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At least 145 records · Page 8Linked to original sources
PubMed2002

Consensus development conference on the medical treatment of non-small cell lung cancer: treatment of the early stages.

Surgery remains the mainstay of treatment for early non-small cell lung cancer (NSCLC) but more than 80% of recurrences occur within 2 years from radical surgery. The pattern of recurrence may differ by histology with more local recurrences seen for patients with squamous cell carcinoma and more distant metastases seen in patients with adenocarcinoma. A number of studies demonstrate that dissemination of cancer cells at levels much below those detected by any current available imaging techniques, including PET scanning also, affect prognosis of patients with clinical early-stage NSCLC. The current clinical evidence does not recommend adjuvant chemotherapy and/or radiotherapy in completely resected stage I-II-IIIA for N1. There are few randomised trials available for analysis of neo-adjuvant chemotherapy involving patients with resectable stage III disease; overall these trials suggest that induction chemotherapy (with or without radiation) improves survival, particularly in those patients who undergo significant downstaging. Heterogeneous study populations limit the ability to define the optimal patient population who would most benefit from this approach. There is no conclusive evidence that neo-adjuvant chemotherapy in early NSCLC is associated with an increased post surgical morbility and mortality. Additional trials are needed. More recently neo-adjuvant chemotherapy has been tested in resectable stage I-II NSCLC and proved to be feasible and better tolerated than adjuvant chemotherapy. Several randomised trials are currently ongoing. In the next future the role of targeted biological therapies as agents acting on minimal residual disease should be explored.

Antineoplastic Agents↗
PubMed2002

Consensus conference on medical treatment of non-small cell lung cancer: adjuvant treatment.

The 5-year survival rate for patients with non-small cell lung cancer (NSCLC) who undergo complete surgical resection is only 40-69%, depending on the stage. It is well known that distant metastatic disease is the dominant site of recurrence in such patients and this observation served as the basis for trials of postoperative systemic therapy. The earliest trials of adjuvant chemotherapy, which consisted of single alkylating agents, did not achieve this goal or, even worse, showed a detrimental effect on survival. The introduction of more active drugs, such as cisplatin and vinca alkaloids, made it possible to obtain more promising results in terms of delayed recurrence of the disease. A recent meta-analysis of all randomized trials with accrual from January 1965 to December 1991 showed that the absolute risk of death was reduced by 3% at 2 years and by 5% at 5 years for patients who were treated with postoperative cisplatin-containing regimens compared with patients who were treated with surgery alone. Although the results of this meta-analysis suggest that postoperative cisplatin chemotherapy regimens may result in a slight survival improvement, adjuvant chemotherapy in NSCLC cannot be considered a standard therapy, and it is important that large, carefully conducted, randomized trials are performed in this group of patients. Four such randomized trials are being conducted in Europe. One of them, the ALPI trial, recently completed its accrual with 1200 patients. The IALT, ANITA, and MRC trials are still ongoing. The results of such trials are eagerly awaited and it is hoped that, once the value of postoperative chemotherapy is well ascertained, future developments can further improve results of combined treatment. In such direction, the recently reported results of PORT meta-analysis evaluating the role of radiation therapy are of great contribution in selecting a suitable population for future studies. In fact, only patients with pN2 disease seem to have a beneficial effect in terms of survival, especially if they have a good performance status, while radiotherapy is not justified in N0-1 patients. The optimal integration of chemotherapy and radiation therapy when both therapies are indicated represents another goal for future research.

Carcinoma, Non-Small-Cell Lung↗
PubMed2003

The need for resources for clinical research: proceedings of a policy conference held at the European Heart House, 27-28 June 2002: executive summary.

The medical profession, in particular cardiologists, acknowledge the fact that during the last 30 years, much of the progress made in the field of medicine has resulted from fruitful and close collaboration between academia and the pharmaceutical industry. However, during the last decade, this relationship has changed considerably. The industry increasingly carries out its own research, development of drugs and trials, according to its own agenda. As a result, academia has lost its influence. This has led to a dramatic increase in the cost of clinical randomised trials. In the meantime, academic careers and research have become less attractive to physicians. Funding for research is increasingly devoted to basic science, in particular genomics, and little is left for clinical research. As a result, many important clinical trials in various areas of medicine, including cardiology, remain unfunded.

Cardiology↗
PubMed2006

[Treatment of invasive fungal infections. 2005. Andalusian Infectious Disease Society].

Invasive fungal infections have increased progressively in the last decades, producing elevated morbidity and mortality. In recent years, there have been numerous advances in the treatment of these diseases, with the introduction of new drugs in clinical practice and the information derived from several types of studies. This has improved the prognosis of some invasive fungal infections and increased the therapeutic options in various clinical situations. This new knowledge must be assessed to determine its application in clinical practice, taking into account available scientific evidence and clinical experience. With this aim, the Andalusian Society of Infectious Diseases has developed this consensus document containing recommendations for the treatment of the invasive fungal infections.

Antifungal Agents↗
PubMedDate not supplied

[Consensus doesn't always mean agreement: limitations of consensus methods in health services].

Taking decisions in uncertain situations has led to a high use of the consensus methods (Nominal Group Technique, Delphi Method, and Consensus Conferences) in the health services. The review made in this article shows that the appropriate use of these techniques requires a high degree of methodologic precision, especially in relation to the financer's declaration of objectives, the appropriate selection of the participants, previous realization of a synthesis of the preexistent information, the definition of the agreement degree which leads to the consensus and in the evaluation of its impact.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

Guidelines based on the principle 'First, do no harm'. New guidelines on tracheal tube confirmation and prevention of dislodgment.

In summary, this editorial and the one on pulse check point out another area in which a total reliance on evidence-based guidelines amy do our patients a disservice. The debate over dropping the pulse check hinged less on the strength of the evidence and more on the widespread clinical principle of fear of false-negative errors. The discussion of secondary confirmation of tracheal tube placement also lacks a strong base of evidence that identifies the one best technique of tube confirmation for patients with a pulse versus those without a pulse. The principles of the zero-risk intervention and first, do no harm come into play in this situation. We must deal with the growing awareness of the fact that tracheal intubation is not only a potentially lethal intervention but now is also a confirmed lethal intervention, and at a much higher death rate than has ever been suspected. Factors that contribute to the transformation of the tracheal tube from a life-saving to a death-causing intervention are being identified by honest and open researchers. National societies in emergency medicine are responding appropriately. We strongly recommend shifting from making an evidence-based recommendation to instead making a principle-based recommendation--killing our patients is unacceptable; we must act on the widespread concept regarding errors in medicine. We must adopt zero-risk interventions in all possible situations.

Humans↗
PubMed1995

Adenosis (atypical adenomatous hyperplasia): histopathology and relationship to carcinoma.

Adenosis is a specific histologic entity which is most frequently seen in transurethral resection of the prostate, although increasingly identified on needle biopsy. The distinction of adenosis from low-grade adenocarcinoma is based on a constellation of histologic features, rather than on any one specific feature (i.e. nucleoli). Although mimicking low grade adenocarcinoma, adenosis has not been shown to be related to adenocarcinoma.

Adenocarcinoma↗
PubMed2001

Standardisation of imaging in neuroendocrine tumours: results of a European delphi process.

In 1998 and 1999, a delphi consensus procedure was performed to establish guidelines for standardised diagnostic imaging of neuroendocrine tumours. The procedure included four consecutive workshops of a European group of experts in neuroendocrine tumours as well as feedback given by specialists from the departments of radiology, nuclear medicine, surgery and internal medicine of the according home institutions. Diverging approaches among the centres, which became apparent during the discussion, reflect a lack of controlled studies specifically for rare subgroups of neuroendocrine tumours. This paper summarises the standards for diagnostic imaging as developed during the delphi process. In particular, the diagnostic workflows as well as the technical properties of different imaging modalities are described in detail.

Delphi Technique↗
PubMed1997

Consensus conferences in critical care medicine. Methodologies and impact.

Consensus conferences for the purposes of producing practice guidelines are occurring with increasing frequency both nationally and internationally. The international collaboration of national sciences in these efforts could have a dramatic impact on international standards of care. Too little emphasis is given to conference evaluations in terms of validity of methods, quality of recommendations, and influence on clinical practice and patient outcome. This article provides an overview of consensus methods used to produce guidelines in critical care. It also discusses the strengths and weaknesses of these methods, and how these may influence consensus guidelines. Finally, a brief overview of theoretically sound methods that can serve as benchmarks to evaluate current methods, and the bases for the development of improved methods is provided.

Consensus Statements as Topic↗
PubMed1999

Nomenclature for factors of the dog major histocompatibility system (DLA), 1998. First report of the ISAG DLA Nomenclature Committee. International Society for Animals Genetics.

A Nomenclature Committee for factors of the dog major histocompatibility system or dog leukocyte antigen (DLA) has been convened under the auspices of the International Society for Animal Genetics (ISAG) to define a sequence-based nomenclature for the genes of the DLA system. The remit of this committee includes: i) assignment of gene names; ii) rules for naming alleles; iii) assignment of names to published alleles; iv) assignment of names to new alleles; and v) rules for acceptance of new alleles.

Amino Acid Sequence↗
PubMed2001

CD antigens 2001.

The most recent Human Leucocyte Differentiation Antigen Workshop ("HLDA7") took place in 2000 in Harrogate, UK and the proceedings are about to be published (Leucocyte Typing VII). New Sections were introduced in this Workship (Dendritic cells, Stem/progenitor cells, Erythroid cells and Carbohydrate Structures) and monoclonal antibodies were selected for which at least some molecular data were already available (to avoid "blind" screening of reagents against known specificities). A total of more than 80 new CD specificities were established (previously the average was less than 30 new CD specificities per Workshop) and these are listed in this article. There is already evidence for the existence of many new leucocyte surface molecules for study at the next HLDA Workshop (in Adelaide in 2004), and we have listed in this article a number of such potential CD candidates (identified following the production of monoclonal antibodies or via gene cloning). There are also today an increasing number of lineage- and/or stage-restricted leucocyte-associated molecules localised within the cell cytoplasm (or nucleus): they will certainly prove of intense in the future for many laboratories studying human haematopoietic cells (regardless of whether a new "intracellular CD" categorisation scheme is devised for such molecules).

Antigens, CD↗