SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
BACKGROUND: Ideally, a consensus panel combines expert knowledge with external evidence derived from the literature. To date, many consensus conferences do not use a structured approach to search the literature, but simply compile an add-on reference list from all papers cited by the panelists. This study examined how well such panelists retrieved the relevant literature. METHODS: We used the reference lists of nine surgeons who took part in a consensus conference on common bile duct stones. We included all papers that were referred to as randomized controlled trials (RCTs). We then compared this list with a database search in order to calculate sensitivity and specificity. RESULTS: The nine experts cited between 35 and 518 papers, but only eight papers on average were RCTs. Of the 49 papers that the experts believed to be RCTs, only 23 actually were RCTs. The sensitivity resp. specificity for correctly identifying an RCT was 0.21 (95% Cl, 0.11-0.30) resp. 0.80 (95% Cl; 0.64-0.95). RCTs that included the word "randomized" in their title were significantly more likely to be identified (relative risk, 1.31; 95% Cl, 1.18-1.45). CONCLUSION: Our data indicate that consensus panelists usually do not perform systematic literature searches, but simply use their favorite papers to back up their arguments. Because this may lead to a biased selection of the evidence base on which the consensus statements are founded, a systematic search of all relevant articles should become a mandatory task in any consensus or guideline process.
The European Competence Network on Mastocytosis (ECNM) is a Europe-wide, multinational cooperative approach attempting to improve recognition, diagnosis, and therapy of mastocytosis. The network is composed of local centers, physicians, and scientists who have dedicated their work to patients with mastocytosis. However, because of the rarity and complexity of the disease, each single component in the network alone would fail to meet important demands and to reach solid conclusions in this field of applied medicine. The ECNM represents an attempt to overcome this restriction as a cooperative multicenter platform that should serve as an important basis for the development of new therapeutic strategies and diagnostic concepts, and for the standardization of techniques used to determine diagnostic and prognostic parameters. Moreover, using future central databases and registries, a suitable infrastructure for the development of co-operative multicenter clinical trials will be established. In addition, the ECNM is dedicated to provide the best available information about the disease to patients and physicians.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The Centers for Disease Control and Prevention (CDC) and 35 partner organizations have engaged in developing an agenda for Preconception Health. A summit was held in June 2005 to discuss the current state of knowledge regarding preconception care and convene a select panel to develop recommendations and action steps for improving the health of women, children, and families through advances in clinical care, public health, and community action. A Select Panel on Preconception Care, convened by CDC, deliberated critical related issues and created refined definition of preconception care. The panel also developed a strategic plan with goals, recommendations, and action steps for improving preconception health. The recommendations and action steps are specific to the implementation of health behavior, access, consumer demand, research, and surveillance activities for monitoring and improving the health of women, children and families. The outcome of the deliberations is the CDC publication of detailed recommendations and action steps in the Morbidity and Mortality Weekly Report series, Recommendations and Reports.
The broadening of the classification systems for manic-depressive illness towards a spectrum of bipolar disorders implicates a more differentiated use of pharmacotherapies. However, many questions still remain open. This implies that all consensus guidelines and recommendations have to be considered as preliminary. On the other hand, research in the last decade has developed many new treatment alternatives, both for mood stabilizers and antidepressants as well as antipsychotics. These recommendations, which have been developed in the process of two consensus meetings, try to consider the broadening of the concept of bipolar disorder by differentiating between subgroups according to acute symptomatology and characteristics of the long-term course, e.g., rapid cycling. In particular, the emerging role and new indications of mood stabilizing antiepileptic drugs, atypical antipsychotics, and new antidepressants will be discussed.
Priapism is an important medical condition that requires immediate evaluation, and depending on etiology, may require emergency management. Based on the classification scheme offered by a recent consensus panel, priapism can be subdivided into ischemic and nonischemic types. The nonischemic type, usually the result of perineal trauma, can be treated with conservative therapy, whereas the nonischemic type, which arises from many varied causes, mandates immediate intervention. Corporal fibrosis and permanent erectile dysfunction can result from ischemic priapism that fails to resolve with therapy.
Explore the source record for details and available documents.
During the fall of 2001 (October 22-25), The Norwegian Radiation Protection Authority (NRPA) and the Agricultural University of Norway arranged a consensus conference on the protection of the environment against ionising radiation. The motive for the conference was the need to study the ethical and philosophical basis for protection of nature in its own right. The conference was funded by Nordic Nuclear Safety Research (NKS), in cooperation with the International Union of Radioecology (IUR). The National Committee for Research Ethics in Science and Technology (NENT) was hired as facilitators for the consensus process. This paper will give a brief outline of the aims and method of the conference, distinguishing these from other kinds of consensus conferences. The paper ends with some general reflections on the appropriateness of seeking consensus on ethics-related issues among experts.
Explore the source record for details and available documents.
The usefulness of consensus conferences has been questioned. We have assessed the impact of a 1989 consensus conference about the treatment of hypovolaemia on prescribing practice at our hospital. Data available from the blood bank enabled us to follow albumin use and costs by department between 1987 and 1991. Medical journals, direct mail, and meetings were used to disseminate the recommendations of the consensus conference, which were that the only indications for albumin are massive haemorrhage, plasmapheresis, massive hypoalbuminaemia, and volume expansion in pregnancy; for hypovolaemia caused by septic shock or vasoplegia, fluid gelatins and crystalloids should be used. In the year after the conference, and in subsequent years, albumin use and costs were 40% lower than before the conference, even though total medical expenditure continued to rise and numbers of patients admitted did not change. We believe that consensus conferences can be a useful means of improving medical practice. The features that ensured success in this programme were the small number of prescribers, the homogeneous setting, and the frequent restatement of the recommendations.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A description is given of the consensus development conference as a method for either technology assessment or quality assurance in health care. The general features of the methodology are discussed, the Dutch approach is explained in more detail, and medical decision analysis and its potential contribution to consensus development are described. Examples are given of the use of this technique during 6 of the 22 consensus conferences held in The Netherlands since 1982.
In the last few years there has been a growing interest in the development of guidelines for care. The most important aim of these guidelines is to improve the quality of care by changing the daily practice of physicians in the desired direction. Therefore besides the scientific basis of guidelines, emphasis should be placed on the implementation of guidelines. Experience in the Netherlands, where medical societies contribute significantly to the procedure of consensus guidelines development, are described in comparison with new ideas in the U.S.A. regarding criteria setting. Involvement of physician organisations to the development procedure is a necessary requirement for guidelines to shape clinical practice. Furthermore, some interventions used in The Netherlands for improving implementation of guidelines in daily practice are mentioned.
The development of practice guidelines is gaining popularity in both North America and Europe. This review article explores the different reasons behind guideline development, the methodologies used and the effects assessed so far. Experience since 1982 with a guideline development programme at CBO is discussed in more detail. The consequences guidelines have for professional autonomy are discussed, and it is concluded that guidelines can enforce professionalization as well as accountability and efficiency when developed within the framework of a consistent goal-method-effect scheme and applied as an integral part of professional quality assurance activities.