860 resultados para Practice Guidelines as Topic
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In many respects, Australian boards more closely approach normative best practice guidelines for corporate governance than boards in other Western countries. Do Australian firms then demonstrate a board demographic-organisational performance link that has not been found in other economies? We examine the relationships between board demographics and corporate performance in 348 of Australia's largest publicly listed companies and describe the attributes of these firms and their boards. We find that, after controlling for firm size, board size is positively correlated with firm value. We also find a positive relationship between the proportion of inside directors and the market-based measure of firm performance. We discuss the implications of these findings and compare our findings to prevailing research in the US and the UK.
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Relatrio da Prtica Profissional Supervisionada Mestrado em Educao Pr-Escolar
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RESUMO: A violncia contra as mulheres (VCM) um problema de sade pblica e uma violao dos direitos humanos. Ele tem uma alta prevalncia na Amrica Latina e no Caribe; o Estudo da Violncia Contra as Mulheres da Organizao Mundial de Sade (OMS) identificou que as mulheres peruanas sofrem o maior ndice de violncia. O Per signatrio da CEDAW e da Conveno de Belm do Par, com recomendaes para resolver este tipo de discriminao e descrever o papel do setor da sade. A lei peruana define a violncia como um problema de sade mental. Objectivos: As trs orientaes clnicas do Ministrio da Sade para avaliar a integrao da componente de sade mental no cuidado de mulheres afetadas pela VCM foram revistas. Mtodo: A proteo da sade mental foi avaliada nas orientaes acima mencionadas. A lei peruana relevante para perceber o reconhecimento das consequncias de VCM na sade mental e os cuidados prestados neste contexto foram revistos. Usando esses padres nacionais e internacionais, foi realizada uma anlise de contedo dos guias peruanos para a ateno da violncia para ver como eles se integram a sade mental. Resultados: Estas orientaes so muito extensas e no definem claramente a responsabilidade dos profissionais de sade. No incluem um exame de sade mental na avaliao da vtima e so vagas na descrio das atividades a serem realizadas pelo prestador dos cuidados de sade. As orientaes recomendam uma triagem universal usando um instrumento com formato antiquado e pesado. Em contrapartida, as orientaes da OMS no recomendam qualquer triagem. Concluso: As vrias orientaes analisadas no fornecem a informao necessria para o profissional de sade avaliar o envolvimento da sade mental e, desnecessariamente, tratam as mulheres sobreviventes de VCM como doentes mentais. Recomenda-se que as orientaes recentes da OMS (Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, 2013) para os cuidados de VCM sejam usadas como um modelo para o desenvolvimento de um nico dispositivo tcnico que incorpora directrizes com base cientfica. legislao com base no gnero, sade, guias, preveno e mujeres 6 RESUMO (PORTUGUESE) A violncia contra as mulheres (VCM) um problema de sade pblica e uma violao dos direitos humanos. Ele tem uma alta prevalncia na Amrica Latina e no Caribe; o Estudo da Violncia Contra as Mulheres da Organizao Mundial de Sade (OMS) identificou que as mulheres peruanas sofrem o maior ndice de violncia. O Per signatrio da CEDAW e da Conveno de Belm do Par, com recomendaes para resolver este tipo de discriminao e descrever o papel do setor da sade. A lei peruana define a violncia como um problema de sade mental. Objectivos: As trs orientaes clnicas do Ministrio da Sade para avaliar a integrao da componente de sade mental no cuidado de mulheres afetadas pela VCM foram revistas. Mtodo: A proteo da sade mental foi avaliada nas orientaes acima mencionadas. A lei peruana relevante para perceber o reconhecimento das consequncias de VCM na sade mental e os cuidados prestados neste contexto foram revistos. Usando esses padres nacionais e internacionais, foi realizada uma anlise de contedo dos guias peruanos para a ateno da violncia para ver como eles se integram a sade mental. Resultados: Estas orientaes so muito extensas e no definem claramente a responsabilidade dos profissionais de sade. No incluem um exame de sade mental na avaliao da vtima e so vagas na descrio das atividades a serem realizadas pelo prestador dos cuidados de sade. As orientaes recomendam uma triagem universal usando um instrumento com formato antiquado e pesado. Em contrapartida, as orientaes da OMS no recomendam qualquer triagem. Concluso: As vrias orientaes analisadas no fornecem a informao necessria para o profissional de sade avaliar o envolvimento da sade mental e, desnecessariamente, tratam as mulheres sobreviventes de VCM como doentes mentais. Recomenda-se que as orientaes recentes da OMS (Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, 2013) para os cuidados de VCM sejam usadas como um modelo para o desenvolvimento de um nico dispositivo tcnico que incorpora directrizes com base cientfica.-----------------ABSTRACT: Violence against women (VAW) is a public health problem and a human rights violation. It is highly prevalent in Latin America and the Caribbean; the Multi-country Study on Violence against Women by the World Health Organization identified rural Peruvian women as suffering the highest rates of VAW. The country is party to CEDAW and Belen Do Para Conventions, which set forth recommendations to overcome this form of discrimination and describe the role of the health sector. Peruvian law defines violence as a mental health issue. Objective: The Ministry of Healths three technical guidelines were reviewed to assess the integration of mental health into the care of women affected by violence Method: The protection of the womans mental health was ascertained in the conventions mentioned above. The recognition of the mental health consequences of VAW and the inclusion of its evaluation and care were assessed in pertinent Peruvian legislation. Using these international and national parameters, the three guidelines for the attention of violence were subject to content analysis to see whether they conform to the conventions and integrate mental health care. Outcome: These guidelines are too extensive and do not clearly define the responsibility of health workers. They do not include a mental health exam in the evaluation of the victim and are vague in the description of the actions to be carried out by the health care provider. Guidelines prescribe universal screening using an outdated instrument and moreover, WHO Guidelines do not recommend screening. Conclusion: These multiple guidelines do not provide useful guidance for health care providers, particularly for the assessment of mental health sequelae, and unnecessarily stigmatize survivors of violence as mentally ill. It is recommended that the World Health Organizations document Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines (2013) be used as a blueprint for only one technical instrument that incorporates evidence -based national policy and guidelines.
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La douleur est frquente en milieu de soins intensifs et sa gestion est l'une des missions des infirmires. Son valuation est une prmisse indispensable son soulagement. Cependant lorsque le patient est incapable de signaler sa douleur, les infirmires doivent se baser sur des signes externes pour l'valuer. Les guides de bonne pratique recommandent chez les personnes non communicantes l'usage d'un instrument valid pour la population donne et bas sur l'observation des comportements. A l'heure actuelle, les instruments d'valuation de la douleur disponibles ne sont que partiellement adapts aux personnes crbrolses dans la mesure o ces personnes prsentent des comportements qui leur sont spcifiques. C'est pourquoi, cette tude vise identifier, dcrire et valider des indicateurs, et des descripteurs, de la douleur chez les personnes crbrolses. Un devis d'tude mixte multiphase avec une dominante quantitative a t choisi pour cette tude. Une premire phase consistait identifier des indicateurs et des descripteurs de la douleur chez les personnes crbrolses non communicantes aux soins intensifs en combinant trois sources de donnes : une revue intgrative des crits, une dmarche consultative utilisant la technique du groupe nominal auprs de 18 cliniciens expriments (6 mdecins et 12 infirmires) et les rsultats d'une tude pilote observationnelle ralise auprs de 10 traumatiss crniens. Les rsultats ont permis d'identifier 6 indicateurs et 47 descripteurs comportementaux, vocaux et physiologiques susceptibles d'tre inclus dans un instrument d'valuation de la douleur destin aux personnes crbrolses non- communicantes aux soins intensifs. Une deuxime phase squentielle vrifiait les proprits psychomtriques des indicateurs et des descripteurs pralablement identifis. La validation de contenu a t teste auprs de 10 experts cliniques et 4 experts scientifiques l'aide d'un questionnaire structur qui cherchait valuer la pertinence et la clart/comprhensibilit de chaque descripteur. Cette dmarche a permis de slectionner 33 des 47 descripteurs et valider 6 indicateurs. Dans un deuxime temps, les proprits psychomtriques de ces indicateurs et descripteurs ont t tudis au repos, lors de stimulation non nociceptive et lors d'une stimulation nociceptive (la latralisation du patient) auprs de 116 personnes crbrolses aux soins intensifs hospitalises dans deux centres hospitaliers universitaires. Les rsultats montrent d'importantes variations dans les descripteurs observs lors de stimulation nociceptive probablement dues l'htrognit des patients au niveau de leur tat de conscience. Dix descripteurs ont t limins, car leur frquence lors de la stimulation nociceptive tait infrieure 5% ou leur fiabilit insuffisante. Les descripteurs physiologiques ont tous t supprims en raison de leur faible variabilit et d'une fiabilit inter juge problmatique. Les rsultats montrent que la validit concomitante, c'est--dire la corrlation entre l'auto- valuation du patient et les mesures ralises avec les descripteurs, est satisfaisante lors de stimulation nociceptive {rs=0,527, p=0,003, n=30). Par contre la validit convergente, qui vrifiait l'association entre l'valuation de la douleur par l'infirmire en charge du patient et les mesures raliss avec les descripteurs, ainsi que la validit divergente, qui vrifiait si les indicateurs discriminent entre la stimulation nociceptive et le repos, mettent en vidence des rsultats variables en fonction de l'tat de conscience des patients. Ces rsultats soulignent la ncessit d'tudier les descripteurs de la douleur chez des patients crbrolss en fonction du niveau de conscience et de considrer l'htrognit de cette population dans la conception d'un instrument d'valuation de la douleur pour les personnes crbrolses non communicantes aux soins intensifs. - Pain is frequent in the intensive care unit (ICU) and its management is a major issue for nurses. The assessment of pain is a prerequisite for appropriate pain management. However, pain assessment is difficult when patients are unable to communicate about their experience and nurses have to base their evaluation on external signs. Clinical practice guidelines highlight the need to use behavioral scales that have been validated for nonverbal patients. Current behavioral pain tools for ICU patients unable to communicate may not be appropriate for nonverbal brain-injured ICU patients, as they demonstrate specific responses to pain. This study aimed to identify, describe and validate pain indicators and descriptors in brain-injured ICU patients. A mixed multiphase method design with a quantitative dominant was chosen for this study. The first phase aimed to identify indicators and descriptors of pain for nonverbal brain- injured ICU patients using data from three sources: an integrative literature review, a consultation using the nominal group technique with 18 experienced clinicians (12 nurses and 6 physicians) and the results of an observational pilot study with 10 traumatic brain injured patients. The results of this first phase identified 6 indicators and 47 behavioral, vocal and physiological descriptors of pain that could be included in a pain assessment tool for this population. The sequential phase two tested the psychometric properties of the list of previously identified indicators and descriptors. Content validity was tested with 10 clinical and 4 scientific experts for pertinence and comprehensibility using a structured questionnaire. This process resulted in 33 descriptors to be selected out of 47 previously identified, and six validated indicators. Then, the psychometric properties of the descriptors and indicators were tested at rest, during non nociceptive stimulation and nociceptive stimulation (turning) in a sample of 116 brain-injured ICLI patients who were hospitalized in two university centers. Results showed important variations in the descriptors observed during the nociceptive stimulation, probably due to the heterogeneity of patients' level of consciousness. Ten descriptors were excluded, as they were observed less than 5% of the time or their reliability was insufficient. All physiologic descriptors were deleted as they showed little variability and inter observer reliability was lacking. Concomitant validity, testing the association between patients' self report of pain and measures performed using the descriptors, was acceptable during nociceptive stimulation (rs=0,527, p=0,003, n=30). However, convergent validity ( testing for an association between the nurses' pain assessment and measures done with descriptors) and divergent validity (testing for the ability of the indicators to discriminate between rest and a nociceptive stimulation) varied according to the level of consciousness These results highlight the need to study pain descriptors in brain-injured patients with different level of consciousness and to take into account the heterogeneity of this population forthe conception of a pain assessment tool for nonverbal brain-injured ICU patients.
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Practice guidelines recommend outpatient care for selected patients with non-massive pulmonary embolism (PE), but fail to specify how these low-risk patients should be identified. Using data from U.S. patients, we previously derived the Pulmonary Embolism Severity Index (PESI), a prediction rule that risk stratifies patients with PE. We sought to validate the PESI in a European patient cohort. We prospectively validated the PESI in patients with PE diagnosed at six emergency departments in three European countries. We used baseline data for the rule's 11 prognostic variables to stratify patients into five risk classes (I-V) of increasing probability of mortality. The outcome was overall mortality at 90 days after presentation. To assess the accuracy of the PESI to predict mortality, we estimated the sensitivity, specificity, and predictive values for low- (risk classes I/II) versus higher-risk patients (risk classes III-V), and the discriminatory power using the area under the receiver operating characteristic (ROC) curve. Among 357 patients with PE, overall mortality was 5.9%, ranging from 0% in class I to 17.9% in class V. The 186 (52%) low-risk patients had an overall mortality of 1.1% (95% confidence interval [CI]: 0.1-3.8%) compared to 11.1% (95% CI: 6.8-16.8%) in the 171 (48%) higher-risk patients. The PESI had a high sensitivity (91%, 95% CI: 71-97%) and a negative predictive value (99%, 95% CI: 96-100%) for predicting mortality. The area under the ROC curve was 0.78 (95% CI: 0.70-0.86). The PESI reliably identifies patients with PE who are at low risk of death and who are potential candidates for outpatient care. The PESI may help physicians make more rational decisions about hospitalization for patients with PE.
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The International Society of Urological Pathology Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to extraprostatic extension (pT3a disease), bladder neck invasion, lymphovascular invasion and the definition of pT4 were coordinated by working group 3. It was agreed that prostate cancer can be categorized as pT3a in the absence of adipose tissue involvement when cancer bulges beyond the contour of the gland or beyond the condensed smooth muscle of the prostate at posterior and posterolateral sites. Extraprostatic extension can also be identified anteriorly. It was agreed that the location of extraprostatic extension should be reported. Although there was consensus that the amount of extraprostatic extension should be quantitated, there was no agreement as to which method of quantitation should be employed. There was overwhelming consensus that microscopic urinary bladder neck invasion by carcinoma should be reported as stage pT3a and that lymphovascular invasion by carcinoma should be reported. It is recommended that these elements are considered in the development of practice guidelines and in the daily practice of urological surgical pathology.
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BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for surveillance after polypectomy and after curative-intent resection of colorectal cancer (CRC), and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of surveillance colonoscopy after polypectomy and after resection of CRC was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: Most CRCs arise from adenomatous polyps. The characteristics of removed polyps, especially the distinction between low-risk adenomas (1 or 2, small [< 1 cm], tubular, no high-grade dysplasia) vs. high-risk adenomas (large [> or = 1 cm], multiple [> 3], high-grade dysplasia or villous features), have an impact on advanced adenoma recurrence. Most guidelines recommend a 3-year follow-up colonoscopy for high-risk adenomas and a 5-year colonoscopy for low-risk adenomas. Despite the lack of evidence to support or refute any survival benefit for follow-up colonoscopy after curative-intent CRC resection, surveillance colonoscopy is recommended by most guidelines. The timing of the first surveillance colonoscopy differs. The expert panel considered that 56 % of the clinical indications for colonoscopy for surveillance after polypectomy were appropriate. For surveillance after CRC resection, it considered colonoscopy appropriate 1 year after resection. CONCLUSIONS: Colonoscopy is recommended as a first-choice procedure for surveillance after polypectomy by all published guidelines and by the EPAGE II criteria. Despite the limitations of the published studies, colonoscopy is also recommended by most of the guidelines and by EPAGE II criteria for surveillance after curative-intent CRC resection.
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Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.
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NanoImpactNet (NIN) is a multidisciplinary European Commission funded network on the environmental, health and safety (EHS) impact of nanomaterials. The 24 founding scientific institutes are leading European research groups active in the fields of nanosafety, nanorisk assessment and nanotoxicology. This 4−year project is the new focal point for information exchange within the research community. Contact with other stakeholders is vital and their needs are being surveyed. NIN is communicating with 100s of stakeholders: businesses; internet platforms; industry associations; regulators; policy makers; national ministries; international agencies; standard−setting bodies and NGOs concerned by labour rights, EHS or animal welfare. To improve this communication, internet research, a questionnaire distributed via partners and targeted phone calls were used to identify stakeholders' interests and needs. Knowledge gaps and the necessity for further data mentioned by representatives of all stakeholder groups in the targeted phone calls concerned: potential toxic and safety hazards of nanomaterials throughout their lifecycles; fate and persistence of nanoparticles in humans, animals and the environment; risks associated to nanoparticle exposure; participation in the preparation of nomenclature, standards, methodologies, protocols and benchmarks; development of best practice guidelines; voluntary schemes on responsibility; databases of materials, research topics and themes. Findings show that stakeholders and NIN researchers share very similar knowledge needs, and that open communication and free movement of knowledge will benefit both researchers and industry. Consequently NIN will encourage stakeholders to be active members. These survey findings will be used to improve NIN's communication tools to further build on interdisciplinary relationships towards a healthy future with nanotechnology.
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Best Practice Guidelines
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This comprehensive Report, which marks the fruition of extensive work and consultations undertaken by the Benzodiazepine Committee represents a major step towards addressing inappropriate benzodiazepine use in this country. It sets out in some detail the facts about benzodiazepine usage in Ireland and makes recommendations across a number of areas. It also includes Good Practice Guidelines to assist clinicians in adopting best practice in what is a complex and difficult area. Download document here
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Undernutrition is a widespread problem in intensive care unit and is associated with a worse clinical outcome. A state of negative energy balance increases stress catabolism and is associated with increased morbidity and mortality in ICU patients. Undernutrition-related increased morbidity is correlated with an increase in the length of hospital stay and health care costs. Enteral nutrition is the recommended feeding route in critically ill patients, but it is often insufficient to cover the nutritional needs. The initiation of supplemental parenteral nutrition, when enteral nutrition is insufficient, could optimize the nutritional therapy by preventing the onset of early energy deficiency, and thus, could allow to reduce morbidity, length of stay and costs, shorten recovery period and, finally, improve quality of life. (C) 2009 Elsevier Masson SAS. All rights reserved.
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NanoImpactNet (NIN) is a multidisciplinary European Commission funded network on the environmental, health and safety (EHS) impact of nanomaterials. The 24 founding scientific institutes are leading European research groups active in the fields of nanosafety, nanorisk assessment and nanotoxicology. This 4-year project is the new focal point for information exchange within the research community. Contact with other stakeholders is vital and their needs are being surveyed. NIN is communicating with 100s of stakeholders: businesses; internet platforms; industry associations; regulators; policy makers; national ministries; international agencies; standard-setting bodies and NGOs concerned by labour rights, EHS or animal welfare. To improve this communication, internet research, a questionnaire distributed via partners and targeted phone calls were used to identify stakeholders' interests and needs. Knowledge gaps and the necessity for further data mentioned by representatives of all stakeholder groups in the targeted phone calls concerned: the potential toxic and safety hazards of nanomaterials throughout their lifecycles; the fate and persistence of nanoparticles in humans, animals and the environment; the associated risks of nanoparticle exposure; greater participation in: the preparation of nomenclature, standards, methodologies, protocols and benchmarks; the development of best practice guidelines; voluntary schemes on responsibility; databases of materials, research topics and themes, but also of expertise. These findings suggested that stakeholders and NIN researchers share very similar knowledge needs, and that open communication and free movement of knowledge will benefit both researchers and industry. Subsequently a workshop was organised by NIN focused on building a sustainable multi-stakeholder dialogue. Specific questions were asked to different stakeholder groups to encourage discussions and open communication. 1. What information do stakeholders need from researchers and why? The discussions about this question confirmed the needs identified in the targeted phone calls. 2. How to communicate information? While it was agreed that reporting should be enhanced, commercial confidentiality and economic competition were identified as major obstacles. It was recognised that expertise was needed in the areas of commercial law and economics for a wellinformed treatment of this communication issue. 3. Can engineered nanomaterials be used safely? The idea that nanomaterials are probably safe because some of them have been produced 'for a long time', was questioned, since many materials in common use have been proved to be unsafe. The question of safety is also about whether the public has confidence. New legislation like REACH could help with this issue. Hazards do not materialise if exposure can be avoided or at least significantly reduced. Thus, there is a need for information on what can be regarded as acceptable levels of exposure. Finally, it was noted that there is no such thing as a perfectly safe material but only boundaries. At this moment we do not know where these boundaries lie. The matter of labelling of products containing nanomaterials was raised, as in the public mind safety and labelling are connected. This may need to be addressed since the issue of nanomaterials in food, drink and food packaging may be the first safety issue to attract public and media attention, and this may have an impact on 'nanotechnology as a whole. 4. Do we need more or other regulation? Any decision making process should accommodate the changing level of uncertainty. To address the uncertainties, adaptations of frameworks such as REACH may be indicated for nanomaterials. Regulation is often needed even if voluntary measures are welcome because it mitigates the effects of competition between industries. Data cannot be collected on voluntary bases for example. NIN will continue with an active stakeholder dialogue to further build on interdisciplinary relationships towards a healthy future with nanotechnology.
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The rate of teenagers who engage in sports activity on a regular basis has decreased since ten years, whereas the rate of overweight and obesity is steadily increasing. This paper discusses the meaning as well as the limits of sports activity during adolescence. Guidelines for sports participation include: a discussion of the frequency and duration of sports training sessions, which have to be adapted to the growth and pubertal stage of the adolescent. Any symptoms suggesting overuse should be tackled seriously. Physician's counselling in the field of protective behaviour (injury prevention) is effective. Finally, the majority of chronic conditions are compatible with moderate sports activity.
