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PubMed1994

Assessment of three methods of evaluating soluble class I HLA molecules in cell culture supernatants and serum samples from the second international workshop on soluble human leukocyte antigens.

Three methodologies were compared in assessing sHLA specificities in cell culture supernatants and serum specimens from the Second International Workshop on sHLA: CDC inhibition, FC inhibition, and cellular ELISA inhibition. Initially, the CDC inhibition assay used polyclonal antisera in commercial HLA-phenotyping trays to confirm known specificities and screen for unknown specificities in 31 specimens. Although partly successful, critical limits were imposed by the variable antiserum titers. Thus, using pools of these same antisera and renal transplant recipient antisera, the FC inhibition assay was employed to determine the endpoint serum titers before confirming the known sHLA specificities. Of 25 specimens, four were not confirmed and five gave weak inhibitory reactions. The cellular ELISA inhibition assay, incorporating patient sera and mAbs toward three HLA, successfully confirmed all three known specificities in eight selected workshop specimens. Each methodology had advantages and disadvantages, but all three methods were successful in detecting and identifying sHLA class I specificities. Success, however, was dependent on the initial characterization (specificity and titer) and titration to end point (appropriate for each method's sensitivity) of each antibody preparation.

Cells, Cultured↗
PubMed1996

A consensus approach to planetary protection requirements: recommendations for Mars lander missions.

Over the last several years, the nature of the surface conditions on the planet Mars, our knowledge of the growth capabilities of Earth organisms under extreme conditions, and future opportunities for Mars exploration have been under extensive review in the United States and elsewhere. As part of these examinations, in 1992 the US Space Studies Board made a series of recommendations to NASA on the requirements that should be implemented on future missions that will explore Mars. In particular, significant changes were recommended in the requirements for Mars landers, changes that significantly alleviated the burden of planetary protection implementation for these missions. In this paper we propose a resolution implementing this new set of recommendations, for adoption by COSPAR at its 30th meeting in Hamburg. We also discuss future directions and study areas for planetary protection, in light of changing plans for Mars exploration.

Consensus Statements as Topic↗
PubMed1991

Who needs consensus?

Explore the source record for details and available documents.

Consensus Statements as Topic↗
PubMed1991

Obstetrical attitudes and practices before and after the Canadian Consensus Conference Statement on Cesarean Birth.

This paper describes one aspect of a research program aimed at reducing the incidence of cesarean section in Ontario for women with a previous cesarean section or a breech presentation. Using data from multiple sources--surveys of obstetricians, and hospital administrators, and hospital record statistics, the authors attempt to assess the response of obstetricians to pressure to change their practice. This pressure comes principally from the Canadian Consensus Conference Statement on Cesarean Birth, released in June 1986 and subsequently endorsed by a number of professional organizations. The Statement provides clear guidelines for the management of labour in women with previous cesarean section or a breech presentation. The findings present a number of interpretive challenges. Based on their response to hypothetical cases obstetricians are favourably disposed to considering a trial of labour for women with previous cesarean section and breech presentation. However, both their reported practices, as well as hospital statistics indicate the continued high prevalence of cesarean section, though there is a small decline in cesareans for previous cesarean section. There was no evidence that hospitals lacked appropriate facilities for a trial of labour or had unduly restricted formal policies. Furthermore, although awareness of and agreement with the Consensus Statement recommendations was high, when questioned on the actual details of the recommendations, obstetrician's recall was surprisingly low. Respondents tended to err in the direction of choosing more conservative measures than those recommended by the Statement.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1995

Treatment planning for Hodgkin's disease: a patterns of care study.

PURPOSE: To conduct a survey of the process of treatment planning for the radiation treatment of Hodgkin's Disease in the United States, and to compare survey results with consensus guidelines as determined by recognized experts. METHODS AND MATERIALS: A consensus committee developed guidelines for the radiotherapeutic management of Hodgkin's Disease. A series of survey forms were designed to evaluate the standards of practice and compare these with the consensus guidelines. A total of 61 facilities divided evenly into the strata of academic, hospital based, and free standing had eligible Hodgkin's Disease cases. There were 275 eligible cases of Hodgkin's Disease evaluated. Data collected from the radiation oncology records included treatment-specific parameters such as energy, dose, blocking, and calculations, as well as treatment planning practices. Statistical analysis was performed on each data element and for all institution strata. RESULTS: For a number of treatment parameters, there were some discrepancies note between the current United States practice and the consensus guidelines. Some significant differences were found in practice between the stratified institution types. A representative sample of results are: the majority of Hodgkin's Disease patients are treated with x-ray energies in the recommended range, between 4 and 10 MV. Standard mantle (for upper extended field treatment) and modified spade (for lower extended field treatments) are the fields of choice for all types of facilities. The consensus guidelines recommended that dose calculations at multiple points be obtained; however, 15% of patients in the survey received only a single point calculation. Current irregular field dosimetry calculation software does not take account of inhomogeneities. Thirty percent of Hodgkin's Disease patients do not receive a gap calculation for the abutment of upper and lower extended fields. In 70% of treatment fields, no compensation is used. Very few patients receive any kind of in vivo dosimetry check. CONCLUSION: The survey served to verify that, in general, Hodgkin's Disease treatment planning at all strata of institution has kept pace with recommended practice as delineated in current literature and texts. Small pockets of practice still need improvement in technique and equipment. Changes in practice were identified that can contribute to improved dose uniformity and accuracy.

Consensus Statements as Topic↗
PubMed1996

[A survey of the diffusion and impact of consensus development conference on infections caused by central venous catheters in an anesthesiologist team].

OBJECTIVES: To assess the diffusion and the impact on the professional practices of a consensus conference (CC) by the French speaking Society of Intensive Care on "Central venous catheter-related sepsis in intensive care". STUDY DESIGN: Before-after survey with two successive questionnaires. MATERIAL AND METHODS: Two questionnaires (Q1 and Q2) were circulated either to intensivists (group 1) or to anaesthetists (group 2) of a University Hospital, before (Q1) and after (Q2) distribution of the CC conclusions. They aimed to assess the diffusion of the conclusions by the CC; the professional practices before the CC and their modifications after consideration of the recommendations by the CC. RESULTS: Out of the 55 consulted, 85% answered Q1, and 71% Q2. Among them, 42% were aware of the conclusions of the CC before starting the survey-73.5% from group 1 and 28% from group 2. Therefore, conversely to anaesthetists, intensivists, did not significantly modify their professional practices after consideration of the CC conclusions. CONCLUSION: This study shows a satisfactory diffusion of the content of jury's recommendations among anesthetists whereas the impact was less satisfactory with intensivists. The impact of a CC could probably be improved by a better diffusion of the consensus statements and by the intervention of local linkmen.

Anesthesiology↗
PubMed1993

Causality assessment of adverse reactions to drugs--I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries.

Despite the great number of methods proposed, assessing the causal role of a drug in the occurrence of an adverse medical event remains one of the most controversial issues. Qualifying terms for criteria, such as "compatible", "suggestive" of "inconclusive", have never been strictly defined, leading to low reproducibility. Weights of the criteria are usually not adapted to the injured organ, decreasing the specificity of the method. In this paper, a new method for drug causality assessment is described. Contents and limits of the criteria have been defined by experts convened to organ-oriented international consensus meetings. Additional criteria have been introduced and weights attributed. The method was applied to reports of acute liver injuries. The reproducibility was tested by an independent team. The validity of this novel method is studied in the following paper, based on an original approach using reports with positive rechallenge as external standard.

Age Factors↗
PubMed2005

What health professionals should know: core competencies for effective practice in youth violence prevention.

BACKGROUND: Youth violence has been identified as a critical health concern in the United States; however, few training resources are available for preparing health professionals to contribute to prevention efforts in their professional practices. Identification of core competencies for health professionals in youth violence prevention can be used to support the development of training resources in this area of professional practice. METHODS: In 2001, experts in youth violence, health care, and health professional education from eight of the ten Academic Centers of Excellence on Youth Violence Prevention met to develop a list of core competencies that health professionals need for effective practice in youth violence prevention. Experts participated in a 2-day facilitated session to identify these competencies. RESULTS: The group identified 40 core competencies that health professionals should acquire for effective practice in youth violence prevention. The competencies were organized across seven domains of practice and at three levels of expertise. CONCLUSIONS: Training is needed to prepare health and public health professionals to contribute to efforts in youth violence prevention in the United States. The core competencies identified by the Academic Centers of Excellence Working Group can support the development of curricula in this area.

Adolescent↗
PubMed2006

Pathophysiology of contrast-induced nephropathy.

Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury in hospitalized patients and is associated with significant patient morbidity. The pathogenesis of CIN is complex and not fully understood, but iodinated contrast agents induce intense and prolonged vasoconstriction at the corticomedullary junction of the kidney. Moreover, high-osmolar dyes directly impair the autoregulatory capacity of the kidney through a loss of nitric oxide production. These effects, coupled with direct tubular toxicity of contrast media, lead to overt acute tubular necrosis and the syndrome of CIN.

Acute Kidney Injury↗
PubMed2006

Baseline renal function screening.

Renal impairment at baseline (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m(2)) is the most important risk marker to predict the risk of contrast-induced nephropathy (CIN) in patients receiving iodinated contrast media. Hence, it is important to assess renal function before administration of contrast medium to ensure that appropriate steps are taken to reduce the risk. Serum creatinine alone does not provide a reliable measure of renal function, hence the National Kidney Foundation Kidney Disease Outcome Quality Initiative (K/DOQI) recommends that clinicians should use an eGFR calculated from the serum creatinine as an index of renal function. The CIN Consensus Working Panel agreed that eGFR should be determined before contrast administration, using the abbreviated Modification of Diet in Renal Disease (MDRD) formula, recommended by K/DOQI as the preferred equation for the calculation of eGFR in adults. Where a serum creatinine measurement or eGFR is not available, a simple survey or questionnaire can be used before contrast agent administration to identify patients at higher risk for CIN compared with the general population. In emergency situations, where the benefit of very early imaging outweighs the risk of waiting, the CIN Consensus Working Panel agreed that the procedure can be performed without assessment of renal function.

Consensus Statements as Topic↗
PubMed2006

Risk prediction of contrast-induced nephropathy.

In order to make appropriate decisions about clinical management, it is important for physicians to be able to stratify patients according to their risk for contrast-induced nephropathy (CIN). The most important risk marker for nephropathy after exposure to iodinated contrast media is preexisting renal impairment. The risk of CIN is elevated and becomes clinically important in patients with chronic kidney disease characterized by an estimated glomerular filtration rate <60 mL/min per 1.73 m(2). In patients with renal impairment, diabetes mellitus amplifies the risk of CIN and complicates postprocedure management. Other markers associated with an increased risk of CIN include cardiovascular disease, periprocedural hemodynamic instability, use of nephrotoxic drugs, and anemia. The effect of risk factors is additive, and the presence of multiple risk factors in the same patient can create a very high risk for CIN and acute renal failure requiring dialysis. Risk models incorporating baseline and periprocedural characteristics have been developed using data from large databases of percutaneous coronary intervention patients. These schemes are potentially valuable, but at present the most practical approach to risk prediction is based on a simple model incorporating renal function and diabetes mellitus.

Cardiovascular Diseases↗