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PubMed1997

The use of consensus methods and expert panels in pharmacoeconomic studies. Practical applications and methodological shortcomings.

The use of expert opinion in pharmacoeconomic studies is widespread. A review of the relevant literature has shown that expert opinion is frequently used in decision analysis, Markov models and disease management, with estimates of potential values derived from Delphi panels, modified Delphi panels and expert round tables. These consensus-gathering methods are often applied as if potential drawbacks to their application were absent. This article reviews and summarises the use of these techniques in pharmacoeconomic research and evaluates the potential shortcomings of the methodology employed. In particular, several areas of concern are noted: the provision of baseline information or seed algorithms to panellists, the high attrition rate of panels, the criteria for selecting experts and the definition of consensus. This article offers recommendations for the future application of these techniques and concludes that expert opinion can still play a valuable role in pharmacoeconomic research.

Consensus Statements as Topic↗
PubMed2004

Treatment of chronic hepatitis B: from research to clinical practice via the consensus conferences.

The aim of antiviral therapy of chronic hepatitis B is to control Hepatitis B Virus (HBV) replication and to cure liver disease avoiding the progression of chronic hepatitis to cirrhosis and the end stage complications of cirrhosis. HBeAg/anti-HBe seroconversion is the hallmark of response in hepatitis B "e" antigen (HBeAg) positive patients. In the patients with antibody against HBeAg (anti-HBe positive) the combination of HBV DNA and anti-HBc IgM tests provides adequate diagnostic accuracy. Patients with biochemical and/or histological disease activity are eligible to therapy. The drug choice is based on age, disease severity, risk of complications, side effects and compliance, particularly in anti-HBe positive patients where prolonged treatment is needed. Interferon (5-6 MU daily or 9-10 MU thrice weekly for 4-6 months) is the first line therapy for HBeAg positive patients and (5-6 MU thrice weekly for 12-24 months) for anti-HBe positive patients. When IFN is contraindicated or ineffective, Lamivudine (100 mg) or Adefovir Dipivoxil (10 mg) are given as long as 4-6 months after HBeAg/anti-HBe seroconversion or for long-term treatments in HBeAg positive non-responders and anti-HBe positive patients. Patients with more advanced forms of cirrhosis and portal hypertension are to be treated within liver transplantation programs. Fifteen to 30% of treated patients achieve sustained response and more than 60% of them experience long-term disease remission during therapy. In perspectives, currently available molecular and immunologic tools and modelling of viral dynamics will help to address the therapy issue with more complex, efficacious and individually tailored treatment schedules.

Antiviral Agents↗
PubMed1992

Report of the commission on health research for development and the countries of the south.

Of late, governments of affluent countries have become more brazen in using United Nations organizations and other global commissions as tools to serve their political and economic interests. WHO and UNICEF have been used by these governments to impose technocentric and dependence-promoting programs on countries of the South. The report of the Commission on Health Research for Development is yet another effort in that direction. It advocates international cooperation in health research. It merely adds to the bulk of documents on international health research. It is ahistorical. It does not analyze why WHO and UNICEF and the governments of affluent countries imposed global programs on immunization and diarrheal and respiratory diseases without bothering to gather even the most elementary data about them. There is a method in the brashness. Worse still, it ignores the rich heritage of health research of the past half a century in countries such as India, Indonesia, and Thailand. It is yet another effort to obscure the message of self-reliance contained in the Alma-Ata Declaration on Primary Health Care.

Consensus Statements as Topic↗
PubMedDate not supplied

Setting the standard.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1990

Reduced use of diagnostic obstetric ultrasound in Norway. Result of consensus panel recommending routine screening in pregnancy?

PURPOSE: To investigate the practice of obstetric ultrasound in Norway before and 2 years after a consensus conference recommending routine screening. Material, method: Two national representative materials sampled with a 2-year interval are compared. RESULTS: The average number of examinations was reduced from 2.46 to 2.2 (p = 0.014). Obstetrical institutions practising screening examined their patient less frequently than non-screening institutions (2.10 vs. 2.75 times, p less than 0.001 whereas in 1986 the converse was the case. CONCLUSIONS: Screening has become more widespread, and a more rational practice has developed.

Consensus Statements as Topic↗
PubMed1996

Direct mailing of consensus recommendations did not alter GPs' knowledge and prescription of oestrogen in the menopause.

OBJECTIVE: To investigate the impact of an information-package (direct mailing) concerning oestrogen therapy, deriving from a consensus conference in 1990, on general practitioners' (GPs') attitudes and knowledge. DESIGN AND SUBJECTS: Controlled randomised study. Two groups of Norwegian GPs. The Intervention group received an information-package consisting of the recommendations from the consensus conference, some headline questions with answers, and a classification of the oestrogens available in Norway, including a table and a graphical presentation of the costs of the different treatments. GPs stated their views on prescribing oestrogen on a five step scale, related to nine short case histories, each containing cues on complaints, smoking, family history suggesting risk for cardiovascular disease, and osteoporosis. MAIN OUTCOME MEASURES: GPs' views on prescribing oestrogen, relation to age, sex, practice type (solo/group) and practice location. RESULTS: The differences in answer distributions between the Intervention (n = 193) and Control (n = 181) groups did not reach statistical significance for any of the nine case histories. The answers indicate a more liberal attitude towards replacement therapy in 1992 compared to a study performed in 1990. The views on contraindications was fundamentally unaltered. CONCLUSION: The study did not reveal any significant effect of direct mailing as means of disseminating consensus conference recommendations to GPs.

Adult↗
PubMedDate not supplied

Impact of guidelines for antihypertensive treatment on clinical practice.

Many Guidelines and Consensus Statements were published in 1993 and 1994. The pressure to produce these guidelines comes from clinicians faced with rapid change, from a wish to provide an independent authoritative view rather than rely on commercial promotion of particular treatments, and from governments seeking assistance with the allocation of scarce resources. Evaluation of the impact that guidelines exert on clinical practice is notoriously difficult, but has been attempted using the self-report questionnaire, or the more reliable but expensive analysis of actual practice data, before and after publication of the guidelines. Rigorous evaluation has been attempted and reported in North America and in Europe, in relation to surgical and obstetrical procedures and psychiatric disorders as well as medical treatments. Specific evaluation of the impact of recommendations from the Joint National Committee in the USA, for the treatment of hypertension, has also been attempted, as well as surveys of doctors' perceptions of Consensus Statements. The evidence available suggests that the main value obtained from Guidelines and Consensus Statements lies in their capacity to codify good or "best practice", at times of rapid change in a particular field. They also serve as a source of support for local opinion leaders, and as they are usually produced by respected authors they have substantial influence with Government. Guidelines are not effective in producing rapid change in clinical practice. If a change in practice is sought a more comprehensive program of action is necessary, with guidelines as one useful element.

Antihypertensive Agents↗
PubMed1992

Electronic communication to promote consensus-building skills: an innovative teaching strategy.

EMail and a local BBS were used as vehicles to promote consensus-building skills of doctoral nursing students. The strategy was implemented into a course that dealt with knowledge-structuring by incorporating content on the use of information along with a synthesizing process. During the last class an evaluative survey was administered, focusing on the students' satisfaction regarding the goals of the assignment, the instructions, and the electronic format. The majority of positive comments support continued use of EMail and a BBS to strengthen consensus-building skills. Based on survey feedback, increased time to learn the computer aspect of the assignment will need to be considered for classes in the future. Electronic technology should be incorporated as a teaching strategy in graduate curricula. Only then will tomorrow's nurse educators be prepared to assume a leadership role in managing information in health care and academic settings.

Computer Communication Networks↗