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PubMed1992

Strategic approaches to cancer control research in NCI-funded research bases.

Although the Community Clinical Oncology Program (CCOP) of the National Cancer Institute (NCI) has always encouraged research on cancer prevention and control issues, the clinical cooperative groups and cancer centers that serve as CCOP "research bases" were not required to conduct cancer control research until June 1987. This article draws upon case studies of six cooperative groups and two cancer centers to examine how CCOP research bases have defined cancer control research to be compatible with their missions, restructured roles and relationships to facilitate protocol development and implementation, and routine cancer control research to make prevention and control studies an accepted component of their scientific programs. Three "deliberate" or "emergent" strategies are found to be associated with the earlier resolution of problems and more rapid assimilation of cancer control studies into research base agendas. These strategies include (1) proactive planning, such as the early formation of a Cancer Control Research Committee (CCRC) and the identification of "idea champions" to promote cancer prevention and control research; (2) a staged approach to defining and introducing cancer control research; and (3) the creation of multiple "bridging" mechanisms to link cancer prevention and control studies with ongoing research activities. Research bases were most successful in building investigator commitment to cancer control research when they framed research questions within an accepted scientific paradigm, sought out and supported investigators with an interest in cancer prevention and control questions, created CCRCs with broadly representative memberships, and widely publicized ideas for prevention and control studies.

Humans↗
PubMed1988

Forum allows LTC facilities to face ethical issues together.

To respond to other facilities' requests for support in dealing with ethical issues in long-term care, Bon Secours Hospital-Villa Maria Nursing Center, North Miami, FL, established and sponsors the Interfacility Ethics Study Group for Long Term Care. The group grew out of the facility's Human Values Committee, which serves as the facility's ethics committee. A general mailing to administrators of area long-term care facilities produced the majority of active group participants, which primarily include administrators, nurses, admissions officers, and social workers. The study group meets bimonthly to discuss such topics as treatment decision making for incompetent residents, documentation of treatment decision making in a long-term care context, artificial nutrition and hydration, ethical issues in coma care, the potential impact of AIDS on long-term care facilities, and ethical issues in the use of chemical and physical restraints. Membership is free, thus providing long-term care facilities with a forum that they probably could not afford otherwise and that demonstrates their commitment to excellence in the delivery of long-term care services.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Higher surgical training in Otolaryngology.

The views of the membership of the Association of Otolaryngologists in Training (all current UK Senior Registrars and Consultants in their first year of post) were sought on topical aspects of Higher Surgical Training. 80 members (72.3%) participated. The main points to emerge were that the intercollegiate exam is unpopular. 66% feel it is neither well suited to the developing career structure nor a good assessor of trainees, 80% of Senior Registrars for whom the exam is voluntary say they will not sit it, 66% have doubts about the confidentiality of the Specialist Advisory Committee (SAC) interview and 73% felt the need for a separate faculty for Otolaryngology at the Royal College of Surgeons.

Education, Medical, Continuing↗
PubMed1991

The Canadian Atherosclerosis Society--history and present status.

Since its inception in 1983 the Canadian Atherosclerosis Society (CAS) has established itself firmly on the national and international scene as a forceful scientific voice. Its presence and activities have had their dominant expression at annual meetings held jointly with the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Canadian Society for Clinical Investigation (CSCI) and in sponsoring other scientific and educational events, the most important of which was the Canadian Consensus Conference on Cholesterol (Ottawa, March 1988). It provided a forum for interaction between the scientific community, government, funding agencies, industry and the general public, and culminated in concrete recommendations for the populace of Canada. It also 'induced' a continuum in governmental and public concern for health with respect to atherosclerosis, and beyond it, the field of cardiovascular diseases. This dialogue continues. As a member (Constituent Society) of the International Atherosclerosis Society (IAS), the CAS has a voice in the international community, its policies and activities. The membership increase from 69 in 1983 to 175 in 1991 reflects steady growth of the CAS. The Society has been active in other areas (publications, awards for young investigators, and common educational endeavours with other groups) and will be host to the 1994 International Symposium on Atherosclerosis. Over a short period of only eight years, all of the above attests to sufficient progress (or achievement) for any scientific society. And yet, there remain quite a few areas not addressed as yet and some sad experiences (eg, that with the Long Term Planning Committee) that must be quickly remedied, if the Society is to keep pace with the everchanging emphasis in research that in the final analysis aims at improving the overall well-being and health of all Canadians. Inherent in the definition of history is the premise that accounts be provided of facts only. Historians who research their subjects derive these facts from studying the necessary accounts relating to these 'facts', using different and preferably controversial resources, so as to present the facts as objectively as possible. It is impossible, however, to fulfill all the above criteria for a historian who lived through every phase of 'life' of the subject of his or her account, because no matter how objective one wishes to remain (and bends backwards to achieve this) there will be always an element of a personal prism through which the historian lived the 'life' with his subject. For being human and thus unable to eliminate entirely that personal component, this writer asks humbly for the reader's understanding.

Arteriosclerosis↗
PubMed1997

Guidelines for the prevention of malaria in travellers from the United Kingdom. PHLS Malaria Reference Laboratory, London School of Hygiene and Tropical Medicine.

These guidelines on malaria prevention are an aid to health care workers who advise travellers, particularly those who will be overseas for less than a year. They represent a virtual consensus of the views of 44 doctors, nurses, and pharmacists with special expertise in malariology or travel medicine who met to develop them in 1996 (see list on R152). The guidelines are in three parts. The first part is a summary that emphasises modifications to the advice given in the last set of guidelines, published in 1995. The second part discusses the issues addressed in formulating the guidelines. Doctors, practice nurses, and pharmacists are asked to read this section to avoid doing harm by giving chemoprophylaxis without due attention to the traveller's history or destination and by using oversimplified lists of recommendations by country. The second part also addresses the health care worker's consultation with prospective travellers. The third part gives specific recommendations for travellers to specific destinations and some details of individual drugs. Fuller information on some points was given in earlier versions of the guidelines, which should not be discarded. Meetings of the sort described above have been held since 1980 and the group's membership has included people with varied views and experience. The views expressed in these guidelines reflect experienced professional opinion, since data are inadequate for unequivocal views to be given on several issues. There is often a range of acceptable options, but to meet the requests of general practitioners the guidelines try to give one recommended option and state alternatives, suggesting when and how different regimens can be used to good effect. Decisions on the terms under which different drugs are licensed for use are the responsibility of the Licensing Authority, advised by the Committee on Safety of Medicines (not of these guidelines). The guidelines should be read as a supplement to and not as a substitute for the relevant data sheets. Chemoprophylaxis lies somewhere between vaccination (for which people expect governments to lay down schedules) and treatment of ill people (for which each physician does what seems most appropriate) in concept and practice. The risks of malaria need to be balanced against the risks of the preventive measures, on the basis of the data available. Travellers may ask for an explanation of these risks and doctors and practice nurses need to be well informed and able to present their knowledge to travellers. The second part of these guidelines may be of use to prospective travellers who wish to read about the options themselves. All readers are recommended to read part two in its entirety to get a balanced picture.

Disease Transmission, Infectious↗
PubMed2004

BRAC initiative towards promoting gender and social equity in health: a longitudinal study of child growth in Matlab, Bangladesh.

OBJECTIVE: To explore the effect of BRAC (formerly Bangladesh Rural Advancement Committee) initiatives towards promoting gender and social equity in health among children of poor mothers who are BRAC members. DESIGN: A cohort of 576 children from the prospective study of a BRAC- International Centre for Diarrhoeal Disease Research, Bangladesh joint research project was analysed. Data were collected three times during 1995-1996 with approximately 4-month intervals. Stunting, defined as height-for-age below minus two standard deviations from the reference median, was the outcome health measure. The study children were stratified into three groups according to their mother's social and BRAC membership status: poor and BRAC member (BM), poor non-member (TG) and non-poor non-member (NTG). SETTING: Matlab, rural area of Bangladesh. SUBJECTS: Children aged 6-72 months. RESULTS: The overall prevalence of stunting was 76%; the highest prevalence was found among TG (84.6%) children and no significant difference was observed between BM and NTG children (67.3% and 69.4%, respectively). In all groups, a significantly larger proportion of girls was stunted compared with boys in the first round. Group-level analysis showed that stunting decreased among all children except BM boys at the end of third round, with the largest decline among BM girls. In contrast, stunting prevalence increased among BM boys. A similar trend was found in the individual-level analysis, where a larger proportion of BM girls recovered from stunting compared with other groups and no recovery was observed among BM boys. At the end of the third round, the nutritional status of BM girls was almost equal to that of the BM boys, while gender inequity remained large among TG and NTG children. CONCLUSION: The BRAC initiative appeared to contribute to a significant equity gain in health for girls, as well as to decreased differences in ill health between the poor and the non-poor.

Bangladesh↗
PubMed1988

Workers' participation and occupational health: the French experience.

In France, workers' participation in occupational health was organized for the first time in 1947, when Hygiene and Safety Committees were created. However, these committees remained ineffective in many firms for more than 20 years. Their role and power were greatly extended in 1976; in 1982, the Auroux Laws gave wage-earners new rights, mainly rights of expression. Here too, the way these laws have been put into operation varies a lot. Generally speaking, a great many regulations and laws exist that should give workers very good protection, but control systems are weak, and wage-earners' information on health is insufficient. Workers' participation is generally set up through trade unions, which are more often nationwide than locally organized. Workers' membership in unions is rather weak. The recent creation and development of quality circles in many firms, controlled by the company, give a false impression of workers' freedom of speech and do not really improve participation. But recent social movements have shown that people increasingly wish to express themselves and to deal with their own employers without any go-between. Nevertheless, participation will become effective only if workers' knowledge is taken into account, if they are trained in analysis and expression, and if their suggestions are seriously considered.

Accidents, Occupational↗
PubMed2002

Tobacco control: consensus report of the National Medical Association.

ISSUES: Tobacco Control remains one of the greatest determinants for reducing the morbidity and mortality of African Americans. OBJECTIVE: To examine the scope and consequences of tobacco use among African Americans and characterize its implications for the National Medical Association physician membership and their patients, and identify policy, education, advocacy and research issues in Tobacco Control for the organization. CONSENSUS PROCESS: Literature review using the MEDLINE database from January 1966 to August 1999 Week 1, searching Medical Subject Heading (MeSH) reading combined with text words "Black" or "African American" and "Tobacco" as a search term, identified 130 articles/110 abstracts published between 1988 and February 1999. The panel selected 61 appropriate articles and a paper summarizing the literature review was developed. The summary paper was used as background material for a formal consensus panel discussion on July 16-17, 1999. Consensus among committee members was reached via mail, fax and e-mail using the summary review paper, annotated bibliographies key informant surveys, and previous NMA resolutions on tobacco control. A formal working session was held on July 16-17, 1999 in which four areas of concentration of issues were determined: Policy, Advocacy, Education and Research. All committee members approved the final report. SUMMARY: Because tobacco control issues in African Americans are both complex and poorly understood, the panel views the NMA's role as pivotal in the coordination of resources and capacity-building to address all four areas identified. Stronger partner-ships with traditional federal and nonprofit agencies associated with tobacco control/advocacy in African Americans as well as nontraditional organizations (i.e., churches, academia, marketing and media organizations) also must occur to strengthen the infra-structure needed to assess needs, design appropriate interventions and evaluate the appropriateness, effectiveness and efficacy of tobacco control efforts in African American communities.

Black or African American↗
PubMed1985

Survey of purchasers of The APIC Curriculum for Infection Control Practice: findings and recommendations.

A survey of purchasers of The APIC Curriculum for Infection Control Practice was conducted in early 1985 by the APIC Curriculum Committee to determine characteristics of purchasers, usability of the text, reasons for purchase, and availability of references cited. Data were obtained from 342 (54.3%) respondents to a nationwide mail survey sent to a 20% sample (630) of all who were purchasers prior to January 1985. The average purchaser was an Infection Control Practitioner (ICP) who was a nurse employed by an acute care community hospital and had 6.9 years experience in infection control practice; 41% of purchasers worked in hospitals with greater than 300 beds. APIC members represented 93% of the respondents, and their disciplines were similar to those of the membership. Primary reasons for purchasing the Curriculum were to use it as the major reference for infection control information and to study for the Infection Control Certification Examination. Almost half of the respondents had taken and passed the examination. The overall satisfaction with format and style suggests that it was well-received and usable. Purchase of the Curriculum was strongly associated with hospital size. ICPs practicing in hospitals with less than 100 beds were less likely to have purchased the book than those in larger hospitals. Availability of references was also associated with hospital size. Future editions of the Curriculum need to reflect consideration of the relationship between hospital size and availability of references in their approach to completeness of information.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The formulary decision-making process in a health maintenance organisation setting.

The goal of a health maintenance organisation (HMO) is to provide high quality, cost-effective healthcare services and products which meet the needs of the membership. Providing and managing pharmaceutical products and services within the HMO is a major aspect of accomplishing this goal. Several decisions must be made in developing, implementing and maintaining a formulary system. The numbers of people seeking their healthcare from HMOs in the US has increased 4-fold in 10 years, and several model types of HMOs have developed, including network HMOs, group HMOs, independent practitioner associations and staff models. HMOs utilising formulary systems provided cover to 76% of enrollees in 1992. Formulary system management and decision making entails the use of open vs closed formularies and the role of the pharmacy and therapeutics (P & T) committee. Product selection takes into account efficacy, safety, costs, patient acceptance, ease of use, dosage forms, preparation requirements, stability and storage requirements and the reputation of the manufacturer and the service it provides. We list and describe various policy decisions which HMO pharmaceutical decision makers must address if the formulary system is to become an efficient tool for the HMO.

Consumer Product Safety↗
PubMedDate not supplied

A silver anniversary tribute to therapists of the American Burn Association.

The year 1993 marks the Twenty-fifth Anniversary of the American Burn Association (ABA). Since Dr. Curtis P. Artz extended an invitation for membership in 1968, therapist membership has increased to 387 current members. During the quarter century the ABA has met, therapists have presented 211 abstracts, and 17 therapists have presented instructional courses and educational symposia. Thirty-three therapists have moderated correlative sessions, and 95 therapists have fulfilled this capacity for Breakfast Symposia. The OT/PT Special Interest Group has been lead by 12 therapists, whereas 30 therapists have participated in two rehabilitation workshops. On the organizational level, three therapists have served as At-Large Members to the Board of Trustees, whereas 11 others have served on the At-Large Advisory Board. Sixty-three therapists have worked on 11 ABA committees. As senior authors, therapists have had 118 articles published in the Journal of Burn Care & Rehabilitation. In addition, four therapists have served the Journal in an editorial capacity. Therapists have been recognized for their efforts as recipients of Distinguished Service Awards, Educational Exchange Grants, and President's Continuing Education Awards.

Burns↗
PubMed2003

Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: use of restraining therapies--American College of Critical Care Medicine Task Force 2001-2002.

OBJECTIVE: To develop clinical practice guidelines for the use of restraining therapies to maintain physical and psychological safety of adult and pediatric patients in the intensive care unit. PARTICIPANTS: A multidisciplinary, multispecialty task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM), the Society of Critical Care Medicine (SCCM), and the American Association of Critical Care Nurses (AACN). EVIDENCE: The task force members reviewed the published literature (MEDLINE articles, textbooks, etc.) and provided expert opinion from which consensus was derived. Relevant published articles were reviewed individually for validity using the Cochrane methodology (http://hiru.mcmaster.ca/cochrane/ or www.cochrane.org). CONSENSUS PROCESS: The task force met as a group and by teleconference to identify the pertinent literature and derive consensus recommendations. Consideration was given to both the weight of scientific information within the literature and expert opinion. Draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft then was reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. CONCLUSIONS: The task force developed nine recommendations with regard to the use of physical restraints and pharmacologic therapies to maintain patient safety in the intensive care unit.

Adult↗
PubMed1997

Resource document for curriculum development in cancer genetics education. American Society of Clinical Oncology.

PURPOSE: The rapid growth in the use of genetic testing for heritable cancers and other diseases has led to the establishment of many committees to assess the status and future implications of such testing. The American Society of Clinical Oncology (ASCO) published a statement on genetic testing for cancer susceptibility in May 1996. In that statement, ASCO recognized the need for a major initiative to develop courses and other educational materials for ASCO members and other health care professionals that were pertinent to cancer genetics and the role of cancer predisposition testing in clinical oncology. These curriculum guidelines represent an effort to promote formal instruction on the assessment and management of familial cancer risks in training programs and continuing education courses. DESIGN AND RESULTS: An Ad hoc Task Force was created from the ASCO membership and other professional organizations. Goals of ASCO's cancer genetics education initiative, curriculum guidelines, and plans for implementation of the curriculum have been developed. To gain understanding and competency in cancer genetics and cancer predisposition testing, the curriculum emphasizes formal instruction in: (1) basic concepts and principles of genetics; (2) an understanding of the role of genetics in the etiology, diagnosis, and management of different malignancies; (3) an understanding of the ethical, legal, and social issues that surround predisposition testing; and (4) long-term management plans for individuals at high risk for cancer. This document is broad in scope and applicable to all types of malignancies. It should be considered as the framework around which cancer genetics education is developed. It is expected that implementation of training activities over the next few years will allow ASCO to fulfill its obligations to the membership. CONCLUSION: This curriculum should prove a valuable guide to those who wish further education on cancer genetics and the appropriate use of cancer predisposition testing.

Curriculum↗
PubMed2002

A service users' research advisory group from the perspectives of both service users and researchers.

Much has been written about the importance of involving service users in the research process. Far less is available about the experience of involvement from the perspective of service users themselves. The present paper is a joint account by service users and researchers of a service users' advisory group set up to support and advise a project to evaluate diabetes services in Bradford, UK. The establishment of a separate advisory group for service users is, to our knowledge, an innovative approach to lay involvement within mainstream National Health Service (NHS)-based research. Factors that contributed to the group's success included personal contact, continuity of membership and integration into the management structure of the project. Also valued were the confidence in numbers which membership of the group gave, and the opportunity to meet and discuss issues away from the formal and somewhat intimidating atmosphere of the project's steering group. Aside from the personal value to participants and any impact on the quality of research outcomes, wider benefits included the ability to share knowledge with others and gain greater intercultural understanding.

Advisory Committees↗
PubMed2003

[A short history of the Swiss Society of Anaesthesiology and Reanimation (SSAR)].

In common with most continental countries, anaesthesia in post-World War II Switzerland was clearly in arrears in comparison to the Anglo-American and Scandinavian countries. As early as in 1947, however, motivated young physicians left Switzerland for England, Scandinavia and the USA to familiarise themselves with the advances made in modern anaesthesia. In March, 1951, three of these pioneers, Ch. Bovay (Lausanne), W. Hügin (Basel), and K. Zeller (Winterthur), founded the Professional Association of Swiss Anaesthesiologists, thus preparing the ground for the Swiss Society of Anaesthesiology which was founded on July 5 th, 1952, on the occasion of the annual meeting of the Swiss Society of Surgery held in Zurich. Members of the first Executive Committee were Ch. Bovay, K. Zimmermann (Zurich), and W. Hügin. In 1963, the latter was appointed first Professor of Anaesthesiology in Switzerland by the University of Basel. Looking back, the 18 physicians involved in the foundation of the Society were indeed most courageous. This step towards independence is all the more admirable since the Swiss Society of Surgery, by founding a Section of Anaesthesiology, attempted to retain sovereignty over this small and new group of specialists. Only in 1954 anaesthesiology was recognised by the Swiss Medical Association as a medical specialty in its own right. In 1967 the name was changed to Swiss Society of Anaesthesiology and Reanimation (SSAR). Since coming into existence, the Society has grown more than 40-fold, with a total membership approaching 800 by 2002 end. In recent years, the SSAR took a particular interest in promoting both the training and CME of anaesthesiologists, in supporting research by its young members and in improving the quality and safety of anaesthesia.

Anesthesiology↗
PubMed2003

How do examiners decide?: a qualitative study of the process of decision making in the oral examination component of the MRCGP examination.

OBJECTIVE: To determine how examiners make decisions about candidates in the oral examination for membership in the Royal College of General Practitioners. DESIGN: Qualitative research using interpersonal process recall interviews with oral examiners immediately following examination of an Medical Research Council General Practitioner (MRCGP) candidate. SETTING: Summer 1999 sessions of the MRCGP examination in Edinburgh and London. PARTICIPANTS: Twenty-six examiners in a convenience sample from the panel of Royal College of General Practitioners (RCGP) oral examiners. RESULTS: Analysis of the transcripts revealed a three-stage process of decision-making consisting of a first impression, followed by a provisional grade and a final grade decision. The examiners used stem questions, exploratory questions and confirming questions during this process. Examiners produced lists of the attributes of successful and unsuccessful candidates, which resembled the grading guidelines provided by the examination committee. Some of the candidates' attributes which influenced the examiners' grading decisions related to personal qualities rather than knowledge or behaviours acquired in vocational training. When examiners were presented with the explanatory model arising from the analysis of the transcripts, they confirmed the validity of the observations. CONCLUSIONS: Decision-making by examiners during oral examinations is a complex process involving initial impressions, hypothesis generation and hypothesis testing. Candidates' knowledge, attitudes and performance influence the final outcome of the examination. Interpersonal process recall is a useful tool for exploring professional communication.

Data Collection↗
PubMed1995

Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine.

OBJECTIVE: The development of practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice. PARTICIPANTS: A task force of more than 40 experts in disciplines related to the use of analgesic and sedative agents in the ICU was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM). EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. DATA SYNTHESIS: To facilitate rapid communication of the six recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council. CONCLUSIONS: A consensus of experts provided six recommendations with supporting data for intravenous analgesia and sedation in the ICU setting: a) morphine sulfate is the preferred analgesic agent for critically ill patients; b) fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability, for patients manifesting symptoms of histamine release with morphine, or morphine allergy; c) hydromorphone can serve as an acceptable alternative to morphine; d) midazolam or propofol are the preferred agents only for the short-term (< 24 hrs) treatment of anxiety in the critically ill adult; e) lorazepam is the preferred agent for the prolonged treatment of anxiety in the critically ill adult; f) haloperidol is the preferred agent for the treatment of delirium in the critically ill adult. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.

Adult↗
PubMed1995

Practice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Society of Critical Care Medicine.

OBJECTIVE: The development of practice parameters for achieving sustained neuromuscular blockade in the adult critically ill patient for the purpose of guiding clinical practice. PARTICIPANTS: A task force of more than 40 experts in disciplines related to the use of neuromuscular blocking agents in the intensive care unit was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM). EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. DATA SYNTHESIS: To facilitate rapid communication of the three recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council. CONCLUSIONS: A consensus of experts provided three recommendations with supporting data for achieving sustained neuromuscular blockade in critically ill patients: a) pancuronium is the preferred neuromuscular blocking agent for most critically ill patients; b) vecuronium is the preferred neuromuscular blocking agent for those patients with cardiac disease or hemodynamic instability in whom tachycardia may be deleterious; c) patients receiving neuromuscular blocking agents should be appropriately assessed for the degree of blockade that is being sustained. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.

Adult↗