Good Practice Criteria Research Articles

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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

Connecting EIA to environmental management systems: lessons from industrial estate developments in England

AbstractThis paper concerns the relationship between environmental assessment and environmental management systems in the context of recent industrial estate developments. Drawing on environmental statements and interviews with developers, an examination was carried out of the level of good practice in estate design and operation, and the way in which this was influenced by environmental impact assessment and environmental management systems. The study concludes that the environmental impact assessment system worked well within the context of land use planning, but that it failed to facilitate the planning of effective environmental management in practice, with the consequence that the projects examined failed to meet many of the good practice criteria against which they were tested. Finally, several recommendations are made to strengthen continuity between the two. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment.

Pharmacoeconomic studies in Italy: a critical review of the literature

To assess the state of pharmacoeconomics in Italy we reviewed all the original studies published by Italian authors in national and international journals from January 1994 to December 2003. We selected 70 articles and broadly assessed 92 economic evaluations (EEs) since some articles contained multiple analyses. We adopted common analysis criteria to allow methodological comparison of the studies. The variables investigated can be grouped into three categories: general methods, costs, and consequences. To further assess the quality of the EEs, we decided to rank them according to criteria of both clinical and economic good practice. Then, to complete our critical evaluation, we analysed whether sponsorship might have somehow affected the results. Our analysis seems to support the widespread scepticism of the Italian NHS decision-makers towards pharmacoeconomic studies, whose results seem to be biased by flawed methods and sponsors' interference with results.

Setting the Standard – UK Neurosurgical Acoustic Neuroma Practice

The aim of this study was to determine how current practice in the UK and Ireland complies with the Clinical Effectiveness Guidelines for the Management of Acoustic Neuromas. A survey of units and consultants using a standardised questionnaire was carried out. Fifty-six neurosurgeons treat acoustic neuromas in 33 out of 34 units. In 27 units, one or two surgeons specialise in this area. Caseload per annum per surgeon ranged from 2 to 30, median 15. Forty-one neurosurgeons (75%) work with an ENT surgeon. All surgeons use facial nerve monitoring during surgery. All neurosurgeons informed patients about stereotactic radiosurgery, tending to recommend it for medically unfit patients, and those with small tumours. Overall, 26 units (79%) and 40 surgeons (73%) met the criteria for good surgical practice. The main reasons for non-compliance were a lack of teamwork with ENT, and insufficient caseload to maintain surgical expertise.

Zorgvuldigheidseisen in de zorgverlening rond het levenseinde

Medical decisions at the end of life include a broad range of decisions and actions, ranging from normal medical care (such as starting a treatment, palliative care etc.) to special medical care (euthanasia or ending a patient’s life without request).These decisions are regulated both by law and professional guidelines. Together these norms and guidelines make up the physician’s professional standard. In the context of this standard a large number of criteria for good medical practice have been developed. These criteria are an important means to improve the quality and transparency of medical decision at the end of life.

ECOREGIONAL RESEARCH IN AFRICA: LEARNING LESSONS FROM IITA'S BENCHMARK AREA APPROACH

Ecoregional research has the potential to help address some of the huge challenges facing agriculture in developing countries by developing technologies that work under different agro-ecological conditions, and the processes by which these technologies can be adapted to work in other areas with similar conditions. The CGIAR system has been developing ecoregional research as a new paradigm for over a decade. In this paper we evaluate one of the most ambitious of these initiatives called the Benchmark Area Approach (BAA) pioneered by the International Institute of Tropical Agriculture. We evaluate the BAA against nine good practice criteria for ecoregional research and finding that the approach is delivering, or has the potential to deliver, on all nine. Many of the lessons learnt from this evaluation will be relevant to current and future attempts to undertake co-ordinated multi-locational research for development.

Laptops in class: What are they good for? What can you do with them?

AbstractThis chapter describes Clemson University's Laptop Faculty Development Program and its assessment, offering the program as one model for designing faculty development to successfully implement laptop mandates. The chapter also acquaints readers with the many types of in‐class, laptop‐based activities that meet best‐practice criteria for effective teaching.

Inhalation Induction of Anesthesia with 8% Sevoflurane in Pediatric Ambulatory Surgery: Conditions for Nasotracheal Intubation and the Effects of Dexamethasone on Postoperative Nausea and Vomiting

Backgrounds: In this study, we assessed nasotracheal intubation conditions following an inhalation induction using 8% sevoflurane and nitrous oxide with fentanyl and evaluated the effect of 0.1 mg/kg dexamethasone on postoperative nausea and vomiting (PONV) in pediatric ambulatory patients. Methods: Forty-two pediatric patients requiring nasotracheal intubation were scheduled for ambulatory procedures. Anesthesia was induced with sevoflurane 8% in a nitrous oxide and oxygen mixture, and after an end-expiratory concentration of sevoflurane of at least 4.5% had been reached, the trachea was intubated. Intubating conditions were graded as excellent, good, poor or impossible according to Good Clinical Research Practice criteria, and the incidence of adverse events during induction were also noted. Patients were randomly allocated to receive normal saline (control group, n = 20) or dexamethasone 0.1 mg/kg (dexamethasone group, n= 22) after the induction of anesthesia. Results: Nasotracheal intubation was accomplished successfully in 100% of the patients and clinically acceptable intubating conditions were obtained in 38 patients (25 excellent and 13 good). There were no significant differences between the two groups in age, sex, and operation time. In the 0 to 6 hour postoperative period, the incidences of PONV were 15% and 9% in the control and dexamethasone groups respectively, but this was not significantly different. Conclusions: Induction with sevoflurane in nitrous oxide and oxygen provided ideal conditions for nasotracheal intubation. Intraoperative dexamethasone did not significantly reduce PONV after inhalation induction and maintenance with sevoflurane during the first 6 hour postoperative period in pediatric patients.

SERVICE-LEARNING IN CHRISTIAN HIGHER EDUCATION: BRINGING OUR MISSION TO LIFE

The purpose of the study reported in this paper was to develop a working definition of service-learning, identify the best practices of service-learning in the context of Christian colleges and universities and, based upon that information, develop a model for replication. The study undertaken included: (a) examination of the findings of unpublished data from a survey on service-learning at 90 Christian colleges and universities and notes from a conference on service-learning at faith-based institutions; (b) a thorough review of the literature on service-learning and the mission and purpose of Christian higher education; and (c) interviews with practitioners from seven Christian colleges or universities that met prescribed criteria for best practices in service-learning, A content analysis resulted in a comprehensive definition of service-learning, key elements of best practices in service-learning, and a model which incorporates guidelines for Christian colleges and universities to use when developing service-learning programs. The comprehensive definition incorporates characteristics from previous definitions, but includes an added component of institutional support for service-learning. The best practices in service-learning in Christian higher education corroborate this finding and include key elements. The model for designing a service-learning program at a Christian college builds further upon the definition and best practices and includes eight guidelines. The model guidelines are meant to address the philosophical and practical implications in designing an effective service-learning course and program in Christian institutions of learning. The data from this study strongly suggest that Christian colleges and universities should implement service-learning as a means of furthering their faith-based missions through their curricula.

Quality management within the competence network of paediatric oncology and haematology

The competence network paediatric oncology and haematology aims at improving the structure of paediatric oncology and haematology as a whole focussing in particular on the quality of clinical trials and study centres. This implicates the following measures: (1) Employment of research and trial assistants in order to improve the quality of documentation and study management in the participating hospitals. (2) Building up of an Internet portal to provide medical information for non-professionals, for patients and their families as well as for health professionals. (3) The project "Study Assistance" supports study centers during the process of writing and examining new treatment protocols so that they are in compliance with the Good Clinical Practice criteria, formal criteria and statutory provisions. It presently works on a structural standardisation of study protocols and case record forms in order to improve their usability. In addition, the working group "Quality Assurance in GPOH Study Centres" is engaged in developing a quality management system for study centers.

Does the choice of intravenous induction drug affect intubation conditions after a fast-onset neuromuscular blocker?

Study objectives To compare intubation conditions and hemodynamic effects resulting from thiopental-rapacuronium, propofol-rapacuronium, and etomidate-rapacuronium intravenous (IV) induction. Design Randomized, blinded study. Setting Operating suites of a large university-affiliated medical center. Patients 60 ASA physical status I and II adult patients without airway abnormalities, who were scheduled for elective surgery requiring endotracheal intubation. Interventions Patients were randomly allocated to receive IV thiopental sodium 5 mg/kg (Group 1), propofol 2 mg/kg (Group 2), or etomidate 0.3 mg/kg (Group 3) followed by rapacuronium 1.5 mg/kg. Fifty seconds later, an anesthesiologist, who had no knowledge of the induction drug used, entered the operating room and attempted laryngoscopy and intubation. Measurements Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded. Main results All patients were intubated within 55 to 70 seconds. Clinically acceptable intubation conditions were not statistically different among the three groups. Moderate tachycardia after induction was seen in all three groups, and blood pressure was significantly lower in Group 2 than in Groups 1 or 3. Conclusions Clinically acceptable intubation conditions are similar after either thiopental, propofol, or etomidate when a fast-onset neuromuscular blocking drug (rapacuronium 1.5 mg/kg) is used to facilitate tracheal intubation.

Application of POM to e‐business: B2C e‐shopping

Can operations management impact significantly the profitability of consumer‐based businesses on the Internet (called B2C)? During the past two years, Internet retailers have not provided satisfactory financial results. Whereas, leading in‐store retailers have been profitable using traditional modes for selling and delivering goods to customers. The research underlying this paper focused on analyzing the costs of doing business which are affected by operations management decisions. We wanted to determine if the criteria for best practice normally used by operations managers applied to firms engaged in e‐tailing (Internet B2C). To do this we singled out a well‐known dot.com retail failure, Webvan. Cost data were studied from startup (1998) to bankruptcy (2001). It was found that operating costs were way out of line with (even) good practice. Under in‐store retailing circumstances, the inability to reach breakeven would not have been tolerated. While concentrating on Webvan, this paper uses information about other firms to provide additional insights.

Principles of Good Practice for Decision Analytic Modeling in Health-Care Evaluation: Report of the ISPOR Task Force on Good Research Practices—Modeling Studies

Objectives Mathematical modeling is used widely in economic evaluations of pharmaceuticals and other health-care technologies. Users of models in government and the private sector need to be able to evaluate the quality of models according to scientific criteria of good practice. This report describes the consensus of a task force convened to provide modelers with guidelines for conducting and reporting modeling studies. Methods The task force was appointed with the advice and consent of the Board of Directors of ISPOR. Members were experienced developers or users of models, worked in academia and industry, and came from several countries in North America and Europe. The task force met on three occasions, conducted frequent correspondence and exchanges of drafts by electronic mail, and solicited comments on three drafts from a core group of external reviewers and more broadly from the membership of ISPOR. Results Criteria for assessing the quality of models fell into three areas: model structure, data used as inputs to models, and model validation. Several major themes cut across these areas. Models and their results should be represented as aids to decision making, not as statements of scientific fact; therefore, it is inappropriate to demand that models be validated prospectively before use. However, model assumptions regarding causal structure and parameter estimates should be continually assessed against data, and models should be revised accordingly. Structural assumptions and parameter estimates should be reported clearly and explicitly, and opportunities for users to appreciate the conditional relationship between inputs and outputs should be provided through sensitivity analyses. Conclusions Model-based evaluations are a valuable resource for health-care decision makers. It is the responsibility of model developers to conduct modeling studies according to the best practicable standards of quality and to communicate results with adequate disclosure of assumptions and with the caveat that conclusions are conditional upon the assumptions and data on which the model is built.

An assessment of the use of Implanon® in three community services

AimsThe aims of the study were three-fold, namely to assess continuation rates with Implanon® fitted in clients from three contraception and sexual health services; to identify factors associated with early...

Protocol for gene transduction and expansion of human T lymphocytes for clinical immunogene therapy of cancer.

In preparation of a clinical phase I/II study in renal cell carcinoma (RCC) patients, we developed a clinically applicable protocol that meets good clinical practice (GCP) criteria regarding the gene transduction and expansion of primary human T lymphocytes. We previously designed a transgene that encodes a single chain (sc) FvG250 antibody chimeric receptor (ch-Rec), specific for a RCC tumor-associated antigen (TAA), and that genetically programs human T lymphocytes with RCC immune specificity. Here we describe the conditions for activation, gene transduction, and proliferation for primary human T lymphocytes to yield: (a) optimal functional expression of the transgene; (b) ch-Rec-mediated cytokine production, and (c) cytolysis of G250-TAA(POS) RCC by the T-lymphocyte transductants. Moreover, these parameters were tested at clinical scale, i.e., yielding up to 5-10 x 10(9) T-cell transductants, defined as the treatment dose according to our clinical protocol. The following parameters were, for the first time, tested in an interactive way: (1) media compositions for production of virus by the stable PG13 packaging cell; (2) T-lymphocyte activation conditions and reagents (anti-CD3 mAb; anti-CD3+anti-CD28 mAbs; and PHA); (3) kinetics of T-lymphocyte activation prior to gene transduction; (4) (i) T-lymphocyte density, and (ii) volume of virus-containing supernatant per surface unit during gene transduction; and (5) medium composition for T-lymphocyte maintenance (i) in-between gene transduction cycles, and (ii) during in vitro T-lymphocyte expansion. Critical to gene transduction of human T lymphocytes at clinical scale appeared to be the use of the fibronectin fragment CH-296 (Retronectin) as well as Lifecell) X-fold cell culture bags. In order to comply with GCP requirements, we used: (a) bovine serum-free human T-lymphocyte transduction system, i.e., media supplemented with autologous patients' plasma, and (b) a closed cell culture system for all lymphocyte processing. This clinical protocol routinely yields 30-65% scFvG250 ch-Rec(POS) T lymphocytes in both healthy donors and RCC patients.

Tracheal intubation conditions and cardiovascular effects after modified rapid-sequence induction with sevoflurane-rapacuronium versus propofol-rapacuronium

Study Objectives: To compare intubation conditions and hemodynamic effects resulting from rapid-sequence induction of anesthesia with sevoflurane-rapacuronium and propofol-rapacuronium. Design: Randomized, blinded study. Setting: Operating suites of a large university-affiliated medical center. Patients: 40 ASA physical status I and II adult patients without airway abnormalities who were scheduled for elective surgery requiring endotracheal intubation. Interventions: Patients were randomly allocated to receive either sevoflurane inhalational induction (Group 1) or propofol (2 mg/kg) intravenous induction (Group 2). Group 1 patients were coached on how to perform vital capacity breathing and the anesthesia machine was primed with sevoflurane 8%, N 2 O:O 2 3.5:1.5 L/min. In both groups, when loss of consciousness was established, rapacuronium 1.5 mg/kg was administered. After 50 seconds, an anesthesiologist blinded to the study entered the room and attempted laryngoscopy and intubation. Measurements: Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice (GCRP) criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded. Main Results: All patients were successfully intubated within 60 seconds. Clinically acceptable intubating conditions (excellent or good scores) were obtained in 19 of 20 Group 1 patients and in 19 of 20 Group 2 patients. Moderate tachycardia was encountered in both groups and mild systolic hypotension in the Group 2 patients. There were no complications. Conclusions: Modified rapid-sequence inhalational induction using sevoflurane and rapacuronium produced clinically acceptable intubation conditions within 60 seconds of muscle relaxant administration. The intubation conditions were similar to those produced after intravenous propofol and rapacuronium.

On the use of specific publication criteria for papers on process-based modelling in plant science

The use of process-based modelling is increasing in most disciplines of plant science, but criteria for what is acceptable modelling work have rarely been made explicit. Unlike empirical work, modelling does not provide direct information on nature, and the goal is generally to explain natural phenomena, or predict their consequences, rather than reveal new phenomena or test specific hypotheses. Goals, methods and results of modelling and empirical work thus differ and they should be judged by different criteria. This note shows how the four criteria of explanation, testability, novelty and good modelling practice can be applied to modelling papers in the plant sciences. The practical implementation of these criteria is discussed, and a checklist of eight questions is derived with which papers can be evaluated. To illustrate the use of the criteria, they are applied to a classic publication from the crop modelling literature [Simulation of Assimilation, Respiration and Transpiration of Crops. Pudoc, Wageningen].

Set-up verification using portal imaging; review of current clinical practice

In this review of current clinical practice of set-up error verification by means of portal imaging, we firstly define the various types of set-up errors using a consistent nomenclature. The different causes of set-up errors are then summarized. Next, the results of a large number of studies regarding patient set-up verification are presented for treatments of patients with head and neck, prostate, pelvis, lung and breast cancer, as well as for mantle field/total body treatments. This review focuses on the more recent studies in order to assess the criteria for good clinical practice in patient positioning. The reported set-up accuracy varies widely, depending on the treatment site, method of immobilization and institution. The standard deviation (1 SD, mm) of the systematic and random errors for currently applied treatment techniques, separately measured along the three principle axes, ranges from 1.6–4.6 and 1.1–2.5 (head and neck), 1.0–3.8 and 1.2–3.5 (prostate), 1.1–4.7 and 1.1–4.9 (pelvis), 1.8–5.1 and 2.2–5.4 (lung), and 1.0–4.7 and 1.7–14.4 (breast), respectively. Recommendations for procedures to quantify, report and reduce patient set-up errors are given based on the studies described in this review. Using these recommendations, the systematic and random set-up errors that can be achieved in routine clinical practice can be less than 2.0 mm (1 SD) for head and neck, 2.5 mm (1 SD) for prostate, 3.0 mm (1 SD) for general pelvic and 3.5 mm (1 SD) for lung cancer treatment techniques.

The Socialisation of Mature Women Student Teachers: The importance of ethnographic accounts to educational research

The article examines the processes of change and adaptation which a group of undergraduate mature women students underwent as they learned to become student teachers. The study sits firmly within the qualitative paradigm and offers a holistic analysis of student teacher socialisation in which the complexity of adaptation is revealed through the inter-relationship of gender, identity, life course, coping strategies and the negotiation of change. A major theme of the study examines the uneasy blend of struggle, contestation, guilt and success which became a daily feature of their lives as mothers, wives and full-time student teachers. The article argues that the ethnographic research approach was the most appropriate method for revealing new insights about student teacher socialisation. Moreover, it is suggested that ethnographic accounts have an important contribution to make to educational theory and knowledge provided that they go beyond minimalist criteria for good practice.

‘Truth’ and ‘Lies’ Revisited

ABSTRACTAnecdotal evidence suggests that many qualitative researchers have had the experience of discovering that their informants had told them lies. This is quite different to those instances where faulty memory, subjective perception, partial or erroneous knowledge, a desire to give the researcher what they think they want, or even where a ‘personal myth’ comes in to play, because a lie is a conscious and deliberate intention to deceive. What should researchers do when they discover that they have been misled? What are the implications for qualitative methodology and its practitioners in the light of the criteria for good practice outlined in the Tooley Report? This article draws on two examples of informants who lied, in order to explore some of the questions and issues that can arise. It suggests, tentatively, that generic criteria may not always be sufficiently sensitive to cope with complexities of social life.