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PubMed1996

A proposed new international TNM staging system for malignant pleural mesothelioma from the International Mesothelioma Interest Group.

STUDY OBJECTIVE: investigation of the behavior and treatment of diffuse malignant pleural mesothelioma (MPM) is hindered by the lack of an accurate universally accepted staging system. To address this problem, the International Mesothelioma Interest Group (IMIG) has developed a new TNM based staging system. METHODS: the staging system was developed at a consensus meeting of IMIG members involved in clinical research in MPM, including the originators of previously proposed staging systems. The new staging system is based on the analysis of emerging information about the impact of T and N status on survival. RESULTS: in contrast to five previous staging systems, the T descriptors designated as T1, T2, T3 and T4, provide precise anatomic definitions of the local extent of the primary tumour. The N descriptors, designated as N0, N1, N2 and N3, are virtually identical to those used in the International Lung Cancer Staging System. The stage groupings recognize new data about the better prognosis of T1 and N0 tumours and classify those tumours into stages I and II. The adverse impact of nodal metastases on survival noted in some recent surgical series warrants placing node positive tumours in stage III. Locally advanced unresectable (T4) tumours and extrathoracic disease (N3 or M1) are classified as stage IV. CONCLUSION: this proposed staging system reconciles and updates several earlier systems, and can provide the framework for analyzing the results of prospective clinical trials aimed at improving the currently dismal prognosis of MPM.

Humans↗
PubMed1995

A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group.

STUDY OBJECTIVE: Investigation of the behavior and treatment of the diffuse malignant pleural mesothelioma (MPM) is hindered by the lack of an accurate universally accepted staging system. To address this problem, the International Mesothelioma Interest Group (IMIG) has developed a new TNM-based staging system. METHODS: The staging system was developed at a consensus meeting of IMIG members involved in clinical research in MPM, including the originators of previously proposed staging systems. The new staging system is based on the analysis of emerging information about the impact of T and N status on survival. RESULTS: In contrast to five previous staging systems, the T descriptors designated as T1, T2, T3, and T4, provide precise anatomic definitions of the local extent of the primary tumor. The N descriptors, designated as N0, N1, N2, and N3, are virtually identical to those used in the International Lung Cancer Staging System. The stage groupings recognize new data about the better prognosis of T1 and N0 tumors and classify those tumors into stages I and II. The adverse impact of nodal metastases on survival noted in some recent surgical series warrants placing node-positive tumors in stage III. Locally advanced unresectable (T4) tumors and extrathoracic disease (N3 or M1) are classified as stage IV. CONCLUSION: This proposed staging system reconciles and updates several earlier systems, and can provide the framework for analyzing the results of prospective clinical trials aimed at improving the currently dismal prognosis of MPM.

Humans↗
PubMedDate not supplied

Interest groups and health reform: lessons from California.

We review the 1992 policy choices in California for expanding health insurance coverage, focusing on the rejection of an employer mandate by legislators and voters. We analyze how interest-group politics, gubernatorial politics, and national politics shaped those choices. Although public opinion and the shift of organized medicine showed considerable support for extending health insurance coverage, the opposition of liberal and conservative groups and a foundering economy prevented a significant change in public policy. The president's health reform plan appears to address many of the unresolved concerns in California, but overcoming resistance to any kind of mandate will require skilled leadership and negotiation.

Attitude to Health↗
PubMed1978

Voting behavior of HSA interest groups: a case study.

A study of the voting behavior of both consumers and providers involved on a Health Systems Agency (HSA) review committee was undertaken to determine the amount of voting cohesion (solidarity) demonstrated by these two basic interest groups as well as the directions in review decisions desired by both of these groups. The case study involved the application of the Rice Index of voting cohesion behavior to 23 decisions in one of the largest HSAs in the country. The conclusions reached are that: 1) consumers and providers do have differences in their intra-group voting cohesion, but that more importantly 2) they do not appear to be different with respect to the decisions (approve or deny) both groups desire for project reviews.

Community Participation↗
PubMed1999

Assessment of the "scholarly project" requirement for emergency medicine residents: report of the SAEM Research Directors' workshop. SAEM Research Directors' Interest Group.

OBJECTIVES: Differences in interpretation of the residency review committee (RRC) directive concerning resident scholarly activity have resulted in inconsistencies in the practical fulfillment of this responsibility among the various training programs in emergency medicine. During a workshop organized by the SAEM Research Directors' Interest Group (RDIG), a consensus statement was developed regarding the scope, definition, and purpose of the scholarly project requirement. METHODS: During the workshop, the NIH model of consensus building was used to develop statements pertaining to specific questions of the goals, definition, and endpoints of the scholarly project. The program consisted of an overview of the history and issues related to the scholarly project and presentations of varying viewpoints from interested parties. A final consensus of answers to the defined questions was then developed by the workshop participants during roundtable discussions and further refined through interactive debate using the RDIG e-mail list server. RESULTS: By consensus it was agreed that the primary role of the scholarly project is to instruct residents in the process of scientific inquiry, to teach problem-solving skills, and to expose the resident to the mechanics of research. To realize these goals, the project should include the general elements of hypothesis formulation, data collection, analytic thinking, and interpretation of results. It was also thought that these elements should be documented in some written form with a literature review. CONCLUSIONS: While each residency program must implement the RRC residency requirements in a manner that best suits the needs and culture of its individual environment, a concurrence of definition and approach to satisfying the scholarly project requirement would provide better consistency in resident training. Guidelines developed by consensus during the SAEM RDIG workshop may serve as a general recipe that can be used to fulfill the goals of the scholarly project and the spirit of the RRC directive.

Decision Making↗
PubMed1994

Transplantation issues need to be addressed with caution in unified push for health care reform. Transplant Special Interest Group.

The American Nephrology Nurses' Association (ANNA) recently joined other specialty nursing organizations and the American Nurses Association (ANA) in presenting a unified nursing voice supporting universal access to health care. This article presents concerns raised by ANNA's Transplant Special Interest Group (SIG) regarding the current package for health care reform proposed by the Clinton Administration.

Health Care Reform↗
PubMed1998

Practice parameter: antiepileptic drug treatment of posttraumatic seizures. Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation.

The practice of antiepileptic drug (AED) prophylaxis for posttraumatic seizures (PTS) is common, although results of clinical trials raise questions regarding the benefits of such treatment. A subcommittee of the Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation was impaneled to review published literature regarding AED prophylaxis of PTS and formulate recommendations in the form of a practice parameter. The subcommittee presents the following recommendations: (1) Treatment standard: Prophylactic use of phenytoin (PHT), carbamazepine (CBZ), sodium valproate (VPA), or phenobarbital (PB) is not recommended for preventing late PTS, defined as seizures that occur after 1 week of injury, in the patient in whom there has been no history of seizures following a nonpenetrating traumatic brain injury (TBI). (2) It is recommended as a treatment option that PHT, PB, and CBZ may be used to prevent early PTS in patients at high risk for seizures following TBI. (3) Prophylactic use of PHT, CBZ, VPA, or PB is not recommended for preventing late PTS following penetrating TBI.

Adult↗
PubMed1994

A national policy on asthma management for schools. The Asthma Special Interest Group, Thoracic Society of Australia and New Zealand.

Since asthma is the most common chronic illness in childhood, many of the problems associated with this condition will impact on the child's education. Because of widespread concerns regarding the management of asthma in schools, a subcommittee of the Thoracic Society of Australia and New Zealand, Asthma Special Interest Group, was convened to draw up national guidelines for school staff in order to provide optimal management of asthma in the school setting. We used current medial literature and the clinical experience of the authors who have dealt with children and adolescents suffering from asthma in the hospital, community and school environment. A number of issues had been identified, including: the availability of an asthma first aid kit; correct use of bronchodilator aerosols by puffer and spacer devices; and clear instructions as to when to notify parents and when to call an ambulance to the school.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1977

Interest-group representation and the HSAs: health planning and political theory.

Examination of the provisions of the National Health Planning and Resources Development Act, P.L. 93-641, concerning the composition of Health Systems Agencies, which are to be the primary building-blocks of local health planning, suggests that expectations of substantial change may be unrealistic. Specifically, in its provision for representation on the HSAs, Congress appears to have been accepting an implicit theory of pluralist interest-group representation that has long been prevalent in other sectors of public life in the United States, and long subject to significant criticism. Such forms of representation tend to lead to bargaining, log-rolling, and collusive competition among narrowly-defined special interests, with the interests of the broader general public less well-served. The application of this theory to health planning in P.L. 93-641 is examined, and predictions drawn about the implications of this analysis for health planning and health policy in the United States in general.

Community Participation↗
PubMed2005

Blood transfusion and autologous donation: a survey of post-surgical patients, interest group members and the public.

Before planned surgery, patients may choose autologous donation in order to avoid the small, but potential, risks of receiving an allogeneic blood transfusion. This study examined the perceived risks of allogeneic blood transfusions, preferences and willingness to pay for autologous donation and the desired role in the decision-making process in three populations: post-surgical patients, special interest group members and the general public. Quantitative and qualitative data were collected from 206 respondents with the help of computer-assisted semi-structured telephone interviews. Thirty-three per cent of the sample voiced concerns about receiving allogeneic blood transfusions. The risks of hepatitis C virus, human immunodeficiency virus, variant Creutzfeldt-Jakob disease and a haemolytic reaction were perceived as being low, but were rated as numerically higher than those of other life events that have equal probability. Autologous donation was perceived as removing all the risks associated with transfusion, and respondents were willing to pay a median $976 AUD ($664 US) to use this technique. Over 80% of respondents preferred to be involved in making the decision about whether to use autologous donation. Even though autologous donation is not 'risk-free' and the blood supply is very safe, people overestimate the associated risks and have a preference for their own blood. Decision aids presenting balanced information on the advantages and disadvantages of both allogeneic and autologous blood may be required.

Adult↗
PubMedDate not supplied

Malignant mesothelioma in 2004: How advanced technology and new drugs are changing the perspectives of mesothelioma patients. Highlights from the VIIth Meeting of the International Mesothelioma Interest Group.

Malignant mesothelioma (MMe) is a seemingly uncommon tumour whose incidence has in fact increased steadily and progressively over the last 30 years. Indeed, an actual "epidemic" is expected in the next 20 years, with over 1300 new cases a year till 2020 at least. Despite unquestionable improvement in the diagnostic methods at our disposal and the availability of new treatment strategies, the prognosis of MMe patients remains dramatically poor. For all the above reasons, translational research is the key to success; indeed, ever increasing knowledge of the molecular mechanisms underlying MMe pathogenesis could lead (and is actually leading) to new, hopefully more active, treatment options. To foster discussion among investigators working in this field, and to exchange different viewpoints concerning the newest advances in MMe pathogenesis and treatment, the VII International Mesothelioma Interest Group (IMIG) meeting was held in Brescia (Italy) between 24 and 26 June 2004 in cooperation with the Italian Group for the Study and Therapy of MMe (GIMe). The aim of this report is to summarize the most significant advances in the different disciplines applied to MMe presented and discussed during the IMIG meeting and how these advances will be changing the perspective of patients with MMe.

Angiogenesis Inhibitors↗
PubMed2000

ESHRE guidelines for good practice in IVF laboratories. Committee of the Special Interest Group on Embryology of the European Society of Human Reproduction and Embryology.

Education has always been a priority for the European Society of Human Reproduction and Embryology (ESHRE). Many efforts have been dedicated to promoting knowledge of techniques, procedures and strategies in order to ensure use of the highest quality practices in reproductive medicine. The need to develop a set of guidelines was a logical consequence that found its first expression in 1990, when Focus on Reproduction (vol. 1, pp. 10-38) published the first guidelines which were distributed among the membership. Five years later a new, more complete edition with several novel techniques and developments appeared in Human Reproduction (vol. 10, pp. 1246-1271). Both have proved to be invaluable references. Five more years have now passed. The necessity to produce current guidelines for good IVF laboratory practice has provided the strongest motivation. This originated from the increasing awareness that embryologists have a duty to prevent unintentional incidents that might result from poor practice in the laboratory. Therefore, the Embryology Special Interest Group (SIG) undertook to draw up guidelines aimed at giving support and guidance to the laboratory staff. All the aspects required to provide a safe working system were taken into consideration by members of the SIG and their effort produced this document. We hope that it will assist staff in achieving the best clinical outcome for their patients.

Cryopreservation↗
PubMed1996

Consensus workshop on advanced diagnostic andrology techniques. ESHRE (European Society of Human Reproduction and Embryology) Andrology Special Interest Group.

The Workshop reviewed four areas of advanced diagnostic andrology identified in the World Health Organization's 1992 Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction as 'research tests'. These were computer-assisted sperm analysis (CASA), acrosome reaction tests, the zona-free hamster egg penetration test and sperm-zona pellucida binding tests. For each topic, the Workshop Report comprises an overview of the particular field, a chronicle of the discussion that followed and a statement of the specific consensus points that were established. Free discussion allowed the elaboration of several general concepts that are presented here as the Workshop participants' perceived framework for future work in this area. While it was recognized that large-scale screening of male partners using advanced sperm function tests is almost certainly totally impractical on grounds of cost and lack of adequate services, urgent consideration was recommended for the development of a sperm function testing strategy capable of providing the likelihood of pregnancy for given diagnostic situations within certain timeframes. Establishing a clear definition of the role of diagnostic andrology in male infertility should be a primary focus of the Special Interest Group's activities. Further initiatives, including training courses, workshops, symposia and multicentre research studies, will be accorded high priority. Similar consideration will also be given to protocols for facilitating rational management decisions to ensure cost-effective therapeutic strategies, including consideration of the hierarchy of complexity and cost versus predicted fecundity. In addition, it was recognized that we need a greater understanding of the genetic basis of male infertility and how this impacts on the achievement of a viable pregnancy, while also minimizing the burden of genetic defects on the next generation.

Acrosome↗
PubMed1997

The development of international emergency medicine: a role for U.S. emergency physicians and organizations. SAEM International Interest Group.

There is a rapidly growing interest in emergency medicine (EM) and emergency out-of-hospital care throughout the world. In most countries, the specialty of EM is either nonexistent or in an early stage of development. Many countries have recognized the need for, and value of, establishing a quality emergency health care system and are striving to create the specialty. These systems do not have to be high tech and expense but can focus on providing appropriate emergency training to physicians and other health care workers. Rather than repeatedly "reinventing the wheel" with the start of each new emergency care system, the preexisting knowledge base of EM can be shared with these countries. Since the United States has an advanced emergency health care system and the longest history of recognizing EM as a distinct medical specialty, lessons learned in the United States may benefit other countries. In order to provide appropriate advice to countries in the early phase of emergency health care development, careful assessment of national resources, governmental structure, population demographics, culture, and health care needs is necessary. This paper lists specific recommendations for EM organizations and physicians seeking to assist the development of the specialty of EM internationally.

Developing Countries↗
PubMed1999

British Co-operative Clinical Group national survey on diagnostic issues surrounding genital herpes. MSSVD Special Interest Group on Genital Herpes and the British Co-operative Clinical Group.

OBJECTIVES: To investigate the current use of diagnostic methods for genital herpes simplex virus (HSV) infection, to determine how information from these tests influences clinical practice, and to identify areas for future guideline development within genitourinary medicine (GUM) clinics in the United Kingdom. METHODS: National survey of 173 consultants in UK GUM clinics. RESULTS: Completed questionnaires were returned by 146 (84%) consultants. Cell culture was the first line diagnostic method for 133 (91%) respondents, the remaining 13 (9%) used antigen detection tests. Typing of isolates (HSV-1 or HSV-2) was available in their local laboratory to 109 (75%) clinicians; however, less than two thirds routinely pass this information on to their patients. Although 74 (51%) respondents had access to serological diagnosis, the majority of methods described were non-specific; only three (2%) had access to type specific tests. Only 81 (56%) respondents frequently (> 90% of the time) recommend notification of recent sexual partners of genital herpes patients. CONCLUSIONS: While access to culture based diagnosis is widespread, type specific serology has limited availability. Information on typing of isolates as HSV-1 or 2, although available in three quarters of centres, is underutilized in counselling patients. As HSV type influences both clinical and subclinical reactivation rates and may also affect probability of transmission, this is an important omission. Future guidelines need to address the optimal use of viral typing and new diagnostic tests to optimise health gain; there is also a need for evidence based recommendations about partner notification in genital herpes.

Contact Tracing↗
PubMed1990

An assessment of the drug therapy education preferences of an interdisciplinary group interested in the elderly.

A survey was conducted to measure the drug therapy education preferences of a diverse group of professionals interested in the elderly. Two hundred forty-four surveys were mailed and 119 were returned (48.8 percent). Seventy-two percent of the respondents were social workers; four percent were registered nurses; the remainder of the respondents (24 percent) were non-health professionals. Most respondents liked all common methods of instruction except self-directed activities and large group discussions. The five topics of greatest interest were drug interactions, adverse drug effects, drugs used to treat depression, drugs used to treat nervousness or anxiety, and drugs used to manage dementia. A survey is an economical means of assessing the preferences of an unfamiliar audience. The methods used to determine content for this program can be used by educators who are planning programs for similar audiences made up of health and non-health professionals.

Aged↗