines. This pilot study indicates that GDCs regularly focused on sex-specific issues. The participation of a trained staff member contributed to this.

AN ASSESSMENT OF STIFFENED COMPOSITE FUSELAGE PANELS BASED ON THE ROBUSTNESS PARAMETER

The European Commission 6th Framework Project COCOMAT was a four-and-a-half-year project (2004 to mid-2008) aimed at exploiting the large reserve of strength in composite structures through more accurate prediction of collapse. In the experimental work packages, significant statistical variations in buckling behaviour and ultimate loading were encountered. During the experiments for the COCOMAT project, it was recognised that there was a gap in knowledge about the effect of initial defects and variations in the input variables of both the experimental and simulated panels. The effect of the defects and variations in the experimental panel resulted in some failure modes that were not predicted with the finite element modelling. This led to the development of stochastic algorithms to relate variations in boundary conditions, material properties and geometries to the variation in buckling modes and compression loads up to the first failure. This paper shows the development of a stochastic methodology to identify the impact of variation in input parameters on the response of stiffened composite panels and the development of a robust index to support the evaluation of panel designs. The stochastic analysis included the generation of metamodels that allow quantification of the impact that the inputs have on the response using two first order variables, influence and sensitivity. These variables were then used to derive the robust indices to quantify the response of two COCOMAT panels that were experimentally tested, including the response of the panels to simulated damage. The robust indices that are shown in this paper are functions of the robustness parameter which has been recommended in the final Design Guidelines for the COCOMAT project to measure the effects of scatter found in postbuckling loads.

OMIPs—Orchestrating multiplexity in polychromatic science

CYTOMETRY is spearheading advances in quantitative cell based research with its technological emphasis on flow and image based cytometric assays. However, it is not only the innovative technologies but also innovations in increasing the quality and reliability of scientific publications. The prominent example is the MIFlowCyt standard that has been published 2 years ago (1) defining the minimal information that is needed to understand and repeat flow cytometry-based experiments. As of today, two manuscripts were published that were prepared in compliance with MIFlowCyt. One by Blimkie et al. (2) and the second now by Heimbeck and colleagues (this issue: page 823). Both manuscripts serve as prototype papers for authors to make their upcoming work in agreement with the rules. To ease their burden, our team has developed a checklist (this issue: page 813) that simplifies MIFlowCyt adaptation of a new manuscript. In this issue is the inauguration of a new publication type for Cytometry Part A, Optimized Multicolor Immunofluorescence Panel (OMIP). OMIPs are designed to fill a gap in the literature: a mechanism for communicating and disseminating complex panels of reagents designed to interrogate phenotypic or functional aspects of cells. Since panels are basically methodological in nature, it is extravagant to devote an entire research paper to a single panel and most journals are appropriately loathe to do so. Similarly, including panel development in the eventual biological research publication is made difficult by publication constraints. Nonetheless, the development and optimization of these panels can be very complex, time-consuming, and laborious, akin to optimization of any new technique in a laboratory; disseminating that information is highly valuable. As proposed, OMIPs will occupy only two printed pages, with a significant amount of supplemental information. Hence, the OMIP becomes a parsimonious publication mechanism by which information about the panel optimization and use can be communicated. By doing so in a peer-reviewed, citable publication, those who have carried out this significant effort can be suitably recognized for their work. In addition, the OMIP can serve to dramatically shorten development efforts in labs that are initiating a new immunophenotyping study, by providing a suitably-optimized panel or, at a minimum, a significant body of information from which a suitable panel can be built. OMIPs embrace a broad field of scientific and clinical applications including clinical immunology (3; and Alamooti et al., this issue: page 890), leukemia (Xie et al. this issue: page 840), cytokine production (4), phenotyping of stem and progenitor cells (5; and Estes et al., this issue: page 831), and leukocytes (Heimbeck et al., this issue: page 823). It should be stressed that OMIPs are not solely in the realm of flow cytometry. Polychromatic microscopes like the laser scanning cytometer (Zoog et al.; this issue: page 849) are becoming more common; panels optimized for fluorescence microscopy are timely and welcome. Image cytometry technologies may also include labeling techniques that apply sequential restaining to obtain highly complex patterns of cellular phenotype and function such as Toponomics (6) or chip based explorative cytometry (7).

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease

TABLE OF CONTENTSPreamble ……………………………….280 Introduction ………………………281 1.1. Methodology and Evidence Review … . .2811.2. Organization of the Writing Committee …2831.3. Document Review and Approval …… .2831.4. Scope of the Guideline ……………283 1.4.1. Critical Issues …………… . .2831.5. Glossary of Terms and

Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain

ABSTRACTUtah Clinical Guidelines on Prescribing Opioids for Treatment of Pain were produced and made available to medical providers in March 2009. These guidelines were developed by a multidisciplinary consensus panel after a review of existing evidence-based guidelines. Common recommendations were compiled and presented to the panel for review. The guidelines consist of a set of recommendations for both acute and chronic pain. A second panel reviewed existing tools for providers and determined the need for any new tools. The final guidelines include 20 tools for providers to use in their practice. The complete version of the guidelines and the accompanying tools are available at: www.useonlyasdirected.org or www.health.utah.gov/prescription.