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PubMed2005

International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.

OBJECTIVE: Although general definitions of the sepsis continuum have been published for adults, no such work has been done for the pediatric population. Physiologic and laboratory variables used to define the systemic inflammatory response syndrome (SIRS) and organ dysfunction require modification for the developmental stages of children. An international panel of 20 experts in sepsis and clinical research from five countries (Canada, France, Netherlands, United Kingdom, and United States) was convened to modify the published adult consensus definitions of infection, sepsis, severe sepsis, septic shock, and organ dysfunction for children. DESIGN: Consensus conference. METHODS: This document describes the issues surrounding consensus on four major questions addressed at the meeting: a) How should the pediatric age groups affected by sepsis be delineated? b) What are the specific definitions of pediatric SIRS, infection, sepsis, severe sepsis, and septic shock? c) What are the specific definitions of pediatric organ failure and the validity of pediatric organ failure scores? d) What are the appropriate study populations and study end points required to successfully conduct clinical trials in pediatric sepsis? Five subgroups first met separately and then together to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiological data, and coagulation variables. All conference participants approved the final draft of the proceedings of the meeting. RESULTS: Conference attendees modified the current criteria used to define SIRS and sepsis in adults to incorporate pediatric physiologic variables appropriate for the following subcategories of children: newborn, neonate, infant, child, and adolescent. In addition, the SIRS definition was modified so that either criteria for fever or white blood count had to be met. We also defined various organ dysfunction categories, severe sepsis, and septic shock specifically for children. Although no firm conclusion was made regarding a single appropriate study end point, a novel nonmortality end point, organ failure-free days, was considered optimal for pediatric clinical trials given the relatively low incidence of mortality in pediatric sepsis compared with adult populations. CONCLUSION: We modified the adult SIRS criteria for children. In addition, we revised definitions of severe sepsis and septic shock for the pediatric population. Our goal is for these first-generation pediatric definitions and criteria to facilitate the performance of successful clinical studies in children with sepsis.

Adolescent↗
PubMed2002

Cloning and deliberation: Korean consensus conference.

This article addresses the 2nd Korean consensus conference on cloning that was held by the Korean National commission for UNESCO in 1999. It notes that the citizens participated directly and handled the important social agenda through deliberative process. The consensus conference is another democratic form derived from preference aggregative democracy in the sense that it basically depends on public judgment of the citizens. Compared to other models (elitist or preference aggregative), it has some advantages: 1. It can solve the problem of political legitimacy. 2. It can check the partiality of expert groups in biotechnology and ethics. 3. It enables us to make informed, responsible decisions. 4. It results in education of citizens' preference. However, we need to expand the deliberative model. First, we need institutional efforts on behalf of future generations because cloning relates to them. Second, we should not include the value of life which cannot be expressed in the form of argument or discourse.

Advisory Committees↗
PubMed2002

Hypertension in pregnancy: do consensus statements make a difference?

OBJECTIVES: (i) To document variation in management of hypertension in pregnancy; (ii) to determine whether this variation falls within current management guidelines; and (iii) to make recommendations for developing future guidelines. DESIGN: Questionnaire-based survey. SETTING: Australia and New Zealand. POPULATION: All specialist obstetricians. METHODS: Questionnaires were sent to 1198 obstetricians in Australia and New Zealand. Those returned by respondents currently in obstetric practice were analysed. Information was obtained on their current clinical practices relating to the diagnosis and management of hypertension in pregnancy. RESULTS: Of 1198 obstetricians surveyed, 973 (81%) replied. Of these, 686 (71%) were responsible for obstetric care. Considerable variation in practice was found, particularly in relation to the measurement of blood pressure, the determination of hypertension and significant proteinuria, and the decision to institute antihypertensive drug treatment. The recommendations of the Australasian 1993 Consensus Statement appeared to have had little influence on practice. There has been a striking increase in the use of magnesium sulphate for the prevention of convulsions in preeclampsia. CONCLUSIONS: There is significant variation in management of hypertensive pregnancies that differs from current guidelines. It is not known whether this diversity adversely affects clinical outcomes. Until further outcome evidence is available, consensus statements may be better confined to basic aspects of management for which there is high level evidence.

Adult↗
PubMed2004

Variability in nomenclature used for nevi with architectural disorder and cytologic atypia (microscopically dysplastic nevi) by dermatologists and dermatopathologists.

BACKGROUND: Although a nevus with the microscopic features of a "dysplastic nevus" is commonly seen, the nomenclature used to describe such a lesion has been thought to be inconsistent. A 1992 National Institutes of Health (NIH) Consensus Conference sought to unify nomenclature and suggested that the term "nevus with architectural disorder" be used along with a comment on melanocytic atypia. METHODS: We performed a cross-sectional mail survey to determine preferred terminology as well as the level of adherence to the NIH-recommended nomenclature. All 856 active members of the American Society of Dermatopathology (ASDP) and 1100 (13.0%) of the 8471 active members of the American Academy of Dermatology (AAD) were surveyed. RESULTS: Five hundred and thirty-three ASDP members and 483 AAD members who fulfilled eligibility criteria completed the questionnaire. The term "dysplastic nevus" was favored by the largest number of responders (favored by 39.1% of ASDP members and 62.3% of AAD members), while the 1992 NIH Consensus Conference-recommended terminology was the second most popular term (25.3% of ASDP and 15.1% of AAD members). Dermatopathologists (OR = 1.9, p = 0.0001) and those who had dual training in dermatology and dermatopathology (OR = 1.6, p = 0.02 for ASDP members; OR = 2.3, p = 0.02 for AAD members) were more likely to adhere to the 1992 NIH Consensus Conference nomenclature. CONCLUSIONS: Despite attempts to unify nomenclature for microscopically dysplastic nevi through the NIH Consensus Conference, wide variation in terminology persists.

Consensus Statements as Topic↗
PubMed2004

Review article: definition and diagnosis in portal hypertension--continued problems with the Baveno consensus?

The goals of the Baveno workshops were to develop consensus definitions of key events related to portal hypertension and variceal bleeding, and to produce guidelines to facilitate the conduct and reporting of clinical trials. The consensus definitions concern the diagnosis of active bleeding, failure to control bleeding, the criteria to distinguish continuing bleeding from rebleeding, and the means of assessing failure to prevent rebleeding. The guidelines concern the timing of diagnostic endoscopy, the policy for blood volume restitution, the measures to prevent infection and encephalopathy, and the treatment options for acute bleeding, as well as primary and secondary prophylaxis. The intention of the experts who developed the guidelines was that, as feedback from their practical application develops, they should be adapted to better fit the practical needs. The applicability of the Baveno definitions has been evaluated in a study where the definitions of clinically significant bleeding, failure to control bleeding, the time frame for the acute bleeding episode and the definition of rebleeding were tested. The main criticism raised in this study was that tachycardia, one of the criteria that define failure to control bleeding, was misleading in 15% of patients who had the symptom but were not bleeding.

Consensus Statements as Topic↗
PubMed2006

Inhibitor treatment in haemophilias A and B: summary statement for the 2006 international consensus conference.

Participants in an international conference on the management of haemophilia patients with inhibitors developed a jointly authored summary of the findings and conclusions of the conference. Current knowledge of the genetic and immunologic mechanisms underlying inhibitor development was briefly summarized. Concerning the purported treatment-related risk factors, conference participants commented on the limitations of the available evidence and the need for more rigorous prospective research in a fully genotyped population. Other clinical considerations discussed included the unproved utility of routine surveillance, the need for assay standardization, the management of acute bleeding and approaches to joint disease prophylaxis and immune tolerance induction (ITI). A number of issues were identified as needing further investigation in larger prospective studies, ideally through international cooperation. Such studies should enroll cohorts that have been scrupulously defined in terms of mutation status and treatment exposure. Finally, conference participants urged their colleagues to participate in the currently ongoing international trials of ITI.

Blood Coagulation Factor Inhibitors↗
PubMed2005

The process of research use in nursing.

AIM: This paper describes the process of research use undertaken by groups of specialist nurses involved in the construction of policy recommendations for nursing practice. BACKGROUND: A number of prescriptive models of research use have been described in the nursing literature. Previous studies have attempted to measure the instrumental use of research findings in nursing practice. However, there is no evidence on how research use occurs, or why results differ across individuals, settings, tasks or time. There has been little investigation into the congruence of prescriptive models with the realities of research use in practice. METHOD: The study used an ethnomethodological approach to describe the practical reasoning undertaken by specialist nurses during research use. The method was participant observation with three clinical workgroups, comprising a series of meetings of practitioners from between 11 and 25 health care provider organizations. Data collected from recording discussions at the meetings were analysed using grounded data reduction, and were subject to external verification of description and inference. FINDINGS: The process of research use consistently contained four stages of practical reasoning comprising research identification, confirmation, evaluation and application. Each stage involved practitioners in cognitive work to translate the research evidence into practice policy. CONCLUSIONS: While the process of research use described in the findings is not markedly different in outline from prescriptive models of the process available in the literature, inconsistencies are highlighted in the way the process is conceptualized. Prescriptive models of research use do not adequately reflect the task of problem-setting, use of multiple frames of reference for evaluation, and how information from research is to be integrated with information from other sources.

Clinical Nursing Research↗
PubMed1995

Developing clinically valid practice guidelines.

Valid guidelines, when appropriately disseminated and implemented, can lead to changes in clinical practice and improvements in patient outcome. Guidelines are more likely to be valid if they are developed using systematic reviews, national or regional guideline development groups (including representatives of key disciplines) and explicit links between recommendations and scientific evidence. This paper discusses the practical implications of adopting this approach for guideline development and the role of peer review guidelines as another element of the process to ensure validity. Considerable resources are required to develop evidence-linked guidelines, but this investment can be recouped by relatively small changes in the process or outcome of care. Good leadership and technical support are required for the successful development of clinically valid guidelines, which is dependent upon the small-group processes of guideline development panels and the translation of evidence into recommendations. Future guideline developers need to gain expertise in these areas. Research priorities are identified.

Consensus Statements as Topic↗
PubMed2006

Treatment of gastroparesis: a multidisciplinary clinical review.

This clinical review on the treatment of patients with gastroparesis is a consensus document developed by the American Motility Society Task Force on Gastroparesis. It is a multidisciplinary effort with input from gastroenterologists and other specialists who are involved in the care of patients with gastroparesis. To provide practical guidelines for treatment, this document covers results of published research studies in the literature and areas developed by consensus agreement where clinical research trials remain lacking in the field of gastroparesis.

Consensus Statements as Topic↗