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PubMed2001

Formal consensus: the development of a national clinical guideline.

BACKGROUND: There is currently a political enthusiasm for the development and use of clinical guidelines despite, paradoxically, there being relatively few healthcare issues that have a sound research evidence base. As decisions have to be made even where there is an undetermined evidence base and that limiting recommendations to where evidence exists may reduce the scope of guidelines, thus limiting their value to practitioners, guideline developers have to rely on various different sources of evidence and adapt their methods accordingly. This paper outlines a method for guideline development which incorporates a consensus process devised to tackle the challenges of a variable research evidence base for the development of a national clinical guideline on risk assessment and prevention of pressure ulcers. METHOD: To inform the recommendations of the guideline a formal consensus process based on a nominal group technique was used to incorporate three strands of evidence: research, clinical expertise, and patient experience. RESULTS: The recommendations for this guideline were derived directly from the statements agreed in the formal consensus process and from key evidence-based findings from the systematic reviews. The existing format of the statements that participants had rated allowed a straightforward revision to "active" recommendations, thus reducing further risk of subjectivity entering into the process. CONCLUSIONS: The method outlined proved to be a practical and systematic way of integrating a number of different evidence sources. The resultant guideline is a mixture of research based and consensus based recommendations. Given the lack of available guidance on how to mix research with expert opinion and patient experiences, the method used for the development of this guideline has been outlined so that other guideline developers may use, adapt, and test it further.

Adult↗
PubMed1998

Formal consensus and consultation: a qualitative method for development of a guideline for dementia.

OBJECTIVES: To use a formal consensus method--the nominal group technique--for developing a clinical practice guideline to improve the diagnosis, needs assessment, and management of dementia at the primary/secondary care interface. To assess the usefulness of this method in an area where there is a dearth of clinical trials thus precluding an evidence-based approach. DESIGN: A qualitative and iterative method was used. The guideline was developed by an expert panel using the nominal group technique, incorporating the deliberations of a Primary Care Professionals' Task Group, recent reviews in the scientific literature, information from semistructured interviews with local specialists, and a local questionnaire survey. SETTING: Mainly Bristol but incorporating other parts of the United Kingdom especially the south and west. SUBJECTS: Expert panel group (including users and non-statutory organisations), local general practitioners (GPs), professionals carrying out the health check for people over 75, local geriatricians and psychogeriatricians, and primary care professionals with an interest in dementia. MAIN MEASURES: Items important in dementia from the nominal group in response to three questions on diagnosis, needs assessment, and management, ranked into a series of top 10 items for each area and allocated a score according to relative importance to each member; summary outputs from the questionnaire survey, semistructured interviews, and primary care professionals' task group. RESULTS: A clinical practice guideline covering diagnosis, needs assessment, and management of dementia in primary care was produced in the form of an algorithm and a management sheet. CONCLUSIONS: A formal consensus method can be used as an acceptable alternative to the evidence-based approach when developing guidelines in situations in which evidence is scarce, in which the guideline is intended as an aid in linking different stages of care, and in which practical and political considerations--such as the links between agencies--are important.

Consensus Statements as Topic↗
PubMed2005

Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement.

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to come to a consensus on the management of thyroid nodules identified with thyroid ultrasonography (US), with particular focus on which nodules should be subjected to US-guided fine needle aspiration and which thyroid nodules need not be subjected to fine-needle aspiration. The panel met in Washington, DC, October 26-27, 2004, and created this consensus statement. The recommendations in this consensus statement, which are based on analysis of the current literature and common practice strategies, are thought to represent a reasonable approach to thyroid nodular disease.

Humans↗
PubMed2000

Consensus guidelines: agreement and debate surrounding the optimal management of Helicobacter pylori infection.

Helicobacter pylori is a recognized cause of a variety of gastroduodenal pathology. The high prevalence of both H pylori infection and related diseases within the community warrants its consideration as a public health care issue. The availability of reliable and safe noninvasive diagnostic techniques coupled with the development of effective and tolerable treatments has enabled primary health care personnel to manage this infection actively. The role of the primary care physician in the future management of H pylori infection is thus of central importance. The wealth of evidence produced by over 15 years of research into H pylori has expanded the list of disease associations and treatment benefits as well as elucidated the pathophysiological mechanisms involved. As a result, there has been a growing need to harmonize this information with clinical practice and to provide direction for the appropriate management by both specialists and general practitioners. Several national guidelines have been produced. The areas relating to H pylori infection that they considered and their recommendations vary. In 1994, the National Institutes of Health produced globally accepted recommendations for the management of H pylori-related peptic ulceration. The broader role of H pylori as a gastroduodenal pathogen and a public health care issue was not addressed. Recently, European and Canadian consensus guidelines have been published that identified overall management issues, including the role of primary and specialist care, and considered the appropriateness of employing eradication therapy for the spectrum of conditions in which H pylori has a direct or indirect association based on the available information. These guidelines, while in agreement regarding many issues, differ considerably in their recommendations for primary health care and regarding central issues such as the management of dyspepsia and gastric cancer. Some variations may reflect differing health care structures as well as the prevalence of both infection and associated diseases. However, the interpretation of evidence produced by recent research contributes to their conflicting statements.

Canada↗
PubMed2006

[Presentation].

Explore the source record for details and available documents.

Blood Transfusion↗
PubMed2001

How valuable is the application on consensus guidelines in the management of functional gastrointestinal disorders?

When patients complain of problems, physicians are used to look for some physical or physiological abnormality ruling out infections, inflammatory or cancer. Unfortunately, when we talk about functional disorders we usually cannot observe any defects and it is only possible for us to know of them through the words of our patients. Developing criteria and guidelines is not an easy process, in particular for functional gastrointestinal diseases, when no disease-based biological markers exist. It is difficult to define a medical disorder in the absence of a biological "gold standard". The Rome II classification is based on the assumption that for each disorder there are symptom clusters. Symptoms have in common disturbances in sensory and/or motor gastrointestinal function, which sometimes may overlap across anatomic regions. Nevertheless, several studies provide evidence for site-specific syndromes.

Colonic Diseases, Functional↗