Adherence to Best Practice

In recent years registers have been established to track the performance of health institutions and organizations. Typically, such registers are disease specific and will measure outputs at a high level (e.g., morbidity and mortality). 

In some cases (e.g., the UK Renal Registry ), the data collected are extensive and include laboratory information. This depth of data is extremely helpful to the laboratory specialist because it begins to provide a basis for looking at issues, such as the impact of the analytical performance of certain tests on clinical outcomes. 

APPLYING THE PRINCIPLES OF EVIDENCE-BASED LABORATORY MEDICINE IN ROUTINE PRACTICE 

It is hopefully clear from the foregoing discussion that the principles of evidence-based laboratory medicine can underpin the way in which laboratory medicine is practiced, from the discovery of a new diagnostic test through to its application in routine patient care. The principles provide the logic on which aU of the elements of practice are founded. The tools of evidence-based laboratory medicine provide the means of delivering the highest quality of service in meeting the needs of patients and the healthcare professionals who serve them. The application of evidence-based practice is far more complex in the case of laboratory medicine than in the major area in which such principles have previously been applied, namely the pharmaceutical intervention. 

The ways in which the test is used, once its efficacy has been demonstrated, will be embodied in the laboratory handbook which, increasingly, will be electronic, fully searchable in real time, and built into clinical protocols and care pathways. Such a handbook can then be supported by an information resource, again searchable, which wiU inform the clinician (and the patient) of the strength of evidence to support the use of the test in a specific situation. Use of these resources is practical as shown by Richardson and Burdette, who observed that information resources could be accessed during patient consultations, with each access completed in 4 to 5 seconds.  

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For example, within the Strategic Direction for Healthy and Safety Community Environments businesses and enployers can support the strategy by Adhere to best practices to promote safety and health, including participatory approaches to hazard identification and remedia-... 

Spreadsheets as data representation format are often used to share, store, and exchange data in engineering enviromnents despite of a set of important drawbacks, such as the implicit data schema hampers automatic and effective processing high-level of freedom and, therefore, high variabUity in data representation, which often does not adhere to best practices of data representation. These weaknesses are balanced by the positive characteristics of spreadsheets. Indeed, from a user point of view, spreadsheets are easy to understand, they do not require sophisticated skills to create and work with and have adequate representational power and expressiveness for many common tasks. 

A well-planned and properly executed technical plant survey should provide a wealth of information for all concerned. And while it may raise some issues, it should also answer many questions concerning best operating practices and the risks of potential problems if those practices are not adhered to. 

The AIChE s Guidelines for Hazard Evaluation Procedures, Second Edition (1992) [5] offers a wide variety of alternates to review systems for hazards. These review procedures can be used to evaluate some plant modifications. No single identification procedure can be considered the best for all companies or all situations. Two basic categories of evaluations are (1) adherence to good engineering practice and (2) predictive hazard evaluation. 

Many novel therapies could be considered high risk if only based on their uniqueness and lack of precedence. The introduction of novel therapies into the clinic has been facilitated by the cooperation between industry and regulatory scientists, and an adherence to sound scientific principles, common sense, and an approach based on flexibility. The case-by-case approach is dependent on acceptance by both regulators and industry that the interpretation of the data has to reflect best scientific practice and that no study in experimental animals can predict with certainty the outcome when a drug is given to humans [40]. 

The analytical protocols used to characterize hazardous wastes are primarily the EPA-approved methodologies found in their publication Test Methods for the Evaluation of Solid Waste, Physical/Chemical Methods, SW-846. Because these methodologies are a part of the waste analysis plan and the feed-stream analysis plan, they are required by the facility s RCRA permit. In the case of the feedstream analysis plan and the LDRs, adherence is required to meet specific regulatory requirements. Occasionally, DuPont will analyze streams for hazardous constituents or properties other than those required under the permit or regulations in order to address a specific issue (e.g., to determine if the stream can be recycled). Analyses like these should be considered not as an industrial best practice but only as an internal planning aid. 

Long-term management of chronic eye conditions depends on patient adherence to therapy. This involves an imderstanding of the ocular condition and a budgeted medical care plan. Clinicians best intentions and efforts toward therapy are imsuccessful if the medical and phar-macotherapeutic plan is not practical and reasonable to that particular patient. 

The API RP521 standard (10) and Bradford and Diurett (60) present an excellent evaluation of various factors often credited, and also present pitfalls of these practices. Other guidelines and recommendations have also been presented by several other authors (9, 10, 293, 351, 414). Many of these considerations, supplemented by this author s experience, are summarized below. As in previous sections of this chapter, it is emphasized that these considerations must not be blindly adhered to they best serve as an initial checklist or starting point. Codes, regulations, and company policy guidelines must be followed. 

Milner et al. [1] have pointed out that the development and implementation of a successful interdisciplinary effort that integrates and exploits a molecular approach to nutrition-related health and disease research will require both time and patience, to which might be added the availability of adequate resources. The quantity of data that such studies will generate over the next few years is difficult to overestimate, and, in science as elsewhere, quantity does not necessarily equate with quality. As pointed out by the authors of the opening chapter, the onus will be on scientists to adhere to well-established good scientific principles of study design and best practice if the anticipated research is to be exploited to the maximum. 

Maximum Parsimony (MP). Maximmn parsimony is an optimization criterion that adheres to the principle that the best explanation of the data is the simplest, which in turn is the one requiring the fewest ad hoc assumptions. In practical terms, the MP tree is the shortest—the one with the fewest changes—which, by definition, is also the one with the fewest parallel changes. There are several variants of MP that differ with regard to the permitted directionality of character state change (Swofford et al., 1996). 

Visit a location where the culture demands good safety practice and immediately, from the appearance of the exterior premises, you will get a feel for the quality of maintenance. That isn t necessarily an absolute indicator, but the opposite is almost always tme if the exterior of the premises is shabby, safety maintenance will likely be inadequate. In the best operations, cleanliness is truly a virtue, maintenance schedules are adhered to, and personnel are encouraged to report on and seek elimination of hazards. 

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