EANM procedure guidelines for brain PET imaging using [18F]FDG, version 3

The present procedural guidelines summarize the current views of the EANM Neuro-Imaging Committee (NIC). The purpose of these guidelines is to assist nuclear medicine practitioners in making recommendations, performing, interpreting, and reporting results of [18F]FDG-PET imaging of the brain. The aim is to help achieve a high-quality standard of [18F]FDG brain imaging and to further increase the diagnostic impact of this technique in neurological, neurosurgical, and psychiatric practice. The present document replaces a former version of the guidelines that have been published in 2009. These new guidelines include an update in the light of advances in PET technology such as the introduction of digital PET and hybrid PET/MR systems, advances in individual PET semiquantitative analysis, and current broadening clinical indications (e.g., for encephalitis and brain lymphoma). Further insight has also become available about hyperglycemia effects in patients who undergo brain [18F]FDG-PET. Accordingly, the patient preparation procedure has been updated. Finally, most typical brain patterns of metabolic changes are summarized for neurodegenerative diseases. The present guidelines are specifically intended to present information related to the European practice. The information provided should be taken in the context of local conditions and regulations.

Severe Accident Management Systems and Procedures

A nuclear power plant’s safe operation involves the planning for non-standard operational emergencies, where pre-determined safety measures and damage control interventions must be taken into consideration depending on the developed event. A nuclear power plant’s safe operation involves the planning for non-standard operational emergencies, where pre-determined safety measures and damage control interventions must be taken into consideration depending on the developed event. The definition of the severe accident management cannot be explained in a single concept, it needs to be examined in detail. As a result of this it becomes necessary to specify the procedure guidelines appropriate to the nature of the event, which can be used with optimal efficiency under hierarchical organisational control. The experience of nuclear accidents in the world and the precognition of future events, the knowledge of existing guidelines for severe accident management needs to be deepened continuously, but at the same time it can be parallelly upgraded with the application of new technologies.

ANALISIS PENERAPAN SISTEM INFORMASI MANAJEMEN PADA TOKO HAI BABY SHOP DI KABUPATEN TULUNGAGUNG

The research aims to know the application of the Management Information System used in the management of financial data to be more effective for the long-term continuity in the Pratama’s Baby Shop store. In an enterprise the revenue and expense cycles are important, for economic growth can be seen from both cycles. Baby Shop Hai stores is a company that movesin to buy baby things. The method of data collection used is with observation, and library studies. The data sources used are the primary data of the general images of the company, the corporate documents, transaction evidence, company procedure guidelines on the Management information system income and expenses. Studies indicate that sales operations still have a few flaws and that improvements should be made especially to running systems.

Biofilm and catheter-related bloodstream infections

Careful attention to detail and adherence to procedure guidelines when inserting and managing intravascular catheters has decreased the incidence of catheter-related bloodstream infections (CRBSIs). In order to limit these, health professionals must understand the underlying microbiology. Biofilms can explain the clinical findings most often seen with CRBSIs, yet they are poorly understood within medicine. Bacteria growing on solid surfaces such as a catheter are predominantly in biofilm phenotype, with a group of genes active that allow the bacteria to be tolerant to antiseptics and antibiotics by producing a self-secreted protective matrix. It is unclear whether it is planktonic seeding or small fragments of biofilm breaking off into the bloodstream that eventually results in the acute infection. The literature identifies four routes for microbes to adhere to a catheter and start biofilm formation: catheter contact, catheter insertion, catheter management and non-catheter-related sources. Routine clinical culture methods are inadequate to fully identify microbes producing catheter biofilm and/or bloodstream infection, therefore DNA methods may be required to diagnose CRBSIs. Treatment is removal and reinsertion of the catheter in a different site when possible. However, antibiofilm strategies can be employed to try to salvage the catheter. The use of high-dose antiseptics or antibiotics for long durations inside the catheter and hub (antibiotic/antiseptic lock) can suppress biofilm enough to reduce the seeding of the blood below a level where the patient's immune system can prevent bloodstream infection.

Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China

ObjectiveEpisiotomy is still performed widely by obstetricians and midwives in some Chinese maternity units, but the reasons are unknown. This study aims to determine the knowledge, attitude and experience towards the practice of episiotomy among obstetricians and midwives in China’s public hospitals and consider strategies to reduce its practice.MethodsA cross-sectional web survey using a self-administered questionnaire was conducted among obstetricians and midwives in 90 public hospitals in Henan Province, China.Results900 (82.21%) participants completed the questionnaire. Average knowledge level (4.15, SD=1.10) on complications and overuse was identified among participants. Episiotomy was performed more frequently in secondary hospitals than in tertiary hospitals (p<0.05). Senior clinicians were more likely to perform episiotomy than younger ones (p<0.05). Almost half of the clinicians (42.11%) considered the current rate of episiotomy (45%) to be right or too low. The most common reason for performing episiotomy identified by obstetricians (83.94%) and midwives (79.69%) was to reduce third-degree or fourth-degree perineal laceration. Both obstetricians (80.29%) and midwives (82.57%) agreed that the most significant obstacle to reducing the rate of episiotomy was lack of training on reducing perineal tears.ConclusionIn sum, episiotomy was driven by previous training, practitioners’ experience and local norms rather than the latest medical evidence. Clinicians in secondary hospitals and senior clinicians are key training targets. It is urgent to improve current clinical policies and surgical procedure guidelines for obstetricians and midwives regarding episiotomy.

Achieving Independence in Toileting: Self-Catheterization Efficacy and the Role of the School Nurse

The school nurse is the most consistent healthcare provider for students who require scheduled intermittent self-catheterization; however, there is little literature regarding the role of the school nurse for educating and promoting self-catheterization independence for pediatric populations in the school setting. School nurses are dependent on research to identify best practices when implementing teaching strategies with young students who are ready to start catheterizing independently. The intent of this article is to contribute relevant information that is both useful and evidence based, so the school nurse is equipped with information to support the assessment, planning, and implementation of independent self-catheterization of school-age children. Additionally, this article will examine how to determine candidates for independent self-catheterization, product information and procedure guidelines, and coordination with caregivers and other members of the school health team to provide best outcomes for students diagnosed with neurogenic bladder in the school setting.

Comparison of 99mTc Injected Activity with Prescribed Activity in Four Types of Nuclear Medicine Exams

Background: 99mTc is a radioactive isotope that is obtained by eluting a 99Mo/99mTc generator. (PINSTECH, Islamabad) and used for radionuclide scanning. Objectives: The objective of this work is to study the uncertainties in 99mTc activity that exist due to time delay between injection preparation and administration to patients, during the process of gamma camera scanning. Methods: Lead canisters were used for storing elution vials and dose calibrator for measuring 99mTc activity in mCi. The activity of preparing 99mTc injection and its administration to patients were compared with the prescribed values of activity recommended in the Society of Nuclear Medicine procedure guidelines. Results: This study showed that uncertainty in the activity existed in one thyroid patient, 38 bone patients, 5 renal patients and 45 cardiac patients. Conclusion: This uncertainty in activity exists due to time delay between injection preparation and administration to patients, as well as due to residual radionuclide that is not injected into patients and remains in the syringe.

TINJAUAN PELAKSANAAN PENGODEAN DIAGNOSIS PENYAKIT PADA PASIEN RAWAT JALAN DI RSUD TUGUREJO PROVINSI JAWA TENGAH

Background: The implementation of diagnosis coding in the Medical Record Unit at a health institution plays an important role in the administration of medical records at the hospital because it describes the quality management of medical records. In order to maintain the quality, it is crucial to accomplish the accreditation standard, especially at ICM. 13 related coding. Objective: This study aimed to understand the procedures of implementation, compliance disease diagnosis code execution in an outpatient based on accreditation standards KARS 2012, the percentage and the resistance of diagnosis coding implementation in outpatients. Methods: This research was a descriptive qualitative approach with cross sectional design. The subjects were medical records staff with Diploma 3 medical record education background, outpatients coding officer, reporting coordinator, the head of clinic space and a clinic nurse. The data collectin techniques used were observation, documentation and interview studies. Testing the validity of the data use triangulate of source and triangulate of techniq. Results: The coding was done by the medical records staffs and nurses, coding reference were in the form of policies, guidelines and standard operating procedure, guidelines used by nurses in coding was assistive book. Tugurejo Hospital Accreditation in Central Java province had fulfilled the five elements of ICM. 13 and passed the accreditation of type B-level plenary meeting. The percentage of outpatient coding implementation reached 78.6%, consisting of JKN amounted to 75.4% and 3.2% were non JKN. The barriers of coding implementation consists of five elements such as man, method, material, machine and money. Conclusion: In general the implementation of the coding in JKN outpatient has already done optimally, but for non JKN has not been optimal because of the inhibiting factors such as man, method, material, machine and money. Keywords: Coding, disease diagnosis, outpatient