Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced Recovery After Surgery (ERAS(®)) society recommendations.

PURPOSE: Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery. OBJECTIVES: The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group. EVIDENCE ACQUISITION: A systematic literature review was performed on ERAS for cystectomy by searching EMBASE and Medline. Relevant articles were selected and quality-assessed by two independent reviewers using the GRADE approach. If no study specific to cystectomy was available for any of the 22 given items, the authors evaluated whether colorectal guidelines could be extrapolated. EVIDENCE SYNTHESIS: Overall, 804 articles were retrieved from electronic databases. Fifteen articles were included in the present systematic review and 7 of 22 ERAS items were studied. Bowel preparation did not improve outcomes. Early nasogastric tube removal reduced morbidity, bowel recovery time and length of hospital stay. Doppler-guided fluid administration allowed for reduced morbidity. A quicker bowel recovery was observed with a multimodal prevention of ileus, including gum chewing, prevention of PONV and minimally invasive surgery. CONCLUSIONS: ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable. The experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy.

Report of recommendations to the Iowa Department of Education, Division of Vocational Rehabilitation Services, June 30, 2010

Report on the Iowa Department of Education, Division of Vocational Rehabilitation Services for the year ended June 30, 2010

Recommendations to reduce hand exposure for standard nuclear medicine procedures

The optimization of the extremity dosimetry of medical staff in nuclear medicine was the aim of the Work Package 4 (WP4) of the ORAMED project, a Collaborative Project (2008-2011) supported by the European Commission within its 7th Framework Programme. Hand doses and dose distributions across the hands of medical staff working in nuclear medicine departments were evaluated through an extensive measurement program involving 32 hospitals in Europe and 139 monitored workers. The study included the most frequently used radionuclides, (99m)Tc- and (18)F-labelled radiopharmaceuticals for diagnostic and (90)Y-labelled Zevalin (R) and DOTATOC for therapy. Furthermore, Monte Carlo simulations were performed in different predefined scenarios to evaluate separately the efficacy of different radiation protection measures by comparing hand dose distributions according to various parameters. The present work gives recommendations based on results obtained with both measurements and simulations. This results in nine practical recommendations regarding the positioning of the dosemeters for an appropriate skin dose monitoring and the best protection means to reduce the personnel exposure.

Report and Recommendations of the Iowa Vertical Infrastructure Advisory Committee, December 15, 2006

This report summaries the work of the committee over the last year and its vision for the future. The committee is followed with interest the work of the Department of Corrections and the Department of Veterans Affairs in evaluating the needs of their facilities and recommends similar evaluations of facilities around the state by other agencies. The committee members are ready to offer advice on the needs of the state's again infrastructure and steps that could be taken to evaluate vacant and underutilized buildings and reduce operational and maintenance costs.

Report and Recommendations of the Iowa Vertical Infrastructure Advisory Committee, December 15, 2009

This report summaries the work of the committee over the last year and its vision for the future. The committee is followed with interest the work of the Department of Corrections and the Department of Veterans Affairs in evaluating the needs of their facilities and recommends similar evaluations of facilities around the state by other agencies. The committee members are ready to offer advice on the needs of the state's again infrastructure and steps that could be taken to evaluate vacant and underutilized buildings and reduce operational and maintenance costs.

Report and Recommendations of the Iowa Vertical Infrastructure Advisory Committee, December 13, 2011

This report summaries the work of the committee over the last year and its vision for the future. The committee is followed with interest the work of the Department of Corrections and the Department of Veterans Affairs in evaluating the needs of their facilities and recommends similar evaluations of facilities around the state by other agencies. The committee members are ready to offer advice on the needs of the state's again infrastructure and steps that could be taken to evaluate vacant and underutilized buildings and reduce operational and maintenance costs.

Report and Recommendations of the Iowa Vertical Infrastructure Advisory Committee, December 15, 2010

This report summaries the work of the committee over the last year and its vision for the future. The committee is followed with interest the work of the Department of Corrections and the Department of Veterans Affairs in evaluating the needs of their facilities and recommends similar evaluations of facilities around the state by other agencies. The committee members are ready to offer advice on the needs of the state's again infrastructure and steps that could be taken to evaluate vacant and underutilized buildings and reduce operational and maintenance costs.

Brief on Branstad-Reynolds administration Recommendations for World-Class School, January 6, 2012

In advance of the 2012 legislative session, I am pleased to provide for your review this legislative brief on Gov. Terry E. Branstad’s and Lt. Gov. Kim Reynolds’ education reform package. The purpose is to provide a broad overview of the components of the package, give some examples of where similar approaches are in place, and provide cost estimates. In collaboration with the Governor’s Office, the staff at the Iowa Department of Education and I have worked intensively to prepare a set of legislative proposals worthy of careful consideration. I believe this package puts us on the path to our unshakable vision of having one of the best school systems in the world. Iowa’s children deserve nothing less.

Dietary fat, lipogenesis and energy balance.

Today, there are still uncertainties about the role of exogenous fat on body fat regulation. Early models of energy utilization (for example, Kleiber's, early 20th century) failed to take into account the nature of substrate oxidized in the control of food intake, whereas more recent models (e.g., Flatt's model, end of 20th century) did. Excess body fat storage is ultimately a problem of chronic positive energy balance mediated by a poor control of energy intake or/and a blunted total energy expenditure. Excess fat storage can stem from exogenous fat and to a more limited extent by nonfat substrates precursors transformed into body fat, mostly from carbohydrates, a process known as de novo lipogenesis. When considered over periods of weeks, months or years, total fat balance is closely related to energy balance. Over periods of days, the net change in fat balance is quantitatively limited as compared to the size of endogenous fat storage. The issues discussed in this article primarily include the stimulation of de novo lipogenesis after acute or prolonged CHO overfeeding and whether de novo lipogenesis is a risk factor for obesity development.

Low Water Stream Crossing: Design and Construction Recommendations, December 2001

Most counties have bridges that are no longer adequate, and are faced with large capital expenditure for replacement structures of the same size. In this regard, low water stream crossings (LWSCs) can provide an acceptable, low cost alternative to bridges and culverts on low volume and reduced maintenance level roads. In addition to providing a low cost option for stream crossings, LWSCs have been designed to have the additional benefit of stream bed stabilization. Considerable information on the current status of LWSCs in Iowa, along with insight of needs for design assistance, was gained from a survey of county engineers that was conducted as part of this research (Appendix A). Copies of responses and analysis are included in Appendix B. This document provides guidelines for the design of LWSCs. There are three common types of LWSCs: unvented ford, vented ford with pipes, and low water bridges. Selection among these depends on stream geometry, discharge, importance of road, and budget availability. To minimize exposure to tort liability, local agencies using low water stream crossings should consider adopting reasonable selection and design criteria and certainly provide adequate warning of these structures to road users. The design recommendations included in this report for LWSCs provide guidelines and suggestions for local agency reference. Several design examples of design calculations are included in Appendix E.

Recommendations to reduce extremity and eye lens doses in interventional radiology and cardiology

The main aim of the Work Package 1 (WP1) of the ORAMED project, Collaborative Project (2008-2011), supported by the European Commission within its 7th Framework Programme, was to obtain a set of standardized data on extremity and eye lens doses for staff in interventional radiology and cardiology (IR/IC) workplaces and to recommend a series of guidelines on radiation protection in order to both guarantee and optimize staff protection. Within the project, coordinated measurements were performed in 34 hospitals in 6 European countries. Furthermore, simulations of the most representative workplaces in IR and IC were performed to determine the main parameters that influence the extremity and eye lens doses. The work presented in this paper shows the recommendations that were formulated by the results obtained from both measurements and simulations. The presented guidelines are directed to operators, assistant personnel, radiation protection officers and medical physics experts. They concern radiation protection issues, such as the use of room protective equipment, as well as the positioning of the extremity and eye lens dosemeters for routine monitoring.

Bed Capacity Recommendations - Summary Table

Summary table of bed capacity recommendations by Durrant, in association with Pulitzer-Bogard & Associates and Criminal Justice Institute.

Report of recommendations to the Iowa Department of Education, Division of Vocational Rehabilitation Services, June 30, 2011

Report on the Iowa Department of Education, Division of Vocational Rehabilitation Services for the year ended June 30, 2011

Polyanalgesic Consensus Conference-2012: Recommendations to Reduce Morbidity and Mortality in Intrathecal Drug Delivery in the Treatment of Chronic Pain.

Introduction:  Targeted intrathecal drug infusion to treat moderate to severe chronic pain has become a standard part of treatment algorithms when more conservative options fail. This therapy is well established in the literature, has shown efficacy, and is an important tool for the treatment of both cancer and noncancer pain; however, it has become clear in recent years that intrathecal drug delivery is associated with risks for serious morbidity and mortality. Methods:  The Polyanalgesic Consensus Conference is a meeting of experienced implanting physicians who strive to improve care in those receiving implantable devices. Employing data generated through an extensive literature search combined with clinical experience, this work group formulated recommendations regarding awareness, education, and mitigation of the morbidity and mortality associated with intrathecal therapy to establish best practices for targeted intrathecal drug delivery systems. Results:  Best practices for improved patient care and outcomes with targeted intrathecal infusion are recommended to minimize the risk of morbidity and mortality. Areas of focus include respiratory depression, infection, granuloma, device-related complications, endocrinopathies, and human error. Specific guidance is given with each of these issues and the general use of the therapy. Conclusions:  Targeted intrathecal drug delivery systems are associated with risks for morbidity and mortality that can be devastating. The panel has given guidance to treating physicians and healthcare providers to reduce the incidence of these problems and to improve outcomes when problems occur.