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PubMed2003

The epidemiology and definition of the acute respiratory distress syndrome.

Acute lung injury and ARDS have been clinically recognized syndromes for nearly 30 years. During that time, the understanding of the risks, pathophysiology, and outcomes has changed and improved. The definition for this disease has evolved in an attempt to identify more accurately and reliably a more homogeneous patient population that could be expected to have similar responses to the disease and therapies. The most widely accepted definition is that developed by the AECC in 1994 and now commonly used in epidemiologic studies and clinical trials. Estimates of the incidence of the disease and of mortality are significantly affected by variability in definitions used. Current estimates of the incidence of ALI, however, range from 3 to 75 cases/100,000 population/year. Mortality estimates range from 30% to 40%. Although mortality has improved from more than 60% 20 years ago, ALI survivors are still faced with an increased risk of death as well as significant decrements in physical function and quality of life through the first 12 months after hospital discharge. A great deal of progress has been made in the understanding and management of ALI patients. Now, as the search for new therapeutic options continues, equal attention must be focused on studying and improving qualitative outcomes for this group of patients.

Consensus Statements as Topic↗
PubMedDate not supplied

[Conformal radiotherapy: principles and classification].

'Conformal radiotherapy' is the name fixed by usage and given to a new form of radiotherapy resulting from the technological improvements observed during, the last ten years. While this terminology is now widely used, no precise definition can be found in the literature. Conformal radiotherapy refers to an approach in which the dose distribution is more closely 'conformed' or adapted to the actual shape of the target volume. However, the achievement of a consensus on a more specific definition is hampered by various difficulties, namely in characterizing the degree of 'conformality'. We have therefore suggested a classification scheme be established on the basis of the tools and the procedures actually used for all steps of the process, i.e., from prescription to treatment completion. Our classification consists of four levels: schematically, at level 0, there is no conformation (rectangular fields); at level 1, a simple conformation takes place, on the basis of conventional 2D imaging; at level 2, a 3D reconstruction of the structures is used for a more accurate conformation; and level 3 includes research and advanced dynamic techniques. We have used our personal experience, contacts with colleagues and data from the literature to analyze all the steps of the planning process, and to define the tools and procedures relevant to a given level. The corresponding tables have been discussed and approved at the European level within the Dynarad concerted action. It is proposed that the term 'conformal radiotherapy' be restricted to procedures where all steps are at least at level 2.

Accreditation↗
PubMed2007

Disease-modifying trials in Alzheimer's disease: a European task force consensus.

After symptomatic treatments, the new target for therapeutic approaches in Alzheimer's disease is the development of disease-modifying drugs. The concept of disease modification in Alzheimer's disease is controversial and the design of these trials raises many questions. Which populations should be studied? For how long? With which principal and secondary endpoints? Are surrogate markers available? Here, we present a European consensus on disease-modifying trials in Alzheimer's disease, agreed under the auspices of the European Alzheimer's Disease Consortium and based on the European perspective of the concept of disease modification, study designs, the role for biomarkers, risk benefit, and pharmacoeconomic issues.

Aged↗
PubMed2003

The role of the private sector in monitoring health care quality and patient safety.

BACKGROUND: As payers, purchasers, and providers, both the public and private sectors have a stake in developing sound methods of measuring health care quality and patient safety. However, the role of the private sector in a national quality monitoring system remains largely underdeveloped. PRIVATE SECTOR ROLE IN HEALTH CARE QUALITY MONITORING: There have been some attempts to pool private-sector data through health care industry efforts to measure and monitor the quality of health care services. Yet despite a number of public/private partnerships, no standard method exists for measuring and monitoring health care quality and safety across public and private payers. THE AHRQ WORKSHOP ON PRIVATE-SECTOR QUALITY MONITORING: The Agency for Healthcare Research and Quality (AHRQ) sponsored a workshop in fall 2000 to address the private sector's role in monitoring quality in the health care system. National experts developed a conceptual framework and recommendations on the design and scope of a private-sector data monitoring system. Ten key attributes of the monitoring system, such as timeliness of reports, flexibility, efficiency, and linkability, were identified. Barriers and gaps to the development of such a system include the cost of data collection, the diversity of the units of data collection, data privacy, and limitations of administrative data elements. SUMMARY: A comprehensive, public/private data collection system would address the multidimensional nature of quality and use data to effectively represent this complexity to the extent possible.

Consensus Statements as Topic↗
PubMedDate not supplied

Consensus and beyond.

Explore the source record for details and available documents.

Consensus Statements as Topic↗
PubMed1990

Format and conduct of consensus development conferences. Multi-nation comparison.

The consensus development conference method developed by the National Institutes of Health in the United States has been adopted and modified by a number of countries. Based on published articles and communication with representatives from each country, we examined whether the organization and conduct of these conferences in nine countries (United States, Canada, Denmark, Finland, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom) enhanced or detracted from achieving the stated conference goals and objectives. We conclude that improvements in the process by which consensus conferences are conducted may be warranted. More scientific methods for synthesizing literature, such as meta-analysis, should be used in developing inputs for the conference panel. Formalizing the decision-making processes through polling or other methods that allow for structured disagreement with parts of a consensus statement would potentially expand the range and type of issues that can be addressed in such conferences. Finally, countries should consider having the consensus statement written over a longer period of time than the traditional overnight session, which seems unlikely to promote clear thinking.

Consensus Statements as Topic↗
PubMed1988

When does information change practitioners' behavior?

Programs that disseminate information to health care practitioners often do so partly to encourage appropriate changes in practice. However, merely providing information is seldom enough to accomplish such changes. If information transfer programs are to influence practice, they must be designed to maximize the conditions facilitating change. Reliance on a diffusion model for thinking about how information reaches practitioners has led researchers to over-emphasize the importance of exposure to information and ignore other factors that determine whether change will occur, such as practitioners' motivation to change, the context in which clinical decisions are made, and how information is presented. The fact that successful dissemination will not necessarily produce change also has implications for how information transfer programs should be monitored and evaluated.

Attitude of Health Personnel↗
PubMed1988

Consensus development conferences in Sweden. Effects on health policy and administration.

Seven consensus development conferences have been held in Sweden since 1982. The conferences, sponsored by the Swedish Medical Research Council and Spri, typically examine social, organizational, and economic aspects of technology, and therefore, generate consensus statements of interest not only to physicians but also to politicians and health administrators. The study presented here examines the influence of the first five consensus development conferences on politicians and health administrators. Data was obtained via a mail questionnaire and personal interviews with leading individuals in these groups. More than half of the respondents indicated that they had found the statements from one or more conferences to be of practical value as a basis for discussing specific technologies with medical staffs. In some cases the statements directly influenced political decisions.

Consensus Statements as Topic↗
PubMed1988

Evaluation of the consensus conference program in Sweden. Its impact on physicians.

The impact of consensus conferences on physicians was studied in 1985 for the first four conferences Sweden held in 1982-1985. For each conference a main target group was defined as hospital-based physicians in supervisory positions within relevant clinics. Data were collected through a postal survey of all 1,668 members of the four different target groups. The total response rate was 86%. Reported awareness of a particular consensus conference as well as professed knowledge of a single conference statement was high--roughly 90%--for all four conferences. The consensus statement evoked changes in clinical practice according to 7%-10% of the respondents and changes were proportionally higher for physicians in smaller hospitals. Most of the respondents (61%-83%) reported no change, claiming that the consensus statement reflected clinical practices established prior to the conference. The validity of self-reported data is discussed.

Consensus Statements as Topic↗
PubMed1988

Update on assessment activities. United States perspective.

The purpose of this paper is to present an update on biomedical technology assessment activities from a United States perspective. In 1985, I described in detail (a) a primary vehicle for technology assessment--the Consensus Development Program (CDP) of the National Institutes of Health (NIH)--and also discussed, in a second paper, (b) the transfer of consensus-enhanced scientific information and some of its impact on U.S. medical practice. Here, I focus on what has transpired during the past year: the changes in the climate in which U.S. technology assessment efforts are being conducted, the consequences of these changes, and the challenges that they pose for all concerned with the provision of quality health care. The first part of this paper centers on the broader framework within which technology assessment plays a role in the United States. Later, it addresses the specific technology assessment and transfer activities in which the NIH is engaged.

Consensus Statements as Topic↗
PubMed1988

Stylistic variations in National Institutes of Health consensus statements, 1979-1983.

This paper describes a content analysis of the statements of 24 Consensus Development Conferences conducted by the Office of Medical Applications of Research (OMAR) of the National Institutes of Health in the years 1979-1983. The goal was to understand the potential influence of the consensus statements by identifying characteristics that might determine whether and how physicians become aware of their findings and adopt their recommendations. Three characteristics emerged, each suggestive of a different style of consensus statement: discursiveness, didacticism, and scholarliness. Variations in style among consensus statements may affect their acceptance by the medical profession.

Consensus Statements as Topic↗
PubMed1988

Consensus conferences in different countries. Aims and perspectives.

The different models of consensus development conferences (CDCs) are analyzed in relation to democratic technology assessment. In some countries CDCs are mainly concerned with influencing the quality of clinical practice and thus are dominated by medical experts. In other countries, CDCs are directed towards the public and the decision makers on the political and administrative level. The Danish experience demonstrates that CDCs may be a forceful social technology with a strong potential to influence decisions about medical as well as non-medical technology.

Consensus Statements as Topic↗
PubMed1988

Diffusion of knowledge in dentistry. The pit and fissure sealant conferences.

This paper presents data on the diffusion to dentists of information from the May 1981 American Dental Association conference and December 1983 National Institutes of Health (NIH) conference on pit and fissure sealants. A mail survey was sent to 521 (72.2% returned) randomly selected dentists in general practice and all 47 (76.6% returned) pedodontists in the State of Washington. Approximately 70% of the dentists were aware that the conferences had taken place and a little over 50% were aware of the conference recommendations. Awareness was related to: being a pedodontist, number of continuing education hours taken, number of referred journals read, and being an officer in a dental organization.

American Dental Association↗