Treatment of Clostridium difficile infection: a national survey of clinician recommendations and the use of faecal microbiota transplantation

Adherence to Clostridium difficile infection treatment guidelines is associated with lower recurrence rates and mortality as well as cost savings. Our survey of Irish clinicians indicates that patients are managed using a variety of approaches. FMT is potentially underutilised despite its recommendation in national and European guidelines.

Transitioning Towards a Development Permit System: Recommendations for the Ministry of Municipal Affairs and Housing

Since 2007, Ontario Regulation 608/06 now provides all municipalities with the authority to establish a development permit system (DPS); however, much of this regulatory power and its functions are largely misunderstood by both professionals and the general public, which has led to a lack of widespread municipal implementation. One main contributor to the uncertainty is the lack of academic literature. Currently, the most comprehensive document has been produced by the Ministry of Municipal Affairs and Housing (MMAH), Development Permit System: A Handbook for Municipal Implementation. The study’s key objective is to identify, analyze, and evaluate the MMAH Handbook in order to effectively provide an updated set of recommendations within the context of Ontario.

Social Media Strategies in the Retail Sector: Analysis and Recommendations for Three Multi-National Retailers

During the last twenty years (1995-2015), the world of commerce has expanded beyond the traditional brick-and-mortar high street to a global shop front accessible to billions of users via the Worldwide Web (WWW). Consumers are now using the web to immerse themselves in virtual shop fronts, using Social Media (SM) to communicate and share product ideas with friends and family. Retail organisations recognise the need to develop and adapt their strategies to respond to the increasing use of SM. New goals must be set in order to identify how companies will integrate social media into current practices. This research aims to suggest an advisable and comprehensive SM strategy for companies operating in the global retail sector, based on an exploratory analysis of three multi-national retail organisations' existing SM strategies. This will be assessed in conjunction with a broader investigation into social media in the retail industry. From this, a strategy will be devised to improve internal and external communication as well as knowledge management through the use of social media. Findings suggest that the use of SM within the retail industry has dramatically improved collaboration and communication processes for organisations as they are now able to converse better with stakeholders and the tools are relatively simple to integrate and implement as they benefit one another.

BRAF mutation testing algorithm for vemurafenib treatment in melanoma: recommendations from an expert panel.

The incidence of melanoma has increased rapidly over the past 30 years, and the disease is now the sixth most common cancer among men and women in the U.K. Many patients are diagnosed with or develop metastatic disease, and survival is substantially reduced in these patients. Mutations in the BRAF gene have been identified as key drivers of melanoma cells and are found in around 50% of cutaneous melanomas. Vemurafenib (Zelboraf(®) ; Roche Molecular Systems Inc., Pleasanton, CA, U.S.A.) is the first licensed inhibitor of mutated BRAF, and offers a new first-line option for patients with unresectable or metastatic melanoma who harbour BRAF mutations. Vemurafenib was developed in conjunction with a companion diagnostic, the cobas(®) 4800 BRAF V600 Mutation Test. The purpose of this paper is to make evidence-based recommendations to facilitate the implementation of BRAF mutation testing and targeted therapy in patients with metastatic melanoma in the U.K. The recommendations are the result of a meeting of an expert panel and have been reviewed by melanoma specialists and representatives of the National Cancer Research Network Clinical Study Group on behalf of the wider melanoma community. This article is intended to be a starting point for practical advice and recommendations, which will no doubt be updated as we gain further experience in personalizing therapy for patients with melanoma.

ERIC recommendations on TP53 mutation analysis in chronic lymphocytic leukemia.

Recent evidence suggests that - in addition to 17p deletion - TP53 mutation is an independent prognostic factor in chronic lymphocytic leukemia (CLL). Data from retrospective analyses and prospective clinical trials show that ∼5% of untreated CLL patients with treatment indication have a TP53 mutation in the absence of 17p deletion. These patients have a poor response and reduced progression-free survival and overall survival with standard treatment approaches. These data suggest that TP53 mutation testing warrants integration into current diagnostic work up of patients with CLL. There are a number of assays to detect TP53 mutations, which have respective advantages and shortcomings. Direct Sanger sequencing of exons 4-9 can be recommended as a suitable test to identify TP53 mutations for centers with limited experience with alternative screening methods. Recommendations are provided on standard operating procedures, quality control, reporting and interpretation. Patients with treatment indications should be investigated for TP53 mutations in addition to the work-up recommended by the International workshop on CLL guidelines. Patients with TP53 mutation may be considered for allogeneic stem cell transplantation in first remission. Alemtuzumab-based regimens can yield a substantial proportion of complete responses, although of short duration. Ideally, patients should be treated within clinical trials exploring new therapeutic agents.

The influence of genotype information on psychiatrists' treatment recommendations: more experienced clinicians know better what to ignore

Objectives: To assess if psychiatrists were influenced by a patient’s genetic information, even when the patient’s response to treatment was already known to them. Methods: Sixty-seven psychiatrists were presented with patients' pre and post-treatment scores on the PANSS for two hypothetical treatments for schizophrenia. Psychiatrists were also informed whether the patient possessed a genotype linked to hyper-responsiveness to one of the treatments, and were asked to recommend one of these two treatments. Attribute non-attendance assessed whether the information on genotype influenced psychiatrists' treatment recommendations. Results: Years of experience predicted whether psychiatrists were influenced by the genetic information. Psychiatrists with one year or less of experience had a 46% probability of considering genetic information, while psychiatrists with at least 15 years of experience had a lower probability (7%). Conclusions: Psychiatrists and other clinicians should be cautious about allowing a patient's genetic information to carry unnecessary weight in their clinical decision making.

EULAR Recommendations for Women's Health and the Management of Family Planning, Assisted Reproduction, Pregnancy and Menopause in Patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome

OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. CONCLUSIONS: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

Iowa as a Litter-Free State : Findings, Implications & Recommendations from the Statewide Litter Surveys, 2002

The research summarized in this report examines: current litter policies and practices of public organizations, the amount and makeup of litter along Iowa roadways, and the opinions of Iowans regarding litter and illegal dumping.

Evaluation, Selection and Planning the Implementation of a Pavement Management Optimization Model: Optimization Recommendations, 1994

This document briefly summarizes the pavement management activities under the existing Iowa Department of Transportation (DOT) Pavement Management System. The second part of the document provides projected increase in use due to the implementation of the Iowa DOT Pavement Management Optimization System. All estimates of existing time devoted to the Pavement Management System and project increases in time requirements are estimates made by the appropriate Iowa DOT office director or function manager. Included is the new Pavement Management Optimization Structure for the three main offices which will work most closely with the Pavement Management Optimization System (Materials, Design, and Program Management).

Why Workplace Coaching Research Needs Greater Scientific Rigour: a Systematic Review and Recommendations for Future Research

To address a significant gap in the workplace coaching literature, we provide an up-to-date, comprehensive review of the literature in order to inform researchers, practitioners and organizations of the current state of play in workplace coaching research. In our review, we apply a systematic assessment of methodological rigour of the extant workplace coaching literature in order to gain insights into the link between rigour and research outcomes. Our review is fully inclusive and therefore includes both quantitative and qualitative studies of workplace coaching including coaching provided by supervisors. We explore the potential antecedents, moderators and mediators impacting on coaching outcomes, such as the coachee and coach profile and coaching intervention variables. Informed by our systematic review and methodological assessment, specific recommendations will be made to guide future research in the field of workplace coaching effectiveness and theoretical development.

The Governor's Transportation Task Force: Recommendations For Increasing Efficiency, Rough draft, 1995

The spirit behind the creation of the task force is one of good government. It rests upon the basic premise that taxpayers demand the best service possible for their tax dollars. Combine this demand for efficiency with Iowa's aging roadway system, and a projected increase in the state's vehicle miles traveled, the need to examine cost savings becomes apparent. Beyond the rational for good and efficient government, however, is a major concern for potential future reductions in Federal highway funds. Iowa is likely entering a period of needing an expanded transportation system with at best a static capacity for maintenance and construction.

Developing leadership in managers to facilitate the implementation of national guideline recommendations : a process evaluation of feasibility and usefulness

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

Recommendations to Create a Systemic Approach to Improving the Teaching and Learning of Iowa History in Iowa’s K-12 Schools / Iowa History Advisory Council (2016)

Report from the Iowa History Advisory Council on the following goals related to the teaching of Iowa history: Identify the current status of the teaching of Iowa history and the resources available regarding K-12 Iowa history instruction. Identify current materials that are dedicated to the teaching of Iowa history at the K-12 level. Study how other states and organizations implement state and local history. Study best practices for the teaching and learning of state and local history. Develop appropriate academic standards related to Iowa history. Provide recommendations to advance the study of Iowa history at the K-12 level.

Report on the Status of Findings and Recommendations from the City of Lambs Grove Periodic Examination Report dated September 4, 2014 for the period June 1, 2015 through February 29, 2016

Report on the Status of Findings and Recommendations from the City of Lambs Grove Periodic Examination Report dated September 4, 2014 for the period June 1, 2015 through February 29, 2016