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PubMed2000

Office spirometry for lung health assessment in adults: A consensus statement from the National Lung Health Education Program.

COPD is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients >/= 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry-office spirometry-for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Adult↗
PubMed2001

National Institutes of Health Consensus Development Conference statement. Diagnosis and management of dental caries throughout life, March 26-28, 2001.

OBJECTIVE: To provide health care providers, patients and the general public with a responsible assessment of currently available data regarding the diagnosis and management of dental caries throughout life. PARTICIPANTS: A nonfederal, nonadvocate, 13-member panel representing the fields of dentistry, epidemiology, genetics, medicine, oral biology, oral radiology, pathology, periodontics, public health, statistics and surgery, as well as a public representative. In addition, 31 experts in these same fields presented data to the panel and to a conference audience of approximately 700. EVIDENCE: Presentations by experts; a systematic review of the dental research literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of dental caries research articles, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the experts and the audience for comment. The panel then met in executive session to consider these comments and released a revised statement at the end of the conference. The statement was made available on the World Wide Web at "consensus.nih.gov" immediately after the conference. This statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the federal government.

Anti-Infective Agents, Local↗
PubMed2002

A review of the science regarding dental unit waterlines.

BACKGROUND: The National Institute of Dental and Craniofacial Research, or NIDCR; the American Dental Association, or ADA; and the Organization for Safety & Asepsis Procedures, or OSAP, sponsored a workshop on the topic of dental unit waterlines, or DUWLs, on Sept. 29, 2000, at the National Institutes of Health in Bethesda, Md. These organizations invited a group of experts from the ADA, NIDCR, OSAP, the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the U.S. Department of Defense, academia and private industry to participate. TYPES OF STUDIES REVIEWED: The sponsors asked the participants to critically review the scientific literature on the subject in an attempt to determine the evidence basis for management of DUWL contamination and potential health risks, if any, in dental procedures. The ultimate goal of the workshop was to determine if a research agenda in the area of DUWLs should be pursued and what questions such an agenda should involve. RESULTS: The workshop yielded four questions that need to be addressed in future research: What is the safest and most effective agent(s)/device(s) for achieving microbial levels of no more than 200 colony-forming units per milliliter, or CFU/mL, in the effluent dental water? How should these products be evaluated and by whom? What are the adverse health effects, if any, of chronic exposure to dental bioaerosol or to the agents introduced into the dental unit to treat the waterlines for both dental staff members and patients? How could these health issues be evaluated? CLINICAL IMPLICATIONS: Developing evidence-based parameters for the management of biofilm contamination that are efficacious and cost-effective will allow clinicians to meet in proposed ADA standard of no more than 200 CFU/mL of effluent water.

American Dental Association↗
PubMed2001

National Institutes of Health Consensus Development Conference Statement: phenylketonuria: screening and management, October 16-18, 2000.

OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding screening for and management of phenylketonuria (PKU). PARTICIPANTS: A nonfederal, nonadvocate, 14-member panel representing the fields of pediatrics, genetics, human development, public policy, nursing, and molecular physiology and including patient representatives. In addition, 19 experts in pediatrics, medical genetics, psychology, pediatric neurology, biochemical and molecular genetics, and gene therapy presented data to the panel and to a conference audience of 312. EVIDENCE: The literature was searched using Medline for January 1980 through July 2000, and an extensive bibliography of 3394 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://consensus.nih.gov. CONCLUSIONS: Genetic testing for PKU has been in place for almost 40 years and has been very successful in preventing severe mental retardation in thousands of children and adults. Metabolic control is necessary across the lifespan of individuals with PKU. A comprehensive, multidisciplinary, integrated system is needed to delivery of care to individuals with PKU. Greatly needed are consistency and coordination between screening, treatment, data collection, and patient support programs. There should be equal access to culturally sensitive, age-appropriate treatment programs. Ethically sound, specific policies for storage, ownership, and use in future studies of archived samples remaining from PKU testing should be established. Research into the pathophysiology of PKU and relationship to genetic, neural, and behavioral variation is strongly encouraged. Uniform policies must be established to remove financial barriers to the acquisition of medical foods and modified low-protein foods and to provide access to support services needed to maintain metabolic control in individuals with PKU. Research on nondietary alternative treatments for PKU is strongly encouraged. To achieve optimal statistical power and cross-cultural applicability, it will be beneficial to use data acquired via national and international collaboration.phenylketonuria, hyperphenylalanimea, phenylketonuria screening, phenylalanine-restricted diet, maternal phenylketonuria, newborn screening, phenylalanine monitoring, phenylketonuria outcomes.

Adult↗
PubMed2004

Research on prevention of bilirubin-induced brain injury and kernicterus: National Institute of Child Health and Human Development conference executive summary. 2003.

In July 2003, the National Institute of Child Health and Human Development convened a conference, "Research on Prevention of Bilirubin-Induced Brain Injury and Kernicterus: Bench-to-Bedside." This article will provide a summary of presentations and discussions from this conference. The summary will focus on the identified knowledge gaps in 5 areas related to bilirubin-induced brain injury and kernicterus: 1) neurobiology and neuroimaging; 2) epidemiology and issues of clinical management; 3) methodologies for assessing clinical jaundice and direct and noninvasive measurement of serum bilirubin and hemolysis; 4) therapies for management of neonatal hyperbilirubinemia; and 5) public health surveillance and systems-based approaches to prevention.

Bilirubin↗
PubMed2005

Executive summary of the workshop on the border of viability.

One of the most complex areas in perinatal-neonatal medicine remains the care of the mother delivering a newborn infant at the border of viability, referred to as "periviable" gestation. To address the knowledge gaps that preclude optimal, evidence-based care in this critical field of perinatal medicine, the National Institute of Child Health and Human Development organized a workshop in March 2004. This article provides a summary of the discussions, focusing on major knowledge gaps and prioritized suggestions for studies in this area.

Ethics, Medical↗
PubMed2006

Definition and classification of negative motor signs in childhood.

In this report we describe the outcome of a consensus meeting that occurred at the National Institutes of Health in Bethesda, Maryland, March 12 through 14, 2005. The meeting brought together 39 specialists from multiple clinical and research disciplines including developmental pediatrics, neurology, neurosurgery, orthopedic surgery, physical therapy, occupational therapy, physical medicine and rehabilitation, neurophysiology, muscle physiology, motor control, and biomechanics. The purpose of the meeting was to establish terminology and definitions for 4 aspects of motor disorders that occur in children: weakness, reduced selective motor control, ataxia, and deficits of praxis. The purpose of the definitions is to assist communication between clinicians, select homogeneous groups of children for clinical research trials, facilitate the development of rating scales to assess improvement or deterioration with time, and eventually to better match individual children with specific therapies. "Weakness" is defined as the inability to generate normal voluntary force in a muscle or normal voluntary torque about a joint. "Reduced selective motor control" is defined as the impaired ability to isolate the activation of muscles in a selected pattern in response to demands of a voluntary posture or movement. "Ataxia" is defined as an inability to generate a normal or expected voluntary movement trajectory that cannot be attributed to weakness or involuntary muscle activity about the affected joints. "Apraxia" is defined as an impairment in the ability to accomplish previously learned and performed complex motor actions that is not explained by ataxia, reduced selective motor control, weakness, or involuntary motor activity. "Developmental dyspraxia" is defined as a failure to have ever acquired the ability to perform age-appropriate complex motor actions that is not explained by the presence of inadequate demonstration or practice, ataxia, reduced selective motor control, weakness, or involuntary motor activity.

Apraxias↗
PubMed1991

Drug abuse prevention evaluation methodology: a bright future.

Drug abuse prevention research findings have been inconsistent. These inconsistencies can be related to several issues including study design and methodology. This article presents consensus recommendations developed to enhance drug abuse prevention evaluation research by a group of prevention researchers and practitioners who met at the National Institute on Drug Abuse in Rockville, Maryland during May 1989. As noted by the number of consensus statements, there was a high level of agreement. After exploring various aspects of evaluating prevention interventions, that agreement was reflected in specific recommendations which are directed to modifying prevention approaches; integrating epidemiologic, etiologic and intervention research methods; and expanding prevention research utilization.

Humans↗