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Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis.

Standardization of terminology used to describe the pattern and course of MS is essential for mutual understanding between clinicians and investigators. It is particularly important in design of, and recruitment for, clinical trials statistically powered for expected outcomes for given patient populations with narrowly defined entry criteria. For agents that prove safe and effective for MS, knowledge of the patient populations in definitive clinical trials assists clinicians in determining who may ultimately benefit from use of the medication. An international survey of clinicians involved with MS revealed areas of consensus about some terms classically used to describe types of the disease and other areas for which there was lack of consensus. In this report, we provide a summary of the survey results and propose standardized definitions for the most common clinical courses of patients with MS.

Disease Progression↗

Issues in the application of the resource-based relative value scale system to pediatrics: a subject review. American Academy of Pediatrics. Resource-Based Relative Value Scale Project Advisory Committee.

In today's rapidly changing health care environment, it is crucial to understand the genesis and concepts of the Medicare Resource-based Relative Value Scale (RBRVS) physician fee schedule. Many third-party payers, including state Medicaid programs, Blue Cross-Blue Shield agencies, and managed care organizations are using variations of the Medicare RBRVS to determine physician reimbursement and capitation rates. Because the RBRVS fee schedule was originally created for Medicare only, pediatric-specific Current Procedural Terminology codes and pediatric practice expense issues were not included. The American Academy of Pediatrics agrees with the use of the Current Procedural Terminology codes and the RBRVS physician fee schedule and continues to work to rectify the inequities of the RBRVS system as they pertain to pediatrics.

Child↗

A registry for carbon monoxide poisoning in New York City. Hyperbaric Center Advisory Committee Emergency Medical Service, City of New York.

In 1983 the North American Hyperbaric Center (affiliated with Bronx Municipal Hospital Center) was designated to provide Hyperbaric oxygen (HBO) for carbon monoxide (CO) patients meeting Emergency Medical System (EMS) criteria: 1. Unconscious or CNS derangement, any carboxyhemoglobin level [( COHb]); 2. [COHb] 25% or more; 3. Pregnant, any [COHb]. Through 1984, 39 CO patients received HBO; in 1985 81 were treated including 8 pregnant and 16 pediatric. CO sources were: fire, 43; heater, 21; engine, 17. 42 of 59 acute patients were initially in coma; 16 required CPR. Time to HBO averaged 4.5 hrs. Mean hospital [COHb] was 31% for acute, 28% for subacute/chronic, 15% for pregnant; mean maximum [COHb] was estimated: 51% for acute, 40% for subacute/chronic patients. Mean half life for [COHb] was 2.1 hrs. HBO typically was 46 min at 3ATA (2 [COHb] half lives), presented few problems, and gave rapid clinical improvement. 13 of 19 patients comatose before HBO were responsive after HBO (mean [COHb] was 1.8%). Four pediatric deaths occurred; brain damage was noted in two other patients. EMS efforts to make HBO available for CO is a success.

Adolescent↗