PubMed · 16403729
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2006. Committee reports & consensus statements.. https://pubmed.ncbi.nlm.nih.gov/16403729/
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Metrics are the driver to positive change toward better patient care. However, the research into the metrics of the science of surge is incomplete, research funding is inadequate, and we lack a criterion standard metric for identifying and quantifying surge capacity. Therefore, a consensus working group was formed through a "viral invitation" process. With a combination of online discussion through a group e-mail list and in-person discussion at a breakout session of the Academic Emergency Medicine 2006 Consensus Conference, "The Science of Surge," seven consensus statements were generated. These statements emphasize the importance of funded research in the area of surge capacity metrics; the utility of an emergency medicine research registry; the need to make the data available to clinicians, administrators, public health officials, and internal and external systems; the importance of real-time data, data standards, and electronic transmission; seamless integration of data capture into the care process; the value of having data available from a single point of access through which data mining, forecasting, and modeling can be performed; and the basic necessity of a criterion standard metric for quantifying surge capacity. Further consensus work is needed to select a criterion standard metric for quantifying surge capacity. These consensus statements cover the future research needs, the infrastructure needs, and the data that are needed for a state-of-the-art approach to surge and surge capacity.
BACKGROUND: Clinical practice guidelines should be based on the best available evidence. However, this evidence is often incomplete, controversial, or lacking. Other considerations beyond the evidence are therefore needed to be able to formulate specific and applicable recommendations for clinical practice. OBJECTIVE: The aim of this study is to obtain consensus among experts about a set of domains and items covering the most relevant 'other considerations' to formulate recommendations in evidence-based guideline development. METHODS: An initial list of 10 domains and 49 items for a systematic and considered judgement of scientific evidence was generated from the literature. A panel of Dutch experts in guideline development tested this list using a two-round Delphi consensus technique. Each expert was asked to independently score the relevance of the items on a 4-point Likert scale, ranging from 'very important' to 'not important'. The final list consisted of items that were included by at least 60% consensus. RESULTS: Twenty-eight experts participated in the first Delphi round and 21 of them in the second round. High scoring domains were 'clinical relevance', 'safety', and 'availability of resources'. There was consensus about the relevance of 37 items. The domain 'conflicts of interest by industry' was excluded because of lack of consensus. CONCLUSION: This is the first formal consensus approach towards structuring the considered judgement process in formulating recommendations in clinical guidelines. The final list of items can be used to facilitate the process of guideline development. The next step is to test the practical usefulness and applicability of this list in guideline development.
CONTEXT: Recent developments in the IGF field have raised questions on whether this is the right time to redefine IGF deficiency. OBJECTIVE: In this controversy, arguments are made against the need for redefining IGF deficiency at this moment, suggesting instead to wait for further clinical developments. CASE: Although a number of rare case reports of IGF deficiency with precise molecular etiologies have been described, the vast majority of the cases remain clinically defined and without a genetic diagnosis. INTERVENTIONS: Because IGF products are now available for clinical use in IGF-deficient patients, we are still using GH stimulation and static IGF levels as our only clinical diagnostic and classification tools. POSITIONS: We need to develop additional clinical tools, side by side with molecular tools, for the diagnosis and subclassification of IGF deficiency. Chief among these are the IGF-generation test for identification of GH-insensitive patients and genetic panels of polymorphic changes in relevant genes. CONCLUSIONS: Until further progress is made in the clinical classification of IGF deficiency, we should not change the current classification, and, when we do, it should be the responsibility of the relevant societies in the field to conduct a consensus statement on the topic first.