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[Diagnostic (STARD) and prognostic (REMARK) studies].

Deficiencies in how research studies are reported are both well-documented and widespread across all medical specialties and study designs. Although randomised trials have received the most attention in this regard, similar concerns have been expressed about reporting of other types of research including diagnostic and epidemiological studies. If a journal article describes in enough detail what was done at each stage of a study, readers will have enough information to allow them to decide on the merits of the results for themselves. From this simple idea comes the scientific rationale of developing guidelines on how to report research. Recommended processes to produce reporting guidelines have evolved over several years during the preparation of a sequence of reporting guidelines starting with CONSORT and QUOROM in the 1990s. We describe initiatives to develop reporting guidelines for diagnostic accuracy studies (STARD) and tumour marker prognostic studies (REMARK).

Biomarkers, Tumor↗

A blueprint for academic obstetrics and gynecology.

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.

Consensus Statements as Topic↗

[Primary treatment of Parkinson's disease: the application of the March 2000 consensus rules in the Nord Pas-de-Calais area].

INTRODUCTION: For Parkinson's disease, the choice of the initial treatment is essentially between L-Dopa and dopaminergic agonists. Selegilin, anticholinergic and amantadine can be used for subjects with moderate symptoms. The first French consensus conference, held in 2000, elaborated decision-making rules which take into account both the age and disease severity. The aim of our study was to evaluate the impact of these recommendations on treatments prescribed for de novo parkinsonian patients in the Nord-Pas de Calais area, comparing initial prescriptions before and after the conference. METHODS: Three groups of 50 patients whose diagnosis of Parkinson's disease had been establish in three periods (1985-1992, 1993-1999, and after July 2000, date of the national publication of the consensus) were constituted. RESULTS: For these 3 groups, the initial treatment complied with the 2000 recommendations for 58, 84 and 82 percent of the patients respectively. The prescriptions of agonists increased progressively while the prescriptions of L-Dopa decreased for younger patients, in concordance with the consensus, but also for older patients, in opposition with the recommendations, though without any increase in the incidence of side effects. The non dopaminergic treatments were almost discarded as initial treatment. CONCLUSION: Prescription habits have gradually changed over the past 10 years. Changes were linked to the elaboration of the national consensus conference guidelines and to the apparent desire to decrease L-Dopa prescriptions.

Aged↗

National Comprehensive Cancer Network guidelines for the management of prostate cancer.

Guidelines for the management of prostate cancer issued by the National Comprehensive Cancer Network provide a basis for rational treatment decisions. These guidelines represent consensus recommendations by a panel of experts that are evidence based and are designated according to the degree of consensus within the expert panel. The initial stratification point is the patient's life expectancy (>5 or <5 years). If life expectancy is >5 years, the recommended intervention is based on clinical stage, prostate-specific antigen (PSA) level, and Gleason score, as well as the presence of symptoms. These assessments establish the patient's risk of recurrence after therapy. Specific initial therapies are then recommended according to whether the risk category is low, intermediate, high, or very high. The guidelines also describe the appropriate use of observation ("watchful waiting") versus active intervention in certain patients. After definitive therapy, patients should be monitored with PSA determinations, digital rectal examination, and bone scans, as outlined in the guidelines. Patients who exhibit increasing PSA levels after prostatectomy are candidates for salvage therapy with androgen ablation, radiotherapy, or observation. If PSA levels begin to increase after radiotherapy, surgery may then be an additional option. Systemic salvage therapy generally consists of androgen ablation; the benefit of total androgen blockade versus initial monotherapy remains controversial. Relapse after initial androgen ablation is treated with an antiandrogen, if none had been administered previously. Patients refractory to further hormonal manipulations are observed or receive palliative therapy, including chemotherapy. The treatment of prostate cancer is complex. Optimal treatment is risk-adapted to the specific characteristics of the cancer and the expected longevity and personal preferences of the patient.

Androgen Antagonists↗

Seeking consensus on important aspects of nursing care.

The authors suggest that the lack of consensus among nurses about important indicators and other measures of quality stems from the lack of consensus on important aspects of nursing care. This article reports on a national conference for nursing quality assurance in which 176 nurses representing 11 specialties developed lists of universal and specialty practice important aspects of care. It discusses questions raised at the conference about definitions of terms, as well as plans for additional follow-up work.

Consensus Statements as Topic↗

The STARD initiative.

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Consensus Statements as Topic↗