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PubMed1989

Good intentions.

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Consensus Statements as Topic↗
PubMed1999

[Consensus conferences and guidelines in gastroenterology: an illusion].

Evidence-based medicine describes the present-day situation of a rational medicine which has its origins in the 19th century. At present evidence-based medicine is an ideal which is unattainable due to inadequate data from randomised controlled studies. Guidelines and consensus conferences which are not based on clearcut scientific data from controlled prospective and randomised studies fail to meet the requirements of evidence-based medicine and so cannot improve patient management. Guidelines and consensus conferences do not substantially reduce health costs.

Consensus Statements as Topic↗
PubMed1999

[Consensus conferences and guidelines in gastroenterology: a valid approach].

The rapid and continuous increase in knowledge has meant that medicine has become more complex and involved, and at the same time less transparent, for physicians and patients. To ensure quality and improve patients confidence, new structures in quality management are necessary. Guidelines, standards and consensus conferences by experts are valid ways of ensuring the future quality of medical care.

Consensus Statements as Topic↗
PubMed1999

Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma.

BACKGROUND: A National Institutes of Health (NIH) Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma, held in June 1990, recommended breast conservation therapy for the majority of women with Stage I or II breast carcinoma. The authors evaluated the national use of breast conservation therapy before and after the conference to determine whether the conference had had an impact on utilization. METHODS: Women with Stage I or II breast carcinoma (n = 109,880), diagnosed during the years 1983-1995, were identified via 9 population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. The likelihood of breast conservation surgery versus mastectomy and, among women who underwent breast conservation surgery, the likelihood of postoperative radiation therapy versus none, were assessed for 3 time periods (January 1983 to April 1985, May 1985 to June 1990, and July 1990 to December 1995). Associations between the use of breast conservation surgery or postoperative radiotherapy according to patient stage, age, race, and region were compared among women diagnosed before and after the NIH Consensus Development Conference. RESULTS: From 1985 (the year that the U.S. randomized controlled trial demonstrating equivalent efficacy between breast conservation therapy and mastectomy was published) through 1989, approximately 35% of women with Stage I and 19% of women with Stage II breast carcinoma underwent breast conservation surgery; these percentages remained constant throughout this period. Beginning in 1990, the year of the NIH Consensus Development Conference, the use of breast conservation surgery increased in each subsequent year; by 1995, 60% of women with Stage I and 39% of women with Stage II breast carcinoma received such treatment. However, regional variation in use was observed (Stage I, range 41.4-71.4% for 1995) and no registry reported breast conservation therapy for the majority of women with Stage II disease (range, 23.8-48.0%). The use of postoperative radiotherapy for women who underwent breast conservation surgery was similar in the periods before and after the conference. CONCLUSIONS: Although breast conservation therapy was performed more frequently following the NIH Consensus Development Conference, variation in use by region of the U.S. suggests the continued presence of barriers to widespread adoption of the recommendations formulated at the conference.

Adult↗
PubMed1999

[Adjuvant chemotherapy for primary breast cancer--review of 1998 St. Gallen's conference].

The 6th International conference on Adjuvant Therapy of Primary Breast Cancer was held in St. Gallen, Switzerland in February 1998, and this is an overview of its guidelines. Since 1995, several specific areas have accumulated important new information and were highlighted at the 1998 conference. These include the following: genetic testing of women at risk; the availability of chemopreventive agents for high-risk and postmenopausal women; changes in diagnostic procedures with an intent to reduce axillary dissection by introducing sentinel-node biopsy; results from trials of preoperative chemotherapy; initiatives to evaluate preoperative endocrine therapies; and debate on the role of increased local control by postmastectomy radiation, its safety and effectiveness. At the conclusion of the Conference, a consensus panel of experts was asked to develop a series of guidelines and recommendations for selection of adjuvant systemic treatments in specific patient populations. The panel reviewed and modified its 1995 guidelines and recommendations based on new evidence that has emerged from clinical research.

Antineoplastic Agents↗
PubMed1999

[From consensus to CBO guideline].

From the start of the consensus development programme by the Dutch Institute for Health Care Improvement CBO in 1981 the primary goal for the institute as an independent non-profit organization was to develop scientific guidelines for care that not only represented the state of the art, but also were acceptable to the medical community. The programme is run for and by the medical profession itself (scientific associations), but finds recognition among government authorities, financiers and patients' organizations. Since in this era of evidence-based medicine guidelines are considered necessary tools to face the complexity of medicine, and since there are so many institutions that offer guidelines of inconsistent format and style, carefully constructed guidelines are needed with standardization of the way the outcome data of the scientific literature is disclosed, analysed and weighed. CBO has adopted a transparent approach to provide such evidence-based guidelines.

Academies and Institutes↗
PubMed1999

[Impact of French consensus conference concerning the follow-up of patients surgically treated for stage I melanoma among French dermatologists and oncologists].

INTRODUCTION: Our aim was to assess the impact of the 1995 French Consensus Conference (CC) on the follow up of patients surgically treated for WHO stage I (AJCC/UICC stages IA to IIB) melanoma, two years after the recommendations had been provided to French dermatologists and oncologists by direct mailing and literature. Prior to this CC, a study of French dematologists' intentions of practice and dermatologists and oncologists effective practices had revealed a lack of homogeneity and the prescription of many paraclinical tests. MATERIAL AND METHODS: In 1997, we sent a questionnaire similar to 1995's one to French dermatologists (3585 practitioners) and oncologists (686), with a pre-paid envelop for the response. The statistical analysis compared these results with those of 1995 for dermatologists, and the results for dermatologists and oncologists using chi(2) test. RESULTS: The response rate was 29 p. 100 for dermatologists, 15 p. 100 for oncologists. Only the number of dermatologists following patients in private practice was increased. Prescriptions of paraclinical tests by dermatologists during initial investigation as well as during follow up dramatically decreased (-30 p. 100 to -50 p. 100), mainly for thoracoabdominal and brain computerized tomography scans and biological tests, to a lesser extent for chest X-rays and abdominal ultrasonographies. Prescriptions of paraclinical tests were higher among oncologists. The frequency of clinical surveillance in 1997 was more often as recommended. Detection of a second melanoma in the patients and their family had improved. However, oncologists' intentions of practice complied less to the CC as compared to dermatologists. DISCUSSION: This study clearly showed an impact of the CC in French dermatologists' intentions of practice leading to both an improvement of patient follow up and a reduction in its cost. This impact was not as great among oncologists.

Consensus Statements as Topic↗