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Report on the NIH Workshop on Pharmacologic Treatment of Obesity.

A National Institutes of Health workshop on pharmacologic treatment of obesity concluded that pharmacologic agents may be effective in reducing body weight over an extended period of time. Drugs should be used as only one component of a comprehensive weight-reduction program, and additional research is needed on the long-term efficacy and safety of drugs for obesity, and especially for combinations of drugs. Improvement in comorbidities and risk factors of obesity should be used along with weight reduction as an outcome measure in clinical trials. Industry, professional societies, and governmental agencies should work together to explore the potential for drugs for obesity and to reassess the regulatory and administrative controls on the use of currently available drugs for obesity and on the approval process for future drugs.

Animals↗

Enhancing nutrition education through faculty development: from workshops to Web sites.

Faculty resistance to changing medical school curricula is a major barrier to overcome in the effort to expand nutrition education. With clinical clerkships becoming more decentralized and basic science courses utilizing more small group teaching, the problem of reform is compounded by the increasing numbers of a more dispersed teaching faculty. A faculty development program was designed to complement a thematic approach to the inclusion of nutrition in a 4-y curriculum. The program offers workshops to help faculty learn how to teach in new settings while acquiring new knowledge about nutrition. Additionally, a themes Web site offers a window that faculty may use to review current nutrition content, to plan their teaching agendas, and to continually reassess where nutrition fits in the curriculum.

Curriculum↗

Quality control in immunohistochemistry. Report of a workshop sponsored by the Biological Stain Commission.

Although immunohistochemical methods are increasingly applied in diagnostic histopathology, there has been little standardization or quality control of immunoreagents; and published reports have not standardized Material and Methods for meaningful comparisons of results among clinicians. The Biological Stain Commission-sponsored workshop was convened to address the following issues: a manufacturers' testing program for probity of commercial antibodies, development of a manual for performance criteria and quality control assurance procedures, standardization of package inserts, standardization of information provided in the Materials and Methods sections of publications, establishment of a reagent and procedure clearing house, study of the effects of different fixation regimes on tissue antigens, and investigation of the environmental conditions needed for antigen-antibody interaction. The recommendations of the ad hoc committee and their implications for the future are discussed.

Antigen-Antibody Complex↗

Workshop report on Hodgkin's disease and related diseases ('grey zone' lymphoma).

Despite advances in immunohistochemistry and molecular biology, the distinction between classical Hodgkin's lymphoma and related diseases such as nodular lymphocyte-predominant Hodgkin's disease, T-cell rich large B-cell lymphoma or anaplastic large cell lymphoma has remained difficult in rare cases. Lack of clear-cut diagnostic criteria represents a problem for both the pathologist and the clinician. To delineate this 'grey zone' between classical Hodgkin's lymphoma and non-Hodgkin's lymphoma (NHL) and to develop criteria for classification of such cases, 12 expert hematopathologists each submitted one to five borderline cases to a workshop. Cases were reviewed and classified at a multiheaded microscope and criteria were established for the diagnosis of questionable cases. Well established entities such as classical Hodgkin's lymphoma, anaplastic large-cell lymphoma and TCRBCL were defined more strictly and cases with unusual morphology or antigen expression could be identified. A distinctive subset of cases representing mediastinal large B-cell lymphomas with features of Hodgkin's lymphoma was identified.

Diagnosis, Differential↗

Infectious Diseases Society of America and Centers for Disease Control. Summary of a workshop on surveillance for congenital cytomegalovirus disease.

Each year in the United States, 30,000 to 40,000 infants are born congenitally infected with cytomegalovirus (CMV), and more than 9,000 of these children suffer permanent sequelae. The purpose of this workshop was to present and discuss current information on the epidemiology, diagnosis, treatment, and prevention of CMV disease in mothers and their infants. The participants concluded that congenital CMV disease is a significant public health problem that, to date, has been largely ignored. They also agreed that certain child-rearing practices, such as the common use of day-care centers and breast-feeding, have changed the epidemiology of CMV in the United States and that the next decade may bring an increase in congenital CMV disease in certain groups. Therefore, a national system for surveillance of congenital CMV disease was established; its goals are to characterize trends over time, to identify risk groups, and to lay the groundwork for evaluation of future intervention programs. In addition, the surveillance system will be used to educate the medical and lay communities about congenital CMV disease and to facilitate collaborative efforts in research.

Centers for Disease Control and Prevention, U.S.↗

Mechanisms of brain injury in bacterial meningitis: workshop summary.

Morbidity and mortality associated with bacterial meningitis remain high, although antibiotic therapy has improved during recent decades. The major intracranial complications of bacterial meningitis are cerebrovascular arterial and venous involvement, brain edema, and hydrocephalus with a subsequent increase of intracranial pressure. Experiments in animal models and cell culture systems have focused on the pathogenesis and pathophysiology of bacterial meningitis in an attempt to identify the bacterial and/or host factors responsible for brain injury during the course of infection. An international workshop entitled "Bacterial Meningitis: Mechanisms of Brain Injury" was organized by the Department of Neurology at the University of Munich and was held in Eibsee, Germany, in June 1993. This conference provided a forum for the exchange of current information on bacterial meningitis, including data on the clinical spectrum of complications, the associated morphological alterations, the role of soluble inflammatory mediators (in particular cytokines) and of leukocyte-endothelial cell interactions in tissue injury, and the molecular mechanisms of neuronal injury, with potential mediators such as reactive oxygen species, reactive nitrogen species, and excitatory amino acids. It is hoped that a better understanding of the pathophysiological events that take place during bacterial meningitis will lead to the development of new therapeutic regimens.

Animals↗

Critical appraisal using the READER method: a workshop-based controlled trial.

BACKGROUND: Critical reading is an important skill for those trying to practice evidence-based medicine. There are a number of recognized structures for critical reading, including the READER model. These methods should be subjected to high-quality studies. OBJECTIVES: We aimed to evaluate the READER method in a practical teaching setting using the highest quality research methodology. METHODS: We carried out a modified randomized controlled trial. Two groups of GP trainers were invited to appraise critically the two articles using either the READER acronym or a semi-structured free appraisal. RESULTS: Of 99 participants in the workshop, 92 completed the study. One-third of participants (33.7%) read more than five articles per month and those who had been in practice the longest read fewer articles (P<0.05). Both groups attributed the lowest score to paper 2. The median total scores were higher using the READER method, although only significant for paper 2 (P<0.05). The median score attributed to the methodology was lower using the READER method than the free appraisal, although this difference was only significant for paper 1 (P<0.05). Overall, 51% (70% of the READER group) believed that taking part in the exercise would encourage them to be more critical of published articles in the future. CONCLUSION: Those using the READER method attributed a higher total score, but were more critical of the methodology than those using a free appraisal. Participants found the study useful and believed that it would be of help in future critical appraisal. The study raises interesting questions about the relative importance to GPs of methodological rigour compared with other factors when evaluating research papers.

Education, Medical, Continuing↗

A model legal-financial education workshop for families caring for neurologically impaired elders.

A program is described through which families become acquainted with the issues, legal terminology, and resources for planning to provide and finance care to neurologically impaired elders. A survey of 68 participating families indicated over 90% had taken one or more planning actions following the workshop, including developing a specific plan for providing and financing services and developing a power-of-attorney for decision-making. Implications for other programs are discussed.

Aged↗

Concordant and discordant effects on cardiovascular risks exerted by oestrogen and progestogen in women using oral contraception and hormone replacement therapy. ESHRE Capri Workshop Group.

The major indications for the clinical use of oestrogen and progestogen are oral contraception (OC) in young women, and hormonal replacement therapy (HRT) in menopause. Over the past few years, epidemiological data have associated the use of these hormones to different cardiovascular conditions such as myocardial infarction, cerebrovascular disease and venous thromboembolism. This review summarizes the data discussed and the conclusions achieved by the ESHRE Capri Workshop Group, recently published in Human Reproduction.

Cardiovascular Diseases↗

From the National Institute of Allergy and Infectious Diseases: Summary of a workshop on disease mechanisms and prospects for prevention of Reye's syndrome.

The workshop participants identified several areas that are worthy of investigation. A better understanding of the populations at risk is necessary. First, the geographic distribution of cases is poorly understood, and efforts should be made to determine whether the apparent clustering of cases in the states bordering the Great Lakes is real or reflects better reporting and identification of cases in these states than in other regions. Second, reports of cases among siblings or relatives suggests either an underlying metabolic risk factor or the possibility of a common environmental risk factor. Further studies of carnitine metabolism would be appropriate in this regard. Third, epidemiologic experience with Reye's syndrome suggests that clusters of cases may occur more frequently when new influenza A or B viruses become epidemic. This pattern was observed most clearly in 1978 during the epidemic of A/USSR/77 (H1N1) influenza virus infection. Additional suggestive evidence was obtained during the epidemic of A/Asian/57 (H2N2) influenza in 1957-1958 [20] and that of B/Hong Kong/72 influenza in 1973-1974. This feature suggests that first infections with these viruses are more likely than reinfections to produce the rare sequela of Reye's syndrome. Fourth, the reported association of Reye's syndrome with the use of acetylsalicylate in the treatment of the antecedent illness requires further study. In this situation the potential risk factor has been recognized as a mitochondrial toxin capable of uncoupling oxidative phosphorylation. Finally, the question of a toxic product produced as a consequence of the prodromal infection or present coincident with the infection remains unresolved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Summary of the NATO advanced research workshop on dietary omega 3 and omega 6 fatty acids: biological effects and nutritional essentiality.

A number of human studies presented at the workshop indicate that the premature infant at birth is biochemically deficient in docosahexaenoic acid (DHA) in both the brain and liver phospholipids, and that DHA is essential for normal visual acuity. The amount of DHA necessary to maintain normal amounts of the liver and brain phospholipids postnatally is 11 mg/kg daily. Elderly patients on long-term gastric tube feedings and others on long-term intravenous fluids and on total parenteral nutrition are particularly prone to deficiencies of alpha-linolenic acid, eicosapentaenoic acid (EPA) and DHA. The amounts estimated to prevent deficiencies in the elderly are 800-1100 mg/d of alpha-linolenic acid and 300-400 mg/d of EPA and DHA combined. Preliminary data indicate that children with malnutrition and mucoviscidosis, women with toxemia, and elderly people have decreased amounts of DHA in plasma phospholipids. The omega 3 fatty acids lower triglycerides and, at high levels, lower cholesterol. The anti-aggregatory, anti-thrombotic and anti-inflammatory properties of omega 3 fatty acids have been confirmed, and a dose-response curve is emerging. Despite the increase in bleeding time, no clinical evidence of bleeding has been noted by the investigators in any of the studies. Clinical trials are necessary in order to precisely define the dose and mechanisms involved in defining the essentiality of omega 3 fatty acids in growth and development and their beneficial effects in coronary heart disease, hypertension, inflammation, arthritis, psoriasis, other autoimmune disorders, and cancer.

Cell Physiological Phenomena↗

Coordinated strategies for controlling micronutrient malnutrition: a technical workshop.

Participants in a November 1991 workshop concluded that coordinated strategies for controlling malnutrition due to iodine, iron, vitamin A and other micronutrients deficiencies are technically feasible and should be given consideration in planning control efforts. Coordinated surveys involving clinical, biochemical and dietary assessment of multiple micronutrients are feasible. Multiple fortification is also possible using such vehicles as salt, processed rice or sugar. Supplementation efforts can be integrated with existing health care programs. Food-based strategies are also effective. The best examples have been community-based and have included a strong nutrition and health education component designed to change food consumption patterns, improve food preservation and preparation practices, and link income-generating activities with food production activities. Successful coordinated efforts will require a strong political commitment and a supportive infrastructure. Specific recommendations include the formation of national coordinating bodies for micronutrient deficiency control, establishment of a micronutrient information network and expansion of technical exchange and training.

Developing Countries↗

Introduction to the 2nd Amino Acid Assessment Workshop.

The proportions of amino acids in diets typical of human populations usually differ from the proportions in which they are required, although adverse effects due to such differences are not common. However, there is little systematic information about the adverse effects and the pathophysiological mechanisms of excessive intakes of single or mixtures of amino acids in human subjects. To promote the safe and effective application of amino acids in clinical nutrition and for health promotion it is necessary to establish a sound scientific basis for evaluating their efficacy and safety under various conditions of use. Hence, a series of Amino Acid Assessment Workshops (AAAW) are being organized to bring together experts in amino acid nutrition, metabolism, cell and molecular biology, toxicology and regulation/policy with the eventual purpose of establishing a paradigm for the characterization of risks associated with the ingestion of specific intakes of amino acids by humans. In this introductory paper I summarize the major issues arising at the 1st AAAW, held in Tokyo June, 2001, and provide an introductory context to the present, 2nd AAAW.

Amino Acids↗

Report of the International Workshop on Screening for Breast Cancer.

BACKGROUND: Over the past 30 years, eight major randomized controlled trials of breast cancer screening--with mammography and/or clinical breast examination--have been conducted. Results from several trials have been updated during the past year, and initial results of three other trials have been reported. PURPOSE: The National Cancer Institute held an International Workshop on Screening for Breast Cancer in February 1993 to conduct a thorough and objective critical review of the world's most recent clinical trial data on breast cancer screening, consider the new evidence, assess the current state of knowledge, and identify issues needing further research. METHODS: Investigators representing the eight randomized controlled trials of breast cancer screening in women aged 40-74 presented published and unpublished data. Evidence relating to the effectiveness of breast cancer screening in different age groups, especially women aged 40-49, was presented. RESULTS: For women aged 40-49, randomized controlled trials consistently demonstrated no benefit from screening in the first 5-7 years after study entry. A meta-analysis of six trials found a relative risk of 1.08 (95% confidence interval = 0.85-1.39) after 7 years' follow-up. After 10-12 years of follow-up, none of four trials have found a statistically significant benefit in mortality; a combined analysis of Swedish studies showed a statistically insignificant 13% decrease in mortality at 12 years. Only one trial (Health Insurance Plan) has data beyond 12 years of follow-up, and results show a 25% decrease in mortality at 10-18 years. Statistical significance of this result is disputed, however. In women aged 50-69, all studies show mortality reductions; three of four studies show reductions of about 30% at 10-12 years after study entry. Results from two of these trials were statistically significant. Too few women over age 70 have been included in studies for adequate analysis. CONCLUSIONS: For women aged 40-49, randomized controlled trials of breast cancer screening show no benefit 5-7 years after entry. At 10-12 years, benefit is uncertain and, if present, marginal; thereafter, it is unknown. For women aged 50-69, screening reduces breast cancer mortality by about a third. Currently available data for women age 70 or older are inadequate to judge the effectiveness of screening. IMPLICATIONS: Randomized trials have provided stronger scientific evidence regarding the effectiveness of screening for breast cancer than for any other cancer. However, much still needs to be learned. Periodic gatherings of scientists in the field should speed the process.

Adult↗

Cancer risk prediction models: a workshop on development, evaluation, and application.

Cancer researchers, clinicians, and the public are increasingly interested in statistical models designed to predict the occurrence of cancer. As the number and sophistication of cancer risk prediction models have grown, so too has interest in ensuring that they are appropriately applied, correctly developed, and rigorously evaluated. On May 20-21, 2004, the National Cancer Institute sponsored a workshop in which experts identified strengths and limitations of cancer and genetic susceptibility prediction models that were currently in use and under development and explored methodologic issues related to their development, evaluation, and validation. Participants also identified research priorities and resources in the areas of 1) revising existing breast cancer risk assessment models and developing new models, 2) encouraging the development of new risk models, 3) obtaining data to develop more accurate risk models, 4) supporting validation mechanisms and resources, 5) strengthening model development efforts and encouraging coordination, and 6) promoting effective cancer risk communication and decision-making.

Breast Neoplasms↗

Health and safety behaviour and compliance in electroplating workshops.

Skin problems are reputedly common in electroplaters. To examine the steps taken by employers and employees to prevent or control skin problems, we visited six randomly selected electroplating establishments in Dorset and interviewed the employers and 50 of the employees using structured questionnaires. Several of the companies had not complied with the statutory requirements of the Control of Substances Hazardous to Health (COSHH) Regulations 1988, and deficiencies were evident in assessment, control and health surveillance. A third of the employees had current or recent work-related skin problems, typically dermatitis. Workers were generally ignorant about the hazards of materials handled. They knew about personal protective equipment, but did not always use it, or used gloveware that was deficient or contaminated. Only one in five employees adopted a rudimentary skin care programme; many were unaware of the provision for skin care. There is an urgent need for better training and more attention to skin care in electroplating workshops.

Adult↗

Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma.

It was considered timely to review the pathological and staging classifications of GI tract lymphoma. This meeting specifically did not address the question of treatment; the management of GI tract lymphoma could perhaps form the basis for a further workshop. The following recommendations were made: to adopt the Isaacson histological classification, that all patients with GI tract lymphoma be investigated uniformly, to record the prognostic factors described above, to use the staging classification shown above. It is hoped that these recommendations will be taken into account in the design of future clinical trials of therapy for GI tract lymphoma.

Gastrointestinal Neoplasms↗