Browsing by Subject "management"

Sort by: Order: Results:

Now showing items 1-20 of 50
  • Barton, David Nicholas; Kelemen, Eszter; Dick, Jan; Martín-López , Berta; Gomez-Baggethun, Erik; Jacobs, Sander; Hendriks, C.M.A.; Termansen, Mette; Garcia-Llorente, M.; Primmer, Eeva; Dunford, Rob; Harrison, Paula; Turkelboom, Francis; Saarikoski, Heli; van Dijk, J.; Rusch, Graciela M.; Palomo, Ignacio; Yli-Pelkonen, Vesa Johannes; Carvalho, Laurence; Baro, Francesc; Langemeyer, Johannes; Tjalling van der Wal, Jan; Mederly, Peter; Priess, Joerg; Luque, Sandra; Berry, Pam; Santos, Rui; Odee, David; Martinez Pastur, Guillermo; Garcia Blanco, Gemma; Saarela, Sanna-Riikka; Silaghi, Diana; Pataki, György; Masi, Fabio; Vadineanu, Angheluta; Mukhopadhyay, Raktima; Lapola, David (2018)
    The operational challenges of integrated ecosystem service (ES) appraisals are determined by study purpose, system complexity and uncertainty, decision-makers' requirements for reliability and accuracy of methods, and approaches to stakeholder-science interaction in different decision contexts. To explore these factors we defined an information gap hypothesis, based on a theory of cumulative uncertainty in ES appraisals. When decision context requirements for accuracy and reliability increase, and the expected uncertainty of the ES appraisal methods also increases, the likelihood of methods being used is expected to drop, creating a potential information gap in governance. In order to test this information gap hypothesis, we evaluate 26 case studies and 80 ecosystem services appraisals in a large integrated EU research project. We find some support for a decreasing likelihood of ES appraisal methods coinciding with increasing accuracy and reliability requirements of the decision-support context, and with increasing uncertainty. We do not find that information costs are the explanation for this information gap, but rather that the research project interacted mostly with stakeholders outside the most decision-relevant contexts. The paper discusses how alternative definitions of integrated valuation can lead to different interpretations of decision-support information, and different governance approaches to dealing with uncertainty. (C) 2017 Elsevier B.V. All rights reserved.
  • Bor, Sanne (Svenska handelshögskolan, 2014)
    Economics and Society – 285
    Organisations collaborate with one another. And they appear to do so more and more frequently in the recent decades. At the same time many of these efforts fail to deliver what the collaboration was set up for. This combination creates the basis for the fascinating and stimulating research field of inter-organisational relations – a field which is still very much in development. In this thesis the focus is on meta-organisations, associations in which organisations are members. The steering of such inter-organisational structures appears to need a novel approach, a collective, multi-level engagement which I set out to examine. The thesis is structured to foreground the process of the research and the development of my thinking. The study is conducted on R&D consortia funded as Networks of Excellence by the European Commission under Framework Programme 6. The study is based primarily on five case studies, by way of documentation and interviews. In addition, the study draws on data collected on 101 consortia and consortium agreements from 50 consortia. The thesis develops the theoretical understanding of meta-organisations and their organisational conditions and implications. Meta-organisation theory, thus far, has focused mainly on the implications following from having organisations as members. This thesis suggests adding to this theory the implications created by constitutional membership, that is, members that constitute the organisation. Constitutional membership makes a difference in three ways: it creates a clear boundary of the meta-organisation; it assumes collective ownership of the meta-organisation; and it makes possible the utilising of indirect resources – the resources of the member organisations, and most importantly their personnel – by the meta-organisation. In addition, the thesis develops a conceptual framework of steering processes, combining governance, management and administration. This framework shows how both decisions and mutual adjustment in top-down, bottom-up, and horizontal directions steer meta-organisations. The framework may, however, be fruitfully used to study other organisations as well. The findings from the analysis of the steering processes show that the utilisation of indirect resources decentralises the governance, management and administration of activities to the participants of member organisations who are undertaking these activities. The results also demonstrate that the governance, management and administration of undivided tasks centralises to those with formal management responsibility. In addition, the analysis shows how control and granting are avoided, externalised or formalised to deal with lack of hierarchical authority. These and other findings of the study seek to refine and extend the hypothesised conditions of meta-organisation theory.
  • Stoddard, Fred; Mäkelä, Pirjo; Puhakainen, Tuula Anneli (INTECHopen, 2011)
  • Kantola, Anu Marjaana; Seeck, Hannele Merja Johanna; Mannevuo, Mona (2019)
    This article explores the role of affect in governmentality and develops the concept of the ‘affective milieu’ to better understand liberal forms of managerial control in market environments. Taking Foucault’s writings on consent, security and technologies of self as a vantage point, we suggest that the regimes of governmentality are both rational and affective milieus and propose that the Spinozan–Deleuzian affect theory provides an entry point for exploring how regimes of governmentality operate as affective milieus. The Spinozan–Deleuzian affect theory helps in understanding affective complexities and attempts to create affective alliances in governmentality. Elucidating this point, we explore how top executives at globally operating paper and metal companies entered a new affective milieu when going through market liberalisation. The affective milieu oscillates between the dangers and promises of the market. Using the notion of priming, we analyse how the top executives use the affective threats and promises of the opening markets and how they attempted to develop managerial techniques to incite and orient employees in the new milieu.
  • Koivula, M.; Niemelä, J. (Finnish Forest Research Institute (Metla), 2002)
  • Fotakopoulos, George; Andrade-Barazarte, Hugo; Kivelev, Juri; Tjahjadi, Mardjono; Goehre, Felix; Hernesniemi, Juha (2022)
    Given the rareness of available data, we performed a systematic review and meta-analysis on therapeutic strategy microsurgical resection and stereotactic radiosurgery (SRS) for brainstem cavernous malformations (BSCMs) and assessed mortality, permanent neurological deficits (PNDs), rebleeding rate, and patients who require reintervention to elucidate the benefits of each treatment modality. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) were used for protocol development and manuscript preparation. After applying all inclusion and exclusion criteria, six remaining articles were included in the final manuscript pool. In total, this meta-analysis included 396 patients, among them 168 patients underwent microsurgical treatment and 228 underwent SRS. Findings of the present meta-analysis suggest that regarding the total group of patients, in terms of mortality, late rebleeding rate, and PNDs, there was no superiority of the one method over the other. Applying the leave-one-out method to our study suggests that with low robust of the results for the bleeding rate and patients who require reintervention outcome factor, there was no statistical difference among the surgical and SRS treatment. Microsurgical treatment of BSCMs immediately eliminates the risk of rehemorrhage; however, it requires complete excision of the lesion and it is associated with a similar rate of PNDs compared with SRS management. Apparently, SRS of BSCMs causes a marked reduction in the risk of rebleeding 2 years after treatment, but when compared with the surgical treatment, there was not any remarkable difference.
  • Anttila, Juhani; Jussila, Kari Pauli (IEEE, 2018)
    Information security management needs to be considered from the perspective of individuals, organizations and the society as a whole. The current situation is not satisfactory with regard to the concepts or practices and is becoming more challenging in the future. Further research and development of the managerial methodologies and practices are necessary for the needs of the new business environments, SMEs and startups. This our research focuses on the comprehensive and multi-disciplinary framework that aims at providing challenges for the new assorted research initiatives and innovations, and insight and guidance for the implementers who integrate the information security solutions within the management of business systems and processes together with other specialized managerial viewpoints. At present, the studies and practical implementations are very scattered and separate from each other, and difficult to be reconciled. Also effective collaboration of the administrative authorities, business leaders and security specialists, and effective links between the managerial, human and technical viewpoints are emphasized.
  • Thyssen, Jacob P.; Berents, Teresa; Bradley, Maria; Deleuran, Mette; Grimstad, Oystein; Korhonen, Laura; Langeland, Tor; Sarnhult, Tore; Thomsen, Simon Francis; Thune, Turid; Wahlgren, Carl-Fredrik; Vestergaard, Christian; Von Kobyletzki, Laura B.; Remitz, Anita (2020)
    Similarities and differences in the everyday clinical management of moderate-to-severe atopic dermatitis in Nordic countries are unknown. Using a modified Delphi approach, 15 dermatologists from Denmark, Finland, Norway and Sweden completed face-to-face and online questionnaires and participated in summary discussions to map expert opinion on the clinical management of moderate-to-severe atopic dermatitis in these Nordic countries. Through discussions, 6 adult patient profiles, reflecting common disease presentations of atopic dermatitis, were identified. Using these case profiles, diagnostic work-up, treatment goals, patient education and treatment approaches were discussed. Patient education was identified as essential for effective management. A treatment sequence of moderate-to-potent topical glucocorticosteroids and emollients, followed by systemic treatment, was recommended, allowing 3 months to ascertain systemic treatment response before switching, if necessary. Consensus was not reached on systemic treatment choice, reflecting differences in clinical practice and reimbursement between countries. Practical, case-based clinical recommendations were developed for optimal patient care.
  • Syyrilä, Tiina; Vehviläinen-Julkunen, Katri; Härkänen, Marja (2020)
    Abstract Aim To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process, and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. Background Communication issues have been found to be amongst the main contributing factors of medication incidents, thus necessitating communication enhancement. Design A sequential exploratory mixed-method design. Methods Medication incident reports from Finland (n=500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively, and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR?s SRQR checklist was followed in reporting. Results Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n=341), nurse-physician (41.6%; n=208), and nurse-patient (9.6%; n=48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n=383). The most commonly identified issues were digital communication (68.2%; n=341), lack of communication within a team (39.6%; n=198), false assumptions about work processes (25.6%; n=128) and being unaware of guidelines (25.0%; n=125). Collegial feedback, and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. Conclusions The interventions should be prioritized to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals, and (f) encouraging patients to communicate about medication. Relevance to clinical practice Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.
  • Larsson, Rolf; Belinskij, Antti; Kløve, Bjørn; Meilutyte-Lukauskiene, Diana; Lode, Elve; Skarbøvik, Eva; Akstinas, Vytautas (IWA Publishing, 2022)
    Hydrology Research
    Highlights •In this paper, the coordination of work with two EU directives in Nordic and Baltic countries is studied. •The potential for synergy effects is reached with varying success in the studied countries. •National legislation and organization of work affect the rate of success with coordination. •Our results confirm conclusions made by the European Commission. Abstract The European Union (EU) Water Framework Directive is of paramount importance for water management. According to the legal text, coordination with other directives like the Floods Directive is imperative and motivated by potential synergy effects. In this paper, the degree to which such coordination is achieved is evaluated for five Nordic and Baltic countries. The evaluation is based on legal documents, management plans, as well as on organizational structure in the five countries. The results show that the coordination between the Water Framework Directive and the Floods Directive (or flood management for Norway's case), have been successful for Estonia and Lithuania, whereas Norway, Finland, and especially Sweden need to improve more.
  • Assouguem, Amine; Kara, Mohammed; Mechchate, Hamza; Korkmaz, Yesim Bulak; Benmessaoud, Safaa; Ramzi, Amal; Abdullah, Khaled R.; Noman, Omar Mohammed; Farah, Abdellah; Lazraq, Abderahim (2022)
    In North Africa, Tetranychus urticae Koch, 1836 represents one of the most destructive generalists among mite herbivores. Unfortunately, it is a source of important annual casualties in crop production. It is a phytophagous mite that can feed on hundreds of host plants and produces significant damage. The control of T. urticae in North Africa has been principally based on acaricide sprays. However, new alternative methods have shown effective results, such as artificial ultraviolet-B, natural enemies, and the introduction of new genetic methods. This review aims to present a synthesis of information surrounding control methods of T. urticae in North Africa. We highlight the principal findings of previous studies. Then, we discuss current control methods and propose new innovative research and sustainable approaches to controlling this pest. The control method can potentially extrapolate in North African regions due to its positive ecological results. Further, studies proved the use of natural enemies, myco-metabolites, bacteria metabolites, and the introduction of a genetic method in an integrated long-term sustainable program that can successfully defeat the populations of T. urticae. We also discuss high-priority research guidelines to investigate new sustainable management strategies. Setting up an integrated long-term ecological monitoring program in different Northwest African countries and incorporating new technologies into monitoring programs is an urgent need to fight this devastating pest.
  • Kuglerová, Lenka; Jyväsjärvi, Jussi; Ruffing, Claire; Muotka, Timo; Jonsson, Anna; Andersson, Elisabet; Richardson, John S. (American Geophysical Union, 2020)
    Water Resources Research 56 9 (2020)
    Forested riparian buffers are recommended to mitigate negative effects of forest harvesting on recipient freshwater ecosystems. Most of the current best practices of riparian buffer retention aim at larger streams. Riparian protection along small streams is thought to be lacking; however, it is not well documented. We surveyed 286 small streams flowing through recent clearcuts in three timber-producing jurisdictions—British Columbia, Canada (BC), Finland, and Sweden. The three jurisdictions differed in riparian buffer implementation. In BC, forested buffers are not required on the smallest streams, and 45% of the sites in BC had no buffer. The average (±SE) width of voluntarily retained buffers was 15.9 m (±2.1) on each side of the stream. An operation-free zone is mandatory around the smallest streams in BC, and 90% of the sites fulfilled these criteria. Finland and Sweden had buffers allocated to most of the surveyed streams, with average buffer width of 15.3 m (±1.4) in Finland and 4 m (±0.4) in Sweden. Most of the streams in the two Nordic countries had additional forestry-associated impairments such as machine tracks, or soil preparation within the riparian zone. Riparian buffer width somewhat increased with stream size and slope of the riparian area, however, not in all investigated regions. We concluded that the majority of the streams surveyed in this study are insufficiently protected. We suggest that a monitoring of forestry practices and revising present forestry guidelines is needed in order to increase the protection of our smallest water courses.
  • Saulamo, Kari; Heikinheimo, Outi; Lappalainen, Jyrki (2020)
    In the Archipelago Sea, pikeperch (Sander lucioperca) is an important species in both commercial and recreational fisheries. Pikeperch is caught mainly with small mesh size gillnets, and annual fishing mortality is high. The possible effects of such fisheries, as well as temperature or density on pikeperch growth have not been studied earlier. The first hypothesis of this study was that the effect of temperature on growth is positive and that of density is negative. The second hypothesis was that size selectivity of gillnets causes the fast-growing individuals to be caught at younger ages than the slow growing ones. The results showed that temperature had a significant positive effect on growth, and this was greater than the negative effect of year-class density, which was also significant. The gillnet selectivity caused a difference of up to 60mm in back-calculated lengths in the fully recruited age groups within the same year class, between pikeperch caught at age 6+ and age 9+. Thus, the Rosa Lee phenomenon caused by gillnet size-selectivity led to the removal of faster growing specimens from the population at younger ages. This can potentially cause underestimation of real growth, and thus, poor fishery management.
  • Peltoniemi, Olli; Björkman, Stefan; Oropeza-Moe, Marianne; Oliviero, Claudio (2019)
    This review aims to describe changes in production environment, management tools and technology to alleviate problems seen with the present hyperprolific sow model. Successful parturition in the pig includes the possibility to express adequate maternal behaviour, rapid expulsion of piglets, complete expulsion of placenta, elimination of uterine contamination and debris, neonatal activity and colostrum intake. We focus on management of large litters, including maternal behaviour, ease of parturition, colostrum production, piglet quality parameters and intermittent suckling. There are also some interesting developments in technology to assess colostrum and immune state of the piglet. These developments may be utilized to improve the success rate of reproductive management around farrowing, lactation and after weaning. We also discuss new insights in how to examine the health of the mammary gland, uterus and ovaries of hyperprolific sows. Finally, we assess the latest developments on breeding and technology of hyperprolific sows, including artificial insemination (AI), real-time ultrasound of the genital tract and embryo transfer (ET). We conclude that 1) for the sow to produce sufficient colostrum, both the behavioural and physiological needs of the sow need to be met before and after parturition. Furthermore, 2) new ultrasound and biopsy technology can be effectively applied for accurate diagnosis of inflammatory processes of the udder and uterus and timing of AI regarding ovulation to improve insemination efficiency. Finally, 3) developments in cryopreservation of germ cells and embryos appear promising but lack of valid oocyte collection techniques and nonsurgical ET techniques are a bottleneck to commercial ET. These latest developments in management of parturition and reproductive technology are necessary to cope with the increasing challenges associated with very large litter sizes.
  • Stacchiotti, S.; Miah, A. B.; Frezza, A. M.; Messiou, C.; Morosi, C.; Caraceni, A.; Antonescu, C. R.; Bajpai, J.; Baldini, E.; Bauer, S.; Biagini, R.; Bielack, S.; Blay, J. Y.; Bonvalot, S.; Boukovinas, I.; Bovee, J. V. M. G.; Boye, K.; Brodowicz, T.; Callegaro, D.; De Alava, E.; Deoras-Sutliff, M.; Dufresne, A.; Eriksson, M.; Errani, C.; Fedenko, A.; Ferraresi, V.; Ferrari, A.; Fletcher, C. D. M.; Del Muro, X. Garcia; Gelderblom, H.; Gladdy, R. A.; Gouin, F.; Grignani, G.; Gutkovich, J.; Haas, R.; Hindi, N.; Hohenberger, P.; Huang, P.; Joensuu, H.; Jones, R. L.; Jungels, C.; Kasper, B.; Kawai, A.; Le Cesne, A.; Le Grange, F.; Leithner, A.; Leonard, H.; Pousa, A. Lopez; Broto, J. Martin; Merimsky, O.; Merriam, P.; Miceli, R.; Mir, O.; Molinari, M.; Montemurro, M.; Oldani, G.; Palmerini, E.; Pantaleo, M. A.; Patel, S.; Piperno-Neumann, S.; Raut, C. P.; Ravi, Arumugam Veera; Razak, A. R. A.; Reichardt, P.; Rubin, B. P.; Rutkowski, P.; Safwat, A. A.; Sangalli, C.; Sapisochin, G.; Sbaraglia, M.; Scheipl, S.; Schoffski, P.; Strauss, D.; Strauss, S. J.; Hall, K. Sundby; Tap, W. D.; Trama, A.; Tweddle, A.; van der Graaf, W. T. A.; Van de Sande, M. A. J.; Van Houdt, W.; van Oortmerssen, G.; Wagner, A. J.; Wartenberg, M.; Wood, J.; Zaffaroni, N.; Zimmermann, C.; Casali, P. G.; Dei Tos, A. P.; Gronchi, A. (2021)
    Epithelioid hemangioendothelioma (EHE) is an ultra-rare, translocated, vascular sarcoma. EHE clinical behavior is variable, ranging from that of a low-grade malignancy to that of a high-grade sarcoma and it is marked by a high propensity for systemic involvement. No active systemic agents are currently approved specifically for EHE, which is typically refractory to the antitumor drugs used in sarcomas. The degree of uncertainty in selecting the most appropriate therapy for EHE patients and the lack of guidelines on the clinical management of the disease make the adoption of new treatments inconsistent across the world, resulting in suboptimal outcomes for many EHE patients. To address the shortcoming, a global consensus meeting was organized in December 2020 under the umbrella of the European Society for Medical Oncology (ESMO) involving >80 experts from several disciplines from Europe, North America and Asia, together with a patient representative from the EHE Group, a global, disease-specific patient advocacy group, and Sarcoma Patient EuroNet (SPAEN). The meeting was aimed at defining, by consensus, evidence-based best practices for the optimal approach to primary and metastatic EHE. The consensus achieved during that meeting is the subject of the present publication.
  • AANZDEM Study Grp; EURODEM Study Grp; Laribi, Said; Harjola, Veli-Pekka (2019)
    Objective The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations. Patients and methods An observational prospective cohort study was carried out in Europe and the Asia-Pacific region. The study included consecutive patients presenting to EDs with dyspnea as the main complaint. Data were collected on demographics, comorbidities, chronic treatment, clinical signs and investigations, treatment in the ED, diagnosis, and disposition from ED. Results A total of 5569 patients were included in the study. The most common ED diagnoses were lower respiratory tract infection (LRTI) (24.9%), heart failure (HF) (17.3%), chronic obstructive pulmonary disease (COPD) exacerbation (15.8%), and asthma (10.5%) in the overall population. There were more LRTI, HF, and COPD exacerbations in the EURODEM population, whereas asthma was more frequent in the AANZDEM population. ICU admission rates were 5.5%. ED mortality was 0.6%. The overall in-hospital mortality was 5.0%. In-hospital mortality rates were 8.7% for LRTI, 7.6% for HF, and 5.6% for COPD patients. Conclusion Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.
  • Pitkänen, Timo P.; Sirro, Laura; Häme, Lauri; Häme, Tuomas; Törmä, Markus; Kangas, Annika (ScienceDirect, 2020)
    International Journal of Applied Earth Observation and Geoinformation 86 (2020)
    The majority of the boreal forests in Finland are regularly thinned or clear-cut, and these actions are regulated by the Forest Act. To generate a near-real time tool for monitoring management actions, an automatic change detection modelling chain was developed using Sentinel-2 satellite images. In this paper, we focus mainly on the error evaluation of this automatized workflow to understand and mitigate incorrect change detections. Validation material related to clear-cut, thinned and unchanged areas was collected by visual evaluation of VHR images, which provided a feasible and relatively accurate way of evaluating forest characteristics without a need for prohibitively expensive fieldwork. This validation data was then compared to model predictions classified in similar change categories. The results indicate that clear-cuts can be distinguished very reliably, but thinned stands exhibit more variation. For thinned stands, coverage of broadleaved trees and detections from certain single dates were found to correlate with the success of the modelling results. In our understanding, this relates mainly to image quality regarding haziness and translucent clouds. However, if the growing season is short and cloudiness frequent, there is a clear trade-off between the availability of good-quality images and their preferred annual span. Gaining optimal results therefore depends both on the targeted change types, and the requirements of the mapping frequency.
  • Saarinen, Anna (Helsingin yliopisto, 2018)
    This present study analyses quantitatively and qualitatively supervisors’ perceptions and experiences of age management in a metal industry organization in Finland. The study aims to describe supervisors’ thoughts about age management and its implementation in practice: how do they take into consideration different-aged team members in their leadership practices, do they feel they have the necessary skills to support different-aged team members’ working ability, and do they experience the age management as part of organizational culture and strategy. Furthermore, the target of the study is to describe supervisors’ experience of need for an additional support regarding age management. The study is part of an internal career path model –project in the case organization, which emphasizes the diverse expectations that employees representing different age groups have on different stages in their career path. The theoretical framework of the study is based on the concepts of management in matrix organizations, age management, diversity in organizations, working ability, burnout and work engagement, as well as, transitions in career path. The study material consisted of an online survey, which included both open questions and multiple-choice questions. Quantitative data was analyzed with SPSS-program by parametric methods and the content based analyze of qualitative data was carried out according to the phenomenological-hermeneutical tradition based on the theory. According to quantitative data, the participants felt that they take well into consideration different aged employees, their competence development and working ability in practical supervisory work. The supervisors experienced the age management quite strongly as part of the organization's culture and strategy, although the qualitative data indicated that the concept of age management was unknown, and more introduction was hoped. In addition, according to the quantitative and qualitative data, taking into consideration the physical nature of the work appeared as a development area; supervisors experienced that they need practical examples concerning how to use career flexibilities. The descriptions of supervisors also highlighted the fact that supporting the younger team members’ working ability has also been challenging. In addition, less experienced supervisors are more likely to evaluate their skills and resources weaker than those who have more experience from supervisory work and thus, age management themes were hoped to be part of the orientation for supervisors. Furthermore, older supervisors did not experience age management that strongly as part of organization’s culture and strategy.
  • Bassetti, Claudio L. A.; Kallweit, Ulf; Vignatelli, Luca; Plazzi, Giuseppe; Lecendreux, Michel; Baldin, Elisa; Dolenc-Groselj, Leja; Jennum, Poul; Khatami, Ramin; Manconi, Mauro; Mayer, Geert; Partinen, Markku; Pollmaecher, Thomas; Reading, Paul; Santamaria, Joan; Sonka, Karel; Dauvilliers, Yves; Lammers, Gert J. (2021)
    Background and purpose Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children. Methods The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. Results A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. Conclusion The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.
  • Bassetti, Claudio L. A.; Kallweit, Ulf; Vignatelli, Luca; Plazzi, Giuseppe; Lecendreux, Michel; Baldin, Elisa; Dolenc-Groselj, Leja; Jennum, Poul; Khatami, Ramin; Manconi, Mauro; Mayer, Geert; Partinen, Markku; Pollmaecher, Thomas; Reading, Paul; Santamaria, Joan; Sonka, Karel; Dauvilliers, Yves; Lammers, Gert J. (2021)
    Background and purpose: Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children. Methods: The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. Results: A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. Conclusion: The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.