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Sample records for european consensus expert

  1. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo.

    Science.gov (United States)

    Pereira, M P; Steinke, S; Zeidler, C; Forner, C; Riepe, C; Augustin, M; Bobko, S; Dalgard, F; Elberling, J; Garcovich, S; Gieler, U; Gonçalo, M; Halvorsen, J A; Leslie, T A; Metz, M; Reich, A; Şavk, E; Schneider, G; Serra-Baldrich, E; Ständer, H F; Streit, M; Wallengren, J; Weller, K; Wollenberg, A; Bruland, P; Soto-Rey, I; Storck, M; Dugas, M; Weisshaar, E; Szepietowski, J C; Legat, F J; Ständer, S

    2017-08-31

    The term prurigo has been used for many decades in dermatology without clear definition, and currently used terminology of prurigo is inconsistent and confusing. Especially, itch-related prurigo remains unexplored regarding the epidemiology, clinical profile, natural course, underlying causes, available treatments and economic burden, although burdensome and difficult to treat. To address these issues, the multicentre European Prurigo Project (EPP) was designed to increase knowledge on chronic prurigo (CPG). In the first step, European experts of the EADV Task Force Pruritus (TFP) aimed to achieve a consensus on the definition, classification and terminology of CPG. Additionally, procedures of the cross-sectional EPP were discussed and agreed upon. Discussions and surveys between members of the TFP served as basis for a consensus conference. Using the Delphi method, consensus was defined as an agreement ≥75% among the present members. Twenty-four members of the TFP participated in the consensus conference. Experts consented that CPG should be used as an umbrella term for the range of clinical manifestations (e.g. papular, nodular, plaque or umbilicated types). CPG is considered a distinct disease defined by the presence of chronic pruritus for ≥6 weeks, history and/or signs of repeated scratching and multiple localized/generalized pruriginous skin lesions (whitish or pink papules, nodules and/or plaques). CPG occurs due to a neuronal sensitization to itch and the development of an itch-scratch cycle. This new definition and terminology of CPG should be implemented in dermatology to harmonize communication in the clinical routine, clinical trials and scientific literature. Acute/subacute forms of prurigo are separated entities, which need to be differentiated from CPG and will be discussed in a next step. In the near future, the cross-sectional EPP will provide relevant clinical data on various aspects of CPG leading to new directions in the scientific

  2. European Expert Consensus Paper on the implementation of Article 14 of the WHO Framework Convention on Tobacco Control.

    Science.gov (United States)

    Clancy, Luke

    2016-11-01

    On 24 November 2015, under the auspices of the European Policy Roundtable on Smoking Cessation, 15 experts on tobacco control and dependence from across the European Union, chaired by Professor Luke Clancy, met in Oslo, Norway, to discuss the implementation of the Tobacco Products Directive and the WHO Framework Convention on Tobacco Control, namely Article 14. On the occasion of the 10th anniversary of the Framework Convention on Tobacco Control, this paper reports the consensus reached by all Roundtable participants on the need to further advance the availability and access to services to support cessation of tobacco use. The implementation of services to support cessation of tobacco use in line with Article 14 can and should be significantly improved to protect the health of European citizens. The meeting was initiated and funded by Pfizer.

  3. Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA).

    Science.gov (United States)

    Banales, Jesus M; Cardinale, Vincenzo; Carpino, Guido; Marzioni, Marco; Andersen, Jesper B; Invernizzi, Pietro; Lind, Guro E; Folseraas, Trine; Forbes, Stuart J; Fouassier, Laura; Geier, Andreas; Calvisi, Diego F; Mertens, Joachim C; Trauner, Michael; Benedetti, Antonio; Maroni, Luca; Vaquero, Javier; Macias, Rocio I R; Raggi, Chiara; Perugorria, Maria J; Gaudio, Eugenio; Boberg, Kirsten M; Marin, Jose J G; Alvaro, Domenico

    2016-05-01

    Cholangiocarcinoma (CCA) is a heterogeneous group of malignancies with features of biliary tract differentiation. CCA is the second most common primary liver tumour and the incidence is increasing worldwide. CCA has high mortality owing to its aggressiveness, late diagnosis and refractory nature. In May 2015, the "European Network for the Study of Cholangiocarcinoma" (ENS-CCA: www.enscca.org or www.cholangiocarcinoma.eu) was created to promote and boost international research collaboration on the study of CCA at basic, translational and clinical level. In this Consensus Statement, we aim to provide valuable information on classifications, pathological features, risk factors, cells of origin, genetic and epigenetic modifications and current therapies available for this cancer. Moreover, future directions on basic and clinical investigations and plans for the ENS-CCA are highlighted.

  4. Management goals for type 1 Gaucher disease: An expert consensus document from the European working group on Gaucher disease.

    Science.gov (United States)

    Biegstraaten, M; Cox, T M; Belmatoug, N; Berger, M G; Collin-Histed, T; Vom Dahl, S; Di Rocco, M; Fraga, C; Giona, F; Giraldo, P; Hasanhodzic, M; Hughes, D A; Iversen, P O; Kiewiet, A I; Lukina, E; Machaczka, M; Marinakis, T; Mengel, E; Pastores, G M; Plöckinger, U; Rosenbaum, H; Serratrice, C; Symeonidis, A; Szer, J; Timmerman, J; Tylki-Szymańska, A; Weisz Hubshman, M; Zafeiriou, D I; Zimran, A; Hollak, C E M

    2018-02-01

    Gaucher Disease type 1 (GD1) is a lysosomal disorder that affects many systems. Therapy improves the principal manifestations of the condition and, as a consequence, many patients show a modified phenotype which reflects manifestations of their disease that are refractory to treatment. More generally, it is increasingly recognised that information as to how a patient feels and functions [obtained by patient- reported outcome measurements (PROMs)] is critical to any comprehensive evaluation of treatment. A new set of management goals for GD1 in which both trends are reflected is needed. To this end, a modified Delphi procedure among 25 experts was performed. Based on a literature review and with input from patients, 65 potential goals were formulated as statements. Consensus was considered to be reached when ≥75% of the participants agreed to include that specific statement in the management goals. There was agreement on 42 statements. In addition to the traditional goals concerning haematological, visceral and bone manifestations, improvement in quality of life, fatigue and social participation, as well as early detection of long-term complications or associated diseases were included. When applying this set of goals in medical practice, the clinical status of the individual patient should be taken into account. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Executive summary. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.

    Science.gov (United States)

    Hansmann, Georg; Apitz, Christian; Abdul-Khaliq, Hashim; Alastalo, Tero-Pekka; Beerbaum, Phillip; Bonnet, Damien; Dubowy, Karl-Otto; Gorenflo, Matthias; Hager, Alfred; Hilgendorff, Anne; Kaestner, Michael; Koestenberger, Martin; Koskenvuo, Juha W; Kozlik-Feldmann, Rainer; Kuehne, Titus; Lammers, Astrid E; Latus, Heiner; Michel-Behnke, Ina; Miera, Oliver; Moledina, Shahin; Muthurangu, Vivek; Pattathu, Joseph; Schranz, Dietmar; Warnecke, Gregor; Zartner, Peter

    2016-05-01

    : The European Paediatric Pulmonary Vascular Disease (PVD) Network is a registered, non-profit organisation that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of paediatric pulmonary hypertensive vascular disease, including specific forms such as pulmonary arterial hypertension (PAH)-congenital heart disease, pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, persistent PH of the newborn, and related cardiac dysfunction. The writing group members conducted searches of the PubMed/MEDLINE bibliographic database (1990-2015) and held five face-to-face meetings with votings. Clinical trials, guidelines, and reviews limited to paediatric data were searched using the terms 'pulmonary hypertensioń' and 5-10 other keywords, as outlined in the other nine articles of this special issue. Class of recommendation (COR) and level of evidence (LOE) were assigned based on European Society of Cardiology/American Heart Association definitions and on paediatric data only, or on adult studies that included >10% children. A total of 9 original consensus articles with graded recommendations (COR/LOE) were developed, and are summarised here. The topics included diagnosis/monitoring, genetics/biomarker, cardiac catheterisation, echocardiography, cardiac magnetic resonance/chest CT, associated forms of PH, intensive care unit/ventricular assist device/lung transplantation, and treatment of paediatric PAH. The multipaper expert consensus statement of the European Paediatric PVD Network provides a specific, comprehensive, detailed but practical framework for the optimal clinical care of children with PH. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Healthy eating at school: consensus among experts

    Directory of Open Access Journals (Sweden)

    Rafaella Guimarães Moraes CAMARGO

    Full Text Available ABSTRACT Objective: To identify attributes that promote healthy eating in order to support a study for the Quality Index for School Meal Menus content validity. Methods: This study used the Delphi technique to consult school nutrition experts in Brazil. These experts were selected among the authors of articles published between 2010 and 2015 that were identified by searching the Web of Science database, using the keywords 'school feeding', 'school nutrition program', and 'school food program', as well as the authors of official documents on this topic. The Likert method was used to record respondent perceptions in two analytical dimensions: foods that are part of a healthy menu for school feeding, and composition of an indicator of nutritional quality for school feeding menus. Results: Most respondents (n=27 were affiliated with public institutions (92.59% and had over six years of experience in the area (70.36%. Assertions resulted in consensus according to the analysis criteria. A consensus was established for fresh food, fruits and vegetables, dairy products, beans, meat and eggs, and a schedule compatible with the meal as promoters of healthy eating, and processed foods, sweets, and fat excess as risk attributes. Conclusion: Since a consensus was not reached in the first round, there is a need to broaden the debate on issues related to foods rich in sugar, replacement of meals by sweets, and foods rich in fat.

  7. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum.

    Science.gov (United States)

    van de Velde, Cornelis J H; Boelens, Petra G; Borras, Josep M; Coebergh, Jan-Willem; Cervantes, Andres; Blomqvist, Lennart; Beets-Tan, Regina G H; van den Broek, Colette B M; Brown, Gina; Van Cutsem, Eric; Espin, Eloy; Haustermans, Karin; Glimelius, Bengt; Iversen, Lene H; van Krieken, J Han; Marijnen, Corrie A M; Henning, Geoffrey; Gore-Booth, Jola; Meldolesi, Elisa; Mroczkowski, Pawel; Nagtegaal, Iris; Naredi, Peter; Ortiz, Hector; Påhlman, Lars; Quirke, Philip; Rödel, Claus; Roth, Arnaud; Rutten, Harm; Schmoll, Hans J; Smith, Jason J; Tanis, Pieter J; Taylor, Claire; Wibe, Arne; Wiggers, Theo; Gambacorta, Maria A; Aristei, Cynthia; Valentini, Vincenzo

    2014-01-01

    Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where

  8. A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

    Science.gov (United States)

    Hiligsmann, Mickaël; Cooper, Cyrus; Guillemin, Francis; Hochberg, Marc C; Tugwell, Peter; Arden, Nigel; Berenbaum, Francis; Boers, Maarten; Boonen, Annelies; Branco, Jaime C; Maria-Luisa, Brandi; Bruyère, Olivier; Gasparik, Andrea; Kanis, John A; Kvien, Tore K; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Pinedo-Villanueva, Rafael; Pinto, Daniel; Reiter-Niesert, Susanne; Rizzoli, René; Rovati, Lucio C; Severens, Johan L; Silverman, Stuart; Reginster, Jean-Yves

    2014-12-01

    General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate

  9. Severe Tooth Wear: European Consensus Statement on Management Guidelines.

    NARCIS (Netherlands)

    Loomans, B.; Opdam, N.J.; Attin, T.; Bartlett, D.; Edelhoff, D.; Frankenberger, R.; Benic, G.; Ramseyer, S.; Wetselaar, P.; Sterenborg, B.; Hickel, R.; Pallesen, U.; Mehta, S.; Banerji, S.; Lussi, A.; Wilson, N.

    2017-01-01

    This paper presents European expert consensus guidelines on the management of severe tooth wear. It focuses on the definition of physiological vs pathological tooth wear and recommends diagnosis, prevention, counseling, and monitoring aimed at elucidating the etiology, nature, rate and means of

  10. The Delphi Method Online: Medical Expert Consensus Via the Internet

    OpenAIRE

    Cam, Kenneth M.; McKnight, Patrick E.; Doctor, Jason N

    2002-01-01

    Delphi is an expert consensus method. The theory behind the Delphi method is that the interaction of experts may lead to a reduction in individual bias. We have developed software that carries out all aspects of the Delphi method via the Internet. The Delphi method online consists of three components: 1) authorship, 2) interactive polling, and 3) reporting/results. We hope that researchers use this tool in future medical expert systems.

  11. IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations

    Science.gov (United States)

    Yutskovskaya, Yana; Gubanova, Elena; Khrustaleva, Irina; Atamanov, Vasiliy; Saybel, Anastasiya; Parsagashvili, Elena; Dmitrieva, Irina; Sanchez, Elena; Lapatina, Natalia; Korolkova, Tatiana; Saromytskaya, Alena; Goltsova, Elena; Satardinova, Elmira

    2015-01-01

    Background Although there are various international consensus recommendations on the use of botulinum neurotoxin type A (BoNT/A) in facial aesthetics, there are no global or Russian guidelines on the optimal dose of incobotulinumtoxinA, free from complexing proteins, within specific aesthetic indications. This article reports the outcomes of two expert consensus meetings, conducted to review and analyze efficacy and tolerability data for incobotulinumtoxinA in various facial aesthetic indications and to give expert consensus recommendations to ensure best clinical practice among Russian clinicians. Methods Thirteen dermatology and/or plastic surgery experts attended meetings held in Paris, France (November 2013), and Moscow, Russia (March 2014). The expert group reviewed and analyzed the existing evidence, consensus recommendations, and Russian experts’ extensive practical experience of incobotulinumtoxinA in aesthetics to reach consensus on optimal doses, potential dose adjustments, and injection sites of incobotulinumtoxinA for facial aesthetics. Results All experts developed guidance on the optimal doses for incobotulinumtoxinA treatment of different regions of the upper and lower face. The expert panel agreed that there are no differences in the efficacy and duration of the effect between the four BoNT/As that are commercially available for facial aesthetic indications in Russia and that, when administered correctly, all BoNT/As can achieve optimal results. Experts also agreed that nonresponse to BoNT/A can be caused by neutralizing antibodies. Conclusion On the basis of the scientific and clinical evidence available for incobotulinumtoxinA, coupled with the extensive clinical experience of the consensus group, experts recommended the optimal doses of incobotulinumtoxinA effective for treatment of wrinkles of the upper and lower face to achieve the expected aesthetic outcome. These first Russian guidelines on the optimal use of incobotulinumtoxinA for

  12. Practical recommendations for the management of cardiovascular risk associated with atherogenic dyslipidemia, with special attention to residual risk. Spanish adaptation of a European Consensus of Experts.

    Science.gov (United States)

    This document has discussed clinical approaches to managing cardiovascular risk in clinical practice, with special focus on residual cardiovascular risk associated with lipid abnormalities, especially atherogenic dyslipidaemia (AD). A simplified definition of AD was proposed to enhance understanding of this condition, its prevalence and its impact on cardiovascular risk. AD can be defined by high fasting triglyceride levels (≥2.3mmol/L / ≥200mg/dL) and low high-density lipoprotein cholesterol (HDL-c) levels (≤1,0 / 40 and ≤1,3mmol/L / 50mg/dL in men and women, respectively) in statin-treated patients at high cardiovascular risk. The use of a single marker for the diagnosis and treatment of AD, such as non-HDL-c, was advocated. Interventions including lifestyle optimization and low density lipoprotein (LDL) lowering therapy with statins (±ezetimibe) are recommended by experts. Treatment of residual AD can be performed with the addition of fenofibrate, since it can improve the complete lipoprotein profile and reduce the risk of cardiovascular events in patients with AD. Others clinical condictions in which fenofibrate may be prescribed include patients with very high TGs (≥5.6mmol/L / 500mg/dL), patients who are intolerant or resistant to statins, and patients with AD and at high cardiovascular risk. The fenofibrate-statin combination was considered by the experts to benefit from a favorable benefit-risk profile. In conclusion, cardiovascular experts adopt a multifaceted approach to the prevention of atherosclerotic cardiovascular disease, with lifestyle optimization, LDL-lowering therapy and treatment of AD with fenofibrate routinely used to help reduce a patient's overall cardiovascular risk. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  13. Consensus document on European brain research.

    Science.gov (United States)

    Olesen, Jes; Baker, Mary G; Freund, Tamas; di Luca, Monica; Mendlewicz, Julien; Ragan, Ian; Westphal, Manfred

    2006-08-01

    countries, greater collaboration between industry, academia and patient organisations, and increased investment in the brain sciences. The EBC was formed in 2002 to bring together scientists, clinicians, the pharmaceutical industry, charities and patient organisations from all over Europe to campaign for these goals. It takes a novel, bottom-up approach to research policy, and in developing this consensus document, it aims to promote a greater and more focused effort in this area, to improve public understanding of the brain sciences and above all, to support brain research as a priority under the European Commission's Seventh Framework Programme (FP7, 2007-2013). The research programme outlined here was first conceived by the EBC board. An outline was sent to all member organisations and a number of individual experts for comments. Following that, a table of contents was developed. The 45 research themes were written by groups of experts from across Europe who represent a wide range of disciplines. Each one contains a proposal for future research on a specific brain-related theme which the EBC believes could form the basis of one or more integrated projects or strategic targeted research projects (STREP) funded under FP7. The EBC has deliberately focused on the major diseases and then described the basic research needed to understand and treat or perhaps even cure those diseases. The programme is therefore constructed "from man to molecule" and not the other way round, with equal importance attached to basic and clinical research. The EBC suggests that each of the proposed integrated projects or STREP should be awarded a budget in the order of Euro 10 to 15 million. In addition, brain research should be treated as an important element of many other parts of FP7, such as the European Research Council and research programmes on information technology and the causes of violence. Any research programme that concerns human behaviour should, by definition, take account of brain

  14. Health economics in the field of osteoarthritis: an expert's consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

    Science.gov (United States)

    Hiligsmann, Mickaël; Cooper, Cyrus; Arden, Nigel; Boers, Maarten; Branco, Jaime C; Luisa Brandi, Maria; Bruyère, Olivier; Guillemin, Francis; Hochberg, Marc C; Hunter, David J; Kanis, John A; Kvien, Tore K; Laslop, Andrea; Pelletier, Jean-Pierre; Pinto, Daniel; Reiter-Niesert, Susanne; Rizzoli, René; Rovati, Lucio C; Severens, Johan L Hans; Silverman, Stuart; Tsouderos, Yannis; Tugwell, Peter; Reginster, Jean-Yves

    2013-12-01

    There is an important need to evaluate therapeutic approaches for osteoarthritis (OA) in terms of cost-effectiveness as well as efficacy. The ESCEO expert working group met to discuss the epidemiological and economic evidence that justifies the increasing concern of the impact of this disease and reviewed the current state-of-the-art in health economic studies in this field. OA is a debilitating disease; it is increasing in frequency and is associated with a substantial and growing burden on society, in terms of both burden of illness and cost of illness. Economic evaluations in this field are relatively rare, and those that do exist, show considerable heterogeneity of methodological approach (such as indicated population, comparator, decision context and perspective, time horizon, modeling and outcome measures used). This heterogeneity makes comparisons between studies problematic. Better adherence to guidelines for economic evaluations is needed. There was strong support for the definition of a reference case and for what might constitute "standard optimal care" in terms of best clinical practice, for the control arms of interventional studies. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  15. The role of calcium supplementation in healthy musculoskeletal ageing : An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF).

    Science.gov (United States)

    Harvey, N C; Biver, E; Kaufman, J-M; Bauer, J; Branco, J; Brandi, M L; Bruyère, O; Coxam, V; Cruz-Jentoft, A; Czerwinski, E; Dimai, H; Fardellone, P; Landi, F; Reginster, J-Y; Dawson-Hughes, B; Kanis, J A; Rizzoli, R; Cooper, C

    2017-02-01

    The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.

  16. Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI).

    Science.gov (United States)

    Nunes, Maria Carmo P; Badano, Luigi Paolo; Marin-Neto, J Antonio; Edvardsen, Thor; Fernández-Golfín, Covadonga; Bucciarelli-Ducci, Chiara; Popescu, Bogdan A; Underwood, Richard; Habib, Gilbert; Zamorano, Jose Luis; Saraiva, Roberto Magalhães; Sabino, Ester Cerdeira; Botoni, Fernando A; Barbosa, Márcia Melo; Barros, Marcio Vinicius L; Falqueto, Eduardo; Simões, Marcus Vinicius; Schmidt, André; Rochitte, Carlos Eduardo; Rocha, Manoel Otávio Costa; Ribeiro, Antonio Luiz Pinho; Lancellotti, Patrizio

    2017-09-25

    To develop a document by Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI) to review and summarize the most recent evidences about the non-invasive assessment of patients with Chagas disease, with the intent to set up a framework for standardized cardiovascular imaging to assess cardiovascular morphologic and functional disturbances, as well as to guide the subsequent process of clinical decision-making. Chagas disease remains one of the most prevalent infectious diseases in Latin America, and has become a health problem in non-endemic countries. Dilated cardiomyopathy is the most severe manifestation of Chagas disease, which causes substantial disability and early mortality in the socially most productive population leading to a significant economical burden. Prompt and correct diagnosis of Chagas disease requires specialized clinical expertise to recognize the unique features of this disease. The appropriate and efficient use of cardiac imaging is pivotal for diagnosing the cardiac involvement in Chagas disease, to stage the disease, assess patients' prognosis and address management. Echocardiography is the most common imaging modality used to assess, and follow-up patients with Chagas disease. The presence of echocardiographic abnormalities is of utmost importance, since it allows to stage patients according to disease progression. In early stages of cardiac involvement, echocardiography may demonstrate segmental left ventricuar wall motion abnormalities, mainly in the basal segments of inferior, inferolateral walls, and the apex, which cannot be attributed to obstructive coronary artery arteries. The prevalence of segmental wall motion abnormalities varies according to the stage of the disease, reaching about 50% in patients with left ventricular dilatation and dysfunction. Speckle tracking echocardiography allows a more precise and quantitative measurement of the regional myocardial function. Since

  17. Expert Consensus on Characteristics of Wisdom: A Delphi Method Study

    Science.gov (United States)

    Jeste, Dilip V.; Ardelt, Monika; Blazer, Dan; Kraemer, Helena C.; Vaillant, George; Meeks, Thomas W.

    2010-01-01

    Purpose: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent definitions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. Design and Methods: A survey questionnaire comprised 53…

  18. Consensus document on European brain research

    DEFF Research Database (Denmark)

    Di Luca, Monica; Baker, Mary; Corradetti, Renato

    2011-01-01

    will increase exponentially in the years to come due to ageing of the European population, it is necessary to act now in order to curb this increase and possibly reverse the trend. Thus, establishing a strong European platform supporting basic and clinical research in neuroscience is needed to confront...... the economic and social challenge posed by management of brain diseases in European countries. To setup a platform for discussion, EBC published in 2006 a Consensus Document on European Brain Research, describing needs and achievements of research in Europe and presenting proposals for future research programs....... Since 2006, European research in neuroscience has advanced tremendously. The present document represents an update elaborated to reflect changes in research priorities and advances in brain research that have taken place since 2006. The same approach and format have been used here as in the previous...

  19. Consensus document on European brain research

    DEFF Research Database (Denmark)

    Di Luca, Monica; Baker, Mary; Corradetti, Renato

    2011-01-01

    the economic and social challenge posed by management of brain diseases in European countries. To setup a platform for discussion, EBC published in 2006 a Consensus Document on European Brain Research, describing needs and achievements of research in Europe and presenting proposals for future research programs....... Since 2006, European research in neuroscience has advanced tremendously. The present document represents an update elaborated to reflect changes in research priorities and advances in brain research that have taken place since 2006. The same approach and format have been used here as in the previous......Psychiatric and neurological diseases combined represent a considerable social and economic burden in Europe. A recent study conducted by the European Brain Council (EBC) quantified the 'cost and burden' of major brain diseases in Europe, amounting to €386bn per year. Considering that these costs...

  20. IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations

    Directory of Open Access Journals (Sweden)

    Yutskovskaya Y

    2015-06-01

    Full Text Available Yana Yutskovskaya,1 Elena Gubanova,2 Irina Khrustaleva,3 Vasiliy Atamanov,4 Anastasiya Saybel,5 Elena Parsagashvili,6 Irina Dmitrieva,7 Elena Sanchez,8 Natalia Lapatina,9 Tatiana Korolkova,10 Alena Saromytskaya,11 Elena Goltsova,12 Elmira Satardinova13 1Department of Dermatovenereology and Cosmetology, Pacific State Medical University, Vladivostock, 2Department of Skin and Venereal Diseases, Postgraduate Medical Institute, Moscow National University of Food Production, Moscow, 3Department of Plastic Surgery, IP Pavlov Medical State University, St Petersburg, 4Department of Reconstructive and Plastic Surgery, SN Fedorova, Federal State Institution, Novosibirsk, 5Clinic Ideal, Laser Technologies Center, Moscow, 6Aestima-clinic, 7Clinic “Academy”, St Petersburg, 8Eklan Medical Center of Cosmetological Correction, 9Clinic of Aesthetic Medicine and Plastic Surgery, Moscow, 10Department of Cosmetology, II Mechnikov North-Western State Medical University, St Petersburg, 11Plastic Surgery Clinic, Center of Aesthetic Medicine and Beauty Cosmetology, 12“Neo-Clinic,” Tyumen, 13Botulinum Toxin Therapy Department, Diagnostic Center of the Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia Background: Although there are various international consensus recommendations on the use of botulinum neurotoxin type A (BoNT/A in facial aesthetics, there are no global or Russian guidelines on the optimal dose of incobotulinumtoxinA, free from complexing proteins, within specific aesthetic indications. This article reports the outcomes of two expert consensus meetings, conducted to review and analyze efficacy and tolerability data for incobotulinumtoxinA in various facial aesthetic indications and to give expert consensus recommendations to ensure best clinical practice among Russian clinicians. Methods: Thirteen dermatology and/or plastic surgery experts attended meetings held in Paris, France (November 2013, and Moscow, Russia (March 2014

  1. Expert consensus panel guidelines on geriatric assessment in oncology.

    Science.gov (United States)

    O'Donovan, A; Mohile, S G; Leech, M

    2015-07-01

    Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. A four-round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations to gain consensus on a given topic. Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cut-off for assessment, represented a higher degree of disagreement. The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. © 2015 John Wiley & Sons Ltd.

  2. Expert Consensus Panel Guidelines on Geriatric Assessment in Oncology

    Science.gov (United States)

    O'Donovan, A.; Mohile, S.G.; Leech, M.

    2015-01-01

    Introduction Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. Methods A four round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations in order to gain consensus on a given topic Results Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cutoff for assessment represented a higher degree of disagreement. Discussion The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. PMID:25757457

  3. Using the Delphi expert consensus method in mental health research.

    Science.gov (United States)

    Jorm, Anthony F

    2015-10-01

    The article gives an introductory overview of the use of the Delphi expert consensus method in mental health research. It explains the rationale for using the method, examines the range of uses to which it has been put in mental health research, and describes the stages of carrying out a Delphi study using examples from the literature. To ascertain the range of uses, a systematic search was carried out in PubMed. The article also examines the implications of 'wisdom of crowds' research for how to conduct Delphi studies. The Delphi method is a systematic way of determining expert consensus that is useful for answering questions that are not amenable to experimental and epidemiological methods. The validity of the approach is supported by 'wisdom of crowds' research showing that groups can make good judgements under certain conditions. In mental health research, the Delphi method has been used for making estimations where there is incomplete evidence (e.g. What is the global prevalence of dementia?), making predictions (e.g. What types of interactions with a person who is suicidal will reduce their chance of suicide?), determining collective values (e.g. What areas of research should be given greatest priority?) and defining foundational concepts (e.g. How should we define 'relapse'?). A range of experts have been used in Delphi research, including clinicians, researchers, consumers and caregivers. The Delphi method has a wide range of potential uses in mental health research. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  4. What European gynaecologists need to master: Consensus on medical expertise outcomes of pan-European postgraduate training in obstetrics & gynaecology.

    Science.gov (United States)

    van der Aa, Jessica E; Tancredi, Annalisa; Goverde, Angelique J; Velebil, Petr; Feyereisl, Jaroslav; Benedetto, Chiara; Teunissen, Pim W; Scheele, Fedde

    2017-09-01

    European harmonisation of training standards in postgraduate medical education in Obstetrics and Gynaecology is needed because of the increasing mobility of medical specialists. Harmonisation of training will provide quality assurance of training and promote high quality care throughout Europe. Pan-European training standards should describe medical expertise outcomes that are required from the European gynaecologist. This paper reports on consensus development on the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. A Delphi procedure was performed amongst European gynaecologists and trainees in Obstetrics & Gynaecology, to develop consensus on outcomes of training. The consensus procedure consisted of two questionnaire rounds, followed by a consensus meeting. To ensure reasonability and feasibility for implementation of the training standards in Europe, implications of the outcomes were considered in a working group thereafter. We invited 142 gynaecologists and trainees in Obstetrics & Gynaecology for participation representing a wide range of European countries. They were selected through the European Board & College of Obstetrics and Gynaecology and the European Network of Trainees in Obstetrics & Gynaecology. Sixty people participated in round 1 and 2 of the consensus procedure, 38 (63.3%) of whom were gynaecologists and 22 (36.7%) were trainees in Obstetrics & Gynaecology. Twenty-eight European countries were represented in this response. Round 3 of the consensus procedure was performed in a consensus meeting with six experts. Implications of the training outcomes were discussed in a working group meeting, to ensure reasonability and feasibility of the material for implementation in Europe. The entire consensus procedure resulted in a core content of training standards of 188 outcomes, categorised in ten topics. European consensus was developed regarding the medical expertise outcomes of pan-European training in Obstetrics and

  5. A European consensus report on blood cell identification: terminology utilized and morphological diagnosis concordance among 28 experts from 17 countries within the European LeukemiaNet network WP10, on behalf of the ELN Morphology Faculty

    DEFF Research Database (Denmark)

    Zini, Gina; Bain, Barbara; Bettelheim, Peter

    2010-01-01

    This paper describes the methodology used to develop a consensual glossary for haematopoietic cells within Diagnostics-WP10 of European-LeukemiaNet EU-project. This highly interactive work was made possible through the use of the net, requiring only a single two-day meeting of actual confrontatio...

  6. Management of anaphylaxis in primary care: Canadian expert consensus recommendations.

    Science.gov (United States)

    Waserman, S; Chad, Z; Francoeur, M J; Small, P; Stark, D; Vander Leek, T K; Kaplan, A; Kastner, M

    2010-09-01

    Anaphylaxis is often managed inadequately. We used findings from a systematic review of gaps in anaphylaxis management to develop evidence-based recommendations for gaps rated as clinically important by a panel of Canadian allergy experts. The nominal group technique (NGT) consensus methodology was used to develop evidence-based recommendations for the management of anaphylaxis in primary care. Physician-specific gaps from our systematic review were prioritized by consensus meeting participants in two rounds, which involved the rating, discussion, and re-rating of gaps. Using current anaphylaxis guidelines, recommendations were then developed for each category of gaps that were identified by the panel as clinically important. Thirty unique physician gaps from the systematic review were categorized according to gaps of knowledge and anaphylaxis practice behaviors. The panel rated diagnosis of anaphylaxis, and when and how to use epinephrine auto-injectors as clinically important knowledge gaps; and rated infrequent or delayed epinephrine administration, low rate of auto-injector prescription, and infrequent or no referrals to allergy specialists after a reaction as important practice behavior gaps. Evidence from four guidelines was used to support the consensus recommendation statements for three resulting categories of gap themes: anaphylaxis management, epinephrine use, and follow-up care. We used an NGT consensus methodology to develop an educational resource for primary care physicians and allergists to better understand how to manage patients with anaphylaxis. Next steps include testing our findings against observed data in primary care settings and to develop other strategies or tools to overcome gaps in anaphylaxis management.

  7. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I

    DEFF Research Database (Denmark)

    Krege, Susanne; Beyer, Jörg; Souchon, Rainer

    2007-01-01

    OBJECTIVES: The first consensus report presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in the year 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the A......OBJECTIVES: The first consensus report presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in the year 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology...... in 2004 remain valid 3 yr later, refinements in the treatment of early- and advanced-stage testicular cancer have emerged from clinical trials. Despite technical improvements, expert clinical skills will continue to be one of the major determinants for the prognosis of patients with germ cell cancer...

  8. Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear-diagnosis and management

    NARCIS (Netherlands)

    Carvalho, T.S.; Colon, P.; Ganss, C.; Huysmans, M.C.D.N.J.M.; Lussi, A.; Schlueter, N.; Schmalz, G.; Shellis, R.P.; Tveit, A.B.; Wiegand, A.

    2015-01-01

    OBJECTIVE: Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. MATERIALS AND METHODS: This report is based on a compilation of the scientific literature, an expert

  9. Consensus Report of the European Federation of Conservative Dentistry: Erosive tooth wear diagnosis and management

    NARCIS (Netherlands)

    Carvalho, T.S.; Colon, P.; Ganss, C.; Huysmans, M.C.D.N.J.M.; Lussi, A.; Schlueter, N.; Schmalz, G.; Shellis, P.R.; Bjorg Tveit, A.; Wiegand, A.

    2016-01-01

    OBJECTIVE: Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. MATERIALS AND METHODS: This report is based on a compilation of the scientific literature, an expert

  10. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update

    DEFF Research Database (Denmark)

    Sweet, David G; Carnielli, Virgilio; Greisen, Gorm

    2010-01-01

    Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up-to-da...

  11. Expert consensus for PVCR in severe, rigid and angular spinal deformity treatment: The Kunming consensus.

    Science.gov (United States)

    Xie, Jing-Ming; Chen, Zhong-Qiang; Shen, Jian-Xiong; Zhang, Xue-Song; Yang, Cao; Zheng, Zhao-Min; Qian, Bang-Ping; Tzeng, Shiau-Tzu; Tian, Hui-Zhong; Li, Chao; Wu, Ji; Wu, Zeng-Hui; Ding, Wen-Yuan; Ma, Yuan; Du, Shi-Xin; Bai, Yu-Shu; Wang, Ying-Song; Liu, Li-Min; Yang, Hua; Zhou, Zhuo-Jia; Xie, Shi-Ming; Cao, Qi; Yang, Zhao

    2017-01-01

    In the past decades, an increasing number of surgeons started using posterior vertebral column resection (PVCR) to treat severe, rigid and angular spinal deformities. Little high-level evidence is available to guide surgical treatment. The aims of our study were to identify important surgical strategies and key technical points of Chinese experts who have extensive experience in the management of severe, rigid and angular spinal deformities using PVCR, and to standardize and unify the current core concepts. Workgroups of consensus were formed by selecting nationwide representing experts and comprehensive consultations. Eight task forces for major issues were established, then retrieval of literature, collection of expert opinions and writing of review articles were carried out. A modified Delphi process was chosen in round-table forum with three face-to-face meetings. Consensus was reached with items graded more than seven points including: indications and contraindications of PVCR; review PVCR in the evolution of spinal osteotomies; The corrective mechanism and safety of spinal cord; monitoring and responses of spinal cord crisis; characteristics and therapeutic outcome of pulmonary function; management of bleeding during PVCR; relationship of pedicle screw insertion and spinal cord safety; and analysis of non-neurologic complications and prevention strategies. In conclusion, The essential properties regarding PVCR procedure are tightly linked with various factors such as medical and surgical indication, range and level of vertebral column resection, strategies of correction, corrective efficiency and control of neurological risk. PVCR is used mainly for severe, rigid spinal deformity that is not manageable by other osteotomy techniques.

  12. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    Energy Technology Data Exchange (ETDEWEB)

    Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Haas, Rick L.M. [Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Kirsch, David G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montreal, Montreal, Quebec (Canada); Salerno, Kilian [Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York (United States); Deville, Curtiland [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Sidney Kimmel Cancer Center, Washington, DC (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); O' Sullivan, Brian [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Le Pechoux, Cecile [Department of Radiotherapy, Institut Gustave-Roussy, Villejuif (France); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  13. Towards a European consensus on conducting and reporting health economic evaluations--a report from the ISPOR Inaugural European Conference.

    Science.gov (United States)

    Goetghebeur, M M; Rindress, D

    1999-01-01

    This report is a summary of key issues in consensus development regarding the conduct and reporting of health economic research in the European context, presented and discussed at the ISPOR Inaugural European Conference in Cologne, Germany, December 1998. Recommendations of the Harmonization by Consensus of the Methodology for Economic Evaluation of Health Care Technologies in the European Union (HARMET) project were presented, as well as two instruments under development: software for Reporting Economic Evaluation Results (REER) and software for collecting and managing cost data called the Health Cost Database Software (HCDS). Working independently, but interrelated with the objectives of the HARMET initiative, preliminary results from the ongoing European Network on Methodology and Application of Economic Evaluation Techniques (EUROMET) project were presented. Each presentation was followed by an expert discussion panel with audience participation. Issues raised included the development of standards and related topics such as usefulness to European decision-makers, and education and training in health economics in Europe.

  14. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II

    DEFF Research Database (Denmark)

    Krege, Susanne; Beyer, Jörg; Souchon, Rainer

    2007-01-01

    OBJECTIVES: The first consensus report that had been presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology...... trials. Despite technical improvements, expert clinical skills will continue to be one of the major determinants for the prognosis of patients with germ cell cancer. In addition, the particular needs of testicular cancer survivors have been acknowledged Udgivelsesdato: 2008/3...

  15. Improvement Research Priorities: USA Survey and Expert Consensus

    Directory of Open Access Journals (Sweden)

    Kathleen R. Stevens

    2013-01-01

    Full Text Available The purpose of this study was to identify stakeholder views about national priorities for improvement science and build agreement for action in a national improvement and implementation research network in the USA. This was accomplished using three stages of identification and consensus. (1 Topics were identified through a multipronged environmental scan of the literature and initiatives. (2 Based on this scan, a survey was developed, and stakeholders (n=2,777 were invited to rate the resulting 33-topic, 9-category list, via an online survey. Data from 560 respondents (20% response were analyzed. (3 An expert panel used survey results to further refine the research priorities through a Rand Delphi process. Priorities identified were within four categories: care coordination and transitions, high-performing clinical systems and microsystems improvement approaches, implementation of evidence-based improvements and best practices, and culture of quality and safety. The priorities identified were adopted by the improvement science research network as the research agenda to guide strategy. The process and conclusions may be of value to quality improvement research funding agencies, governments, and research units seeking to concentrate their resources on improvement topics where research is capable of yielding timely and actionable answers as well as contributing to the knowledge base for improvement.

  16. European consensus conference on faecal microbiota transplantation in clinical practice.

    Science.gov (United States)

    Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

    2017-04-01

    Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Judicial Deference Allows European Consensus to Emerge

    DEFF Research Database (Denmark)

    Dothan, Shai

    2018-01-01

    conceived as competing doctrines: the more there is of one, the less there is of another. This paper suggests a novel rationale for the emerging consensus doctrine: the doctrine can allow the ECHR to make good policies by drawing on the independent decision-making of many similar countries. In light of that......, the paper demonstrates that a correct application of the margin of appreciation doctrine actually helps emerging consensus reach optimal results, by giving countries an incentive to make their policies independently....

  18. Localized neuropathic pain: an expert consensus on local treatments

    Directory of Open Access Journals (Sweden)

    Pickering G

    2017-09-01

    Full Text Available Gisèle Pickering,1–3 Elodie Martin,1,3 Florence Tiberghien,4 Claire Delorme,5 Gérard Mick6,7 1Centre de Pharmacologie Clinique, CHU Clermont-Ferrand, 2Inserm, CIC 1405, Neurodol 1107, 3Laboratoire de Pharmacologie, Faculté de Médecine, Clermont Université, Clermont-Ferrand, 4Centre d’Evaluation et de Traitement de la Douleur, CHU Jean Minjoz, Besançon, 5Centre d’Evaluation et Traitement de la Douleur, Bayeux, 6Unité d’Evaluation et Traitement de la Douleur, Voiron, 7Laboratoire AGEIS, Université Grenoble Alpes, Grenoble, France Background: Pain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP, its assessment and the existing topical pharmacological treatments. Materials and methods: Literature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice. Results: Successive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously. Conclusion: Although there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major

  19. Screening for pre-school and school-age hearing problems: European Consensus Statement.

    Science.gov (United States)

    Skarżyński, Henryk; Piotrowska, Anna

    2012-01-01

    To formulate consensus statement and policies on structured hearing screening programs in pre-school and school-age children in Europe. This consensus will be brought before the European Union's Member States as a working and effective program with recommendations for adoption. A distinguished panel of experts discussed hearing screening of pre-school and school-age children during the 10th Congress of European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on June 22, 2011. The panel included experts in audiology, otolaryngology, communication disorders, speech language pathology, education and biomedical engineering. Consensus was reached on thirteen points. Key elements of the consensus, as described herein, are: (1) defining the role of pre-school and school screening programs in the identification and treatment of hearing problems; (2) identifying the target population; (3) recognizing the need for a quality control system in screening programs. The European Consensus Statement on Hearing Screening of Pre-school and School-age Children will encourage the appropriate authorities of the various countries involved to initiate hearing screening programs of pre-school and school-age children. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Vitamin D status correction in Saudi Arabia: an experts' consensus under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO).

    Science.gov (United States)

    Al-Daghri, Nasser M; Al-Saleh, Yousef; Aljohani, Naji; Sulimani, Riad; Al-Othman, Abdulaziz M; Alfawaz, Hanan; Fouda, Mona; Al-Amri, Fahad; Shahrani, Awad; Alharbi, Mohammed; Alshahrani, Fahad; Tamimi, Waleed; Sabico, Shaun; Rizzoli, Rene; Reginster, Jean-Yves

    2017-12-01

    Vitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region. The selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20--21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations. Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were

  1. A European consensus on learning objectives for a core communication curriculum in health care professions.

    Science.gov (United States)

    Bachmann, Cadja; Abramovitch, Henry; Barbu, Carmen Gabriela; Cavaco, Afonso Miguel; Elorza, Rosario Dago; Haak, Rainer; Loureiro, Elizabete; Ratajska, Anna; Silverman, Jonathan; Winterburn, Sandra; Rosenbaum, Marcy

    2013-10-01

    To develop learning objectives for a core communication curriculum for all health care professions and to survey the acceptability and suitability of the curriculum for undergraduate European health care education. Learning objectives for a Health Professions Core Communication Curriculum (HPCCC) in undergraduate education were developed based on international literature and expert knowledge by an international group of communication experts representing different health care professions. A Delphi process technique was used to gather feedback and to provide a consensus from various health care disciplines within Europe. 121 communication experts from 15 professional fields and 16 European countries participated in the consensus process. The overall acceptance of the core communication curriculum was high. 61 core communication objectives were rated on a five-point scale and found to be relevant for undergraduate education in health care professions. A thematic analysis revealed the benefits of the HPCCC. Based on a broad European expert consensus, the Health Professions Core Communication Curriculum can be used as a guide for teaching communication inter- and multi-professionally in undergraduate education in health care. It can serve for curriculum development and support the goals of the Bologna process. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. THE EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS AND OSTEOARTHRITIS (ESCEO ALGORITHM FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS IS APPLICABLE TO RUSSIAN CLINICAL PRACTICE: A CONSENSUS STATEMENT OF LEADING RUSSIAN AND ESCEO OSTEOARTHRITIS EXPERTS

    Directory of Open Access Journals (Sweden)

    L. N. Denisov

    2016-01-01

    Full Text Available The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO treatment algorithm for the management of knee osteoarthritis (OA, published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS (Rottapharm/Meda and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow

  3. European consensus for starting and stopping enzyme replacement therapy in adult patients with Pompe disease

    DEFF Research Database (Denmark)

    van der Ploeg, Ans T.; Kruijshaar, Michelle E.; Toscano, A.

    2017-01-01

    synthesis is presented. RESULTS: Consensus was reached on how the diagnosis of Pompe disease should be confirmed, when treatment should be started, reasons for stopping treatment and the use of ERT during pregnancy. This was based on expert opinion and supported by the literature. One clinical trial and 43......BACKGROUND AND PURPOSE: Pompe disease is a rare inheritable muscle disorder for which enzyme replacement therapy (ERT) has been available since 2006. Uniform criteria for starting and stopping ERT in adult patients were developed and reported here. METHODS: Three consensus meetings were organized...... through the European Pompe Consortium, a network of experts from 11 European countries in the field of Pompe disease. A systematic review of the literature was undertaken to determine the effectiveness of ERT in adult patients on a range of clinical outcome measures and quality of life. A narrative...

  4. International, Expert-Based, Consensus Statement Regarding the Management of Acute Diverticulitis.

    Science.gov (United States)

    O'Leary, D Peter; Lynch, Noel; Clancy, Cillian; Winter, Desmond C; Myers, Eddie

    2015-09-01

    This Delphi study provides consensus related to many aspects of acute diverticulitis and identifies other areas in need of research. To generate an international, expert-based, consensus statement to address controversies in the management of acute diverticulitis. This study was conducted using the Delphi technique from April 3 through October 21, 2014. A survey website was used and a panel of acute diverticulitis experts was formed via the snowball method. The top 5 acute diverticulitis experts in 5 international geographic regions were identified based on their number of publications related to acute diverticulitis. The Delphi study used 3 rounds of questions, after which the consensus statement was collated. A consensus statement related to the management of acute diverticulitis. Twenty items were selected for inclusion in the consensus statement following 3 rounds of questioning. A clear definition of uncomplicated and complicated diverticulitis is provided. In uncomplicated diverticulitis, consensus was reached regarding appropriate laboratory and radiological evaluation of patients as well as nonsurgical, surgical, and follow-up strategies. A number of important topics, including antibiotic treatment, failed to reach consensus. In addition, consensus was reached regarding many nonsurgical and surgical treatment strategies in complicated diverticulitis. Controversy continues internationally regarding the management of acute diverticulitis. This study demonstrates that there is more nonconsensus among experts than consensus regarding most issues, even in the same region. It also provides insight into the status quo regarding the treatment of acute diverticulitis and provides important direction for future research.

  5. Definition of a COPD self-management intervention: International Expert Group consensus

    National Research Council Canada - National Science Library

    Effing, T.W; Vercoulen, J.H; Bourbeau, J; Trappenburg, J; Lenferink, A; Cafarella, P; Coultas, D; Meek, P; Valk, P. van de; Bischoff, E.W; Bucknall, C; Dewan, N.A; Early, F; Fan, V; Frith, P; Janssen, D.J; Mitchell, K; Morgan, M; Nici, L; Patel, I; Walters, H; Rice, K.L; Singh, S; ZuWallack, R; Benzo, R; Goldstein, R; Partridge, M.R; van der Palen, J

    2016-01-01

    ...) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique...

  6. The European Hematology Association Roadmap for European Hematology Research: a consensus document.

    Science.gov (United States)

    Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

    2016-02-01

    The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap.The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders.The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients. Copyright© Ferrata Storti Foundation.

  7. Expert Consensus on Cosmetic Outcomes After Treatment of Actinic Keratosis.

    Science.gov (United States)

    Berman, Brian; Ablon, Glynis R; Bhatia, Neal D; Ceilley, Roger I; Goldberg, David J; Nestor, Mark S; Weinkle, Susan H

    2017-03-01

    Dermatologists treat actinic keratosis (AK) primarily because these lesions have the potential to progress to invasive squamous cell carcinoma. Patients, on the other hand, generally seek treatment to remove the lesions and achieve an improved appearance of their skin following treatment. In selecting a treatment option for AK, dermatologists should consider post-treatment cosmesis, because cosmetic outcomes differ across AK treatments. To obtain expert opinion on the cosmetic sequelae related to chronically photodamaged skin and the treatment of AK, an expert panel meeting among dermatologists was conducted in February 2016. These experts reviewed current treatment options for photodamage, including AK, and discussed the relative merits of the various cosmetic assessments commonly used by investigators and patients in both clinical trial and dermatology practice settings. A main goal of the expert panel meeting was to propose assessment tools that could be specifically designed to characterize cosmesis results after treatment of AK. The panel agreed that existing tools for measurement of cosmetic outcomes following treatment of photodamage could also be used to evaluate cosmesis after treatment of AK. Digital photography is probably the best method used for this, with validation by other technologies. Better measurement tools specifically for assessing cosmesis after AK treatment are needed. Once they are developed and validated, regulatory agencies should be educated about the importance of including cosmetic outcomes as a component of product labeling. J Drugs Dermatol. 2017;16(3):260-265..

  8. Teaching statistics to nursing students: an expert panel consensus.

    Science.gov (United States)

    Hayat, Matthew J; Eckardt, Patricia; Higgins, Melinda; Kim, MyoungJin; Schmiege, Sarah J

    2013-06-01

    Statistics education is a necessary element of nursing education, and its inclusion is recommended in the American Association of Colleges of Nursing guidelines for nurse training at all levels. This article presents a cohesive summary of an expert panel discussion, "Teaching Statistics to Nursing Students," held at the 2012 Joint Statistical Meetings. All panelists were statistics experts, had extensive teaching and consulting experience, and held faculty appointments in a U.S.-based nursing college or school. The panel discussed degree-specific curriculum requirements, course content, how to ensure nursing students understand the relevance of statistics, approaches to integrating statistics consulting knowledge, experience with classroom instruction, use of knowledge from the statistics education research field to make improvements in statistics education for nursing students, and classroom pedagogy and instruction on the use of statistical software. Panelists also discussed the need for evidence to make data-informed decisions about statistics education and training for nurses. Copyright 2013, SLACK Incorporated.

  9. Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer.

    Science.gov (United States)

    Evangelista, Arturo; Czerny, Martin; Nienaber, Christoph; Schepens, Marc; Rousseau, Hervé; Cao, Piergiorgio; Moral, Sergio; Fattori, Rossella

    2015-02-01

    An expert panel on the treatment of type B intramural haematoma (IMH) and penetrating atherosclerotic ulcer (PAU) consisting of cardiologists, cardiothoracic surgeons, vascular surgeons and interventional radiologists reviewed the literature to develop treatment algorithms using a consensus method. Data from 46 studies considered relevant were retrieved for a total of 1386 patients consisting of 925 with IMH, and 461 with PAU. The weighted mean 30-day mortality from IMH was 3.9%, 3-year aortic event-related mortality with medical treatment 5.4%, open surgery 23.2% and endovascular therapy 7.1%. In patients with PAU early and 3-year aortic event-mortality rates with open surgery were 15.9 and 25.0%, respectively, and with TEVAR were 7.2 and 10.4%, respectively. According to panel consensus statements, haemodynamic instability, persistent pain, signs of impending rupture and progressive periaortic haemorrhage in two successive imaging studies require immediate surgical or endovascular treatment. In the absence of these complications, medical treatment is warranted, with imaging control at 7 days, 3 and 6 months and annually thereafter. In the chronic phase, aortic diameter >55 mm or a yearly increase ≥ 5 mm should be considered indications for open surgery or thoracic endovascular treatment, with the latter being preferred. In complicated type B aortic PAU and IMH, endovascular repair is the best treatment option in the presence of suitable anatomy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  10. API expert consensus document on management of ischemic heart disease.

    Science.gov (United States)

    2006-06-01

    bypass surgery. Early reperfusion is key to management of patients presenting with STEMI. If facilities are available, primary percutaneous coronary intervention (angioplasty with stenting) is treatment of choice for patients with STEMI. In our country, thrombolysis still remains the most frequently utilized reperfusion therapy and all efforts should be devoted to provide this therapy at the earliest. All high risk patients with STEMI (including cardiogenic shock) are best treated in higher centres and these patients should be promptly transported to such centres. Early coronary angiography is recommended for majority of patients following thrombolysis for risk stratification and further treatment. In acute coronary syndromes there is drift towards early invasive treatment and this is reflected in marked increase in cardiac care (catheterization laboratories and cardiac surgery centers) facilities throughout India. All patients with CAD require life-long supervised treatment which includes medication, control of risk factors and lifestyle modification. Avoidance of smoking, heart healthy diet, proper exercise, ideal weight management are important for all the patients. Statins, ACE inhibitors, beta-blockers, antiplatelet agents have a great role to play in treatment and prevention and these drugs should be utilized under medical supervision. It is important that the medical profession play an important role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection and management of cardiac disorders. The American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), Society for Cardiovascular Angiography and Interventions (SCAI) and several other societies engage in production of guidelines in the area of cardiovascular diseases from time to time. These guidelines attempt to define practices that meet the needs of most patients in most circumstances. The aim of

  11. Expert consensus v. evidence-based approaches in the revision of the DSM.

    Science.gov (United States)

    Kendler, K S; Solomon, M

    2016-08-01

    The development of DSM-III through DSM-5 has relied heavily on expert consensus. In this essay, we provide an historical and critical perspective on this process. Over the last 40 years, medicine has struggled to find appropriate methods for summarizing research results and making clinical recommendations. When such recommendations are issued by authorized organizations, they can have widespread influence (i.e. DSM-III and its successors). In the 1970s, expert consensus conferences, led by the NIH, reviewed research about controversial medical issues and successfully disseminated results. However, these consensus conferences struggled with aggregating the complex available evidence. In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field. Like the recommendations made for the NIH consensus conferences, we argue that the DSM process should be modified to require systematic evidence-based reviews before Work Groups make their assessments. Our suggestions - which would require leadership and additional resources to set standards for appropriate evidence hierarchies, carry out systematic reviews, and upgrade the group process - should improve the objectivity of the DSM, increase the validity of its results, and improve the reception of any changes in nosology.

  12. International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process.

    Science.gov (United States)

    Howell, Ann-Marie; Burns, Elaine M; Hull, Louise; Mayer, Erik; Sevdalis, Nick; Darzi, Ara

    2017-02-01

    Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care. To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role. After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised. Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally. We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study

    DEFF Research Database (Denmark)

    Devillé, Walter; Greacen, Tim; Bogic, Marija

    2011-01-01

    different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results: The scoring procedures resulted in 10...... influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health...... care services for immigrants. Conclusions: Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some...

  14. Consensus on a multidisciplinary treatment guideline for de Quervain disease: results from the European HANDGUIDE study.

    Science.gov (United States)

    Huisstede, Bionka M A; Coert, J Henk; Fridén, Jan; Hoogvliet, Peter

    2014-08-01

    De Quervain disease is a common pathology resulting in pain caused by resisted gliding of the abductor pollicis longus and extensor pollicis brevis tendons in the fibro-osseous canal. In a situation of wavering assumptions and expanding medical knowledge, a treatment guideline is useful because it can aid in implementation of best practices, the education of health care professionals, and the identification of gaps in existing knowledge. The aim of this study was to achieve consensus on a multidisciplinary treatment guideline for de Quervain disease. A Delphi consensus strategy was used. A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of surgical and nonsurgical interventions was conducted and published and was used as an evidence-based starting point for this study. In total, 35 experts (hand therapists and hand surgeons selected by the national member associations of their European federations and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report. Consensus was achieved on the description, symptoms, and diagnosis of de Quervain disease. The experts agreed that patients with this disorder should always receive instructions and that these instructions should be combined with another form of treatment and should not be used as a sole treatment. Instructions combined with nonsteroidal anti-inflammatory drugs (NSAIDs), splinting, NSAIDs plus splinting, corticosteroid injection, corticosteroid injections plus splinting, or surgery were considered suitable treatment options. Details on the use of instructions, NSAIDs, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of these treatment options (ie, severity and duration of the disorder, previous treatments given) were identified. A relationship between the severity and duration of the disorder

  15. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting

    Energy Technology Data Exchange (ETDEWEB)

    Beets-Tan, Regina G.H. [Maastricht University Medical Centre+, Maastricht (Netherlands); Maastricht University Medical Centre+, Department of Radiology, P.O. Box 5800, AZ, Maastricht (Netherlands); Lambregts, Doenja M.J.; Maas, Monique [Maastricht University Medical Centre+, Maastricht (Netherlands); Bipat, Shandra; Stoker, Jaap [Academic Medical Centre, Amsterdam (Netherlands); Barbaro, Brunella [Catholic University School of Medicine, Rome (Italy); Caseiro-Alves, Filipe; Curvo-Semedo, Luis [Coimbra University Hospitals, Coimbra (Portugal); Fenlon, Helen M. [Mater Misericordiae University Hospital, Dublin (Ireland); Gollub, Marc J. [Memorial Sloan-Kettering Cancer Center, New York (United States); Gourtsoyianni, Sofia [University Hospital of Heraklion, Crete (Greece); Guy' s and St. Thomas' NHS FT, London (United Kingdom); Halligan, Steve; Taylor, Stuart A. [University College London, Centre for Medical Imaging, London (United Kingdom); Hoeffel, Christine [Reims University Hospital, Reims (France); Kim, Seung Ho [Inje University Haeundae Paik Hospital, Busan (Korea, Republic of); Laghi, Andrea [Sapienza - University of Rome, Rome (Italy); Maier, Andrea [Medical University of Vienna, Vienna (Austria); Rafaelsen, Soeren R. [Vejle Hospital, Vejle (Denmark); Torkzad, Michael R. [Uppsala University, Uppsala (Sweden); Blomqvist, Lennart [Karolinska University Hospital and Karolinska Institutet, Stockholm (Sweden)

    2013-09-15

    To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by {>=} 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted. Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. (orig.)

  16. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation.

    Science.gov (United States)

    Bonet, Mercedes; Nogueira Pileggi, Vicky; Rijken, Marcus J; Coomarasamy, Arri; Lissauer, David; Souza, João Paulo; Gülmezoglu, Ahmet Metin

    2017-05-30

    There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis. All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego. Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition "Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period". Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population. The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of

  17. European consensus for starting and stopping enzyme replacement therapy in adult patients with Pompe disease: a 10-year experience.

    Science.gov (United States)

    van der Ploeg, A T; Kruijshaar, M E; Toscano, A; Laforêt, P; Angelini, C; Lachmann, R H; Pascual Pascual, S I; Roberts, M; Rösler, K; Stulnig, T; van Doorn, P A; Van den Bergh, P Y K; Vissing, J; Schoser, B

    2017-06-01

    Pompe disease is a rare inheritable muscle disorder for which enzyme replacement therapy (ERT) has been available since 2006. Uniform criteria for starting and stopping ERT in adult patients were developed and reported here. Three consensus meetings were organized through the European Pompe Consortium, a network of experts from 11 European countries in the field of Pompe disease. A systematic review of the literature was undertaken to determine the effectiveness of ERT in adult patients on a range of clinical outcome measures and quality of life. A narrative synthesis is presented. Consensus was reached on how the diagnosis of Pompe disease should be confirmed, when treatment should be started, reasons for stopping treatment and the use of ERT during pregnancy. This was based on expert opinion and supported by the literature. One clinical trial and 43 observational studies, covering a total of 586 individual adult patients, provided evidence of a beneficial effect of ERT at group level. At individual patient level, the response to treatment varied, but factors associated with a patient's response to ERT were not described in many studies. Eleven observational studies focused on more severely affected patients, suggesting that ERT can also be beneficial in these patients. There are no studies on the effects of ERT in pre-symptomatic patients. This is the first European consensus recommendation for starting and stopping ERT in adult patients with Pompe disease, based on the extensive experience of experts from different countries. © 2017 EAN.

  18. Expert consensus building using e-Delphi for necrotizing enterocolitis risk assessment.

    Science.gov (United States)

    Gephart, Sheila M; Effken, Judith A; McGrath, Jacqueline M; Reed, Pamela G

    2013-01-01

    To confirm content validity of GutCheck(NEC) , a risk index for necrotizing enterocolitis (NEC) and to determine the level of agreement among experts about NEC risk factors in premature infants. Electronic Delphi method (e-Delphi). Online electronic surveys and e-mail communication supported by an interactive study website. Nurses and physicians (N = 35) from four countries and across the United States who rated themselves as at least moderately expert about NEC risk. e-Delphi involved three rounds of surveys and qualitative thematic analysis of experts' comments. Surveys continued until criteria for consensus and/or stability were met. Of 64 initial items, 43 were retained representing 33 risk factors (final GutCheck(NEC) Content Validity Index [CVI] = .77). Two broad themes about NEC risk emerged from 242 comments: the impact of individual physiologic vulnerability and variation in neonatal intensive care unit (NICU) clinicians' practices. Controversy arose over the impact of treatments on NEC, including probiotics, packed red blood cell (PRBC) transfusions, and patent ductus arteriosus (PDA) management using indomethacin. GutCheck(NEC) achieved borderline content validity for a new scale. The e-Delphi process yielded a broad perspective on areas in which experts share and lack consensus on NEC risk. Future testing is underway to reduce the number of risk items to the most parsimonious set for a clinically useful risk tool and test reliability. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  19. Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Abraham J., E-mail: wua@mskcc.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Bosch, Walter R. [Washington University, St. Louis, Missouri (United States); Chang, Daniel T. [Stanford Cancer Institute, Stanford, California (United States); Hong, Theodore S. [Massachusetts General Hospital, Boston, Massachusetts (United States); Jabbour, Salma K. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Kleinberg, Lawrence R. [Johns Hopkins Medical Center, Baltimore, Maryland (United States); Mamon, Harvey J. [Brigham and Women' s Hospital, Boston, Massachusetts (United States); Thomas, Charles R. [Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon (United States); Goodman, Karyn A. [Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2015-07-15

    Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future.

  20. Development of geriatric competencies for emergency medicine residents using an expert consensus process.

    Science.gov (United States)

    Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

    2010-03-01

    The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

  1. Management of locally advanced prostate cancer: a European consensus.

    Science.gov (United States)

    Boccon-Gibod, L; Bertaccini, A; Bono, A V; Dev Sarmah, B; Höltl, W; Mottet, N; Tunn, U; Zamboglou, N

    2003-04-01

    This report summarises the findings of a European Consensus Group review of current standards of care in locally advanced prostate cancer defined as (a) untreated cancer extending clinically beyond the prostatic capsule in patients with no evidence of lymph node invasion or distant metastases, and (b) residual disease remaining after local treatment with positive surgical margins, seminal vesicle invasion, persistent prostate-specific antigen (PSA) and/or secondary PSA relapse. There was no overall consensus as to the standard of care in clinically apparent locally advanced prostate cancer. It was agreed, however, that hormonal therapy (e.g. with a gonadotrophin releasing hormone analogue [GnRHa]) represents a valid treatment in these patients. Treatment practices and regimens vary considerably between European countries, but GnRHa is widely used, either alone or in combination with antiandrogens. Hormonal therapy alone is a valid option, though the optimal modality, timing and duration of treatment remain to be defined. Adjuvant therapy with a GnRHa has been shown to improve survival in patients undergoing external beam radiotherapy. It is a viable option after prostatectomy in patients with persistent or secondary relapsing PSA. It was determined that optimal treatment will be different according to PSA, clinical staging and Gleason score, and the treatment of locally advanced disease should be individually tailored after discussion between physician and patient. In many instances, patients prefer and expect some form of treatment in preference to watchful waiting. Treatment nomograms such as the Kattan nomograms provide precise, comprehensive and invaluable tools for everyday use and may be used to predict outcomes and guide treatment decisions.

  2. European Network of Bipolar Research Expert Centre (ENBREC)

    DEFF Research Database (Denmark)

    Henry, Chantal; Andreassen, Ole A; Barbato, Angelo

    2013-01-01

    clinical decision-making as well as being applicable to research. Reliable, established measures have been prioritised, and instruments have been translated and validated when necessary. An electronic healthcare record and monitoring system (e-ENBREC©) has been developed to collate the data. Protocols...... of a critical mass of expertise and multicentre collaborative projects. Within the framework of the European FP7 programme, we developed a European Network of Bipolar Research Expert Centres (ENBREC) designed specifically to facilitate EU-wide studies. ENBREC provides an integrated support structure...... facilitating research on disease mechanisms and clinical outcomes across six European countries (France, Germany, Italy, Norway, Spain and the UK). The centres are adopting a standardised clinical assessment that explores multiple aspects of bipolar disorder through a structured evaluation designed to inform...

  3. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I.

    NARCIS (Netherlands)

    Krege, S.; Beyer, J.; Souchon, R.; Albers, P.; Albrecht, W.; Algaba, F.; Bamberg, M.; Bodrogi, I.; Bokemeyer, C.; Cavallin-Stahl, E.; Classen, J.; Clemm, C.; Cohn-Cedermark, G.; Culine, S.; Daugaard, G.; Mulder, P.H.M. de; Santis, M. de; Wit, M. de; Wit, R. de; Derigs, H.G.; Dieckmann, K.P.; Dieing, A.; Droz, J.P.; Fenner, M.; Fizazi, K.; Flechon, A.; Fossa, S.D.; Muro, X.G. del; Gauler, T.; Geczi, L.; Gerl, A.; Germa-Lluch, J.R.; Gillessen, S.; Hartmann, J.T.; Hartmann, M.; Heidenreich, A.; Hoeltl, W.; Horwich, A.; Huddart, R.; Jewett, M.; Joffe, J.; Jones, W.G.; Kisbenedek, L.; Klepp, O.; Kliesch, S.; Koehrmann, K.U.; Kollmannsberger, C.; Kuczyk, M.; Laguna, P.; Galvis, O.L.; Loy, V.; Mason, M.D.; Mead, G.M.; Mueller, R.; Nichols, C.; Nicolai, N.; Oliver, T.; Ondrus, D.; Oosterhof, G.O.; Ares, L.P.; Pizzocaro, G.; Pont, J.; Pottek, T.; Powles, T.; Rick, O.; Rosti, G.; Salvioni, R.; Scheiderbauer, J.; Schmelz, H.U.; Schmidberger, H.; Schmoll, H.J.; Schrader, M.; Sedlmayer, F.; Skakkebaek, N.E.; Sohaib, A.; Tjulandin, S.; Warde, P.; Weinknecht, S.; Weissbach, L.; Wittekind, C.; Winter, E.; Wood, L.; Maase, H. von der

    2008-01-01

    OBJECTIVES: The first consensus report presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in the year 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the

  4. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II.

    NARCIS (Netherlands)

    Krege, S.; Beyer, J.; Souchon, R.; Albers, P.; Albrecht, W.; Algaba, F.; Bamberg, M.; Bodrogi, I.; Bokemeyer, C.; Cavallin-Stahl, E.; Classen, J.; Clemm, C.; Cohn-Cedermark, G.; Culine, S.; Daugaard, G.; Mulder, P.H.M. de; Santis, M. De; Wit, M. de; Wit, R. de; Derigs, H.G.; Dieckmann, K.P.; Dieing, A.; Droz, J.P.; Fenner, M.; Fizazi, K.; Flechon, A.; Fossa, S.D.; Muro, X.G. del; Gauler, T.; Geczi, L.; Gerl, A.; Germa-Lluch, J.R.; Gillessen, S.; Hartmann, J.T.; Hartmann, M.; Heidenreich, A.; Hoeltl, W.; Horwich, A.; Huddart, R.; Jewett, M.; Joffe, J.; Jones, W.G.; Kisbenedek, L.; Klepp, O.; Kliesch, S.; Koehrmann, K.U.; Kollmannsberger, C.; Kuczyk, M.; Laguna, P.; Galvis, O.L.; Loy, V.; Mason, M.D.; Mead, G.M.; Mueller, R.; Nichols, C.; Nicolai, N.; Oliver, T.; Ondrus, D.; Oosterhof, G.O.; Paz-Ares, L.; Pizzocaro, G.; Pont, J.; Pottek, T.; Powles, T.; Rick, O.; Rosti, G.; Salvioni, R.; Scheiderbauer, J.; Schmelz, H.U.; Schmidberger, H.; Schmoll, H.J.; Schrader, M.; Sedlmayer, F.; Skakkebaek, N.E.; Sohaib, A.; Tjulandin, S.; Warde, P.; Weinknecht, S.; Weissbach, L.; Wittekind, C.; Winter, E.; Wood, L.; Maase, H. von der

    2008-01-01

    OBJECTIVES: The first consensus report that had been presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the

  5. The development of a consensus definition for healthcare improvement science (HIS) in seven European countries: A consensus methods approach.

    Science.gov (United States)

    Skela-Savič, Brigita; Macrae, Rhoda; Lillo-Crespo, Manuel; Rooney, Kevin D

    2017-06-01

    There is a limited body of research in the field of healthcare improvement science (HIS). Quality improvement and 'change making' should become an intrinsic part of everyone's job, every day in all parts of the healthcare system. The lack of theoretical grounding may partly explain the minimal transfer of health research into health policy. This article seeks to present the development of the definition for healthcare improvement science. A consensus method approach was adopted with a two-stage Delphi process, expert panel and consensus group techniques. A total of 18 participants were involved in the expert panel and consensus group, and 153 answers were analysed as a part of the Delphi survey. Participants were researchers, educators and healthcare professionals from Scotland, Slovenia, Spain, Italy, England, Poland, and Romania. A high level of consensus was achieved for the broad definition in the 2nd Delphi iteration (86%). The final definition was agreed on by the consensus group: 'Healthcare improvement science is the generation of knowledge to cultivate change and deliver person-centred care that is safe, effective, efficient, equitable and timely. It improves patient outcomes, health system performance and population health.' The process of developing a consensus definition revealed different understandings of healthcare improvement science between the participants. Having a shared consensus definition of healthcare improvement science is an important step forward, bringing about a common understanding in order to advance the professional education and practice of healthcare improvement science.

  6. Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group

    National Research Council Canada - National Science Library

    Glüer, C C

    1997-01-01

    .... The performance of QUS techniques has been evaluated in a large number of studies. Reviewing existing knowledge, an international expert panel formulated the following consensus regarding the current status of this technology...

  7. Retention or deletion of personality disorder diagnoses for DSM-5: an expert consensus approach.

    Science.gov (United States)

    Mullins-Sweatt, Stephanie N; Bernstein, David P; Widiger, Thomas A

    2012-10-01

    One of the official proposals for the fifth edition of the American Psychiatric Association's (APA) diagnostic manual (DSM-5) is to delete half of the existing personality disorders (i.e., dependent, histrionic, narcissistic, paranoid, and schizoid). Within the APA guidelines for DSM-5 decisions, it is stated that there should be expert consensus agreement for the deletion of a diagnostic category. Additionally, categories to be deleted should have low clinical utility and/or minimal evidence for validity. The current study surveyed members of two personality disorder associations (n = 146) with respect to the utility, validity, and status of each DSM-IV-TR personality disorder diagnosis. Findings indicated that the proposal to delete five of the personality disorders lacks consensus support within the personality disorder community.

  8. Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder.

    Science.gov (United States)

    Esteban, M; Salinas, J; Arlandis, S; Díez, J; Jiménez, M; Rebassa, M; Angulo, J C

    2014-05-01

    Overactive bladder (OAB) is a pathology impairing patients' quality of life and with a high percentage of patients who are refractory to medication. In this paper, technical opinion of an «expert panel» is assessed in order to gain the most reliable professional consensus on scientific evidence available on the criteria of use of Onabotulinumtoxin A (OnabotA) in OAB. according to DELPHI method, 42 panelists answered a survey of 93 items divided into four strategic areas including clinical criteria and recommendations in order to improve, at different levels, the current approach to patients with OAB. The recent advances in the field, areas of controversy and their real application possibilities in the different areas of our health care system were taken into consideration. Two rounds of the questionnaire were completed by all experts. In the first round, a criteria consensus was reached for 64 of 93 (68.8%) questions analyzed; in the second round the consensus reached was for 83 items evaluated (89.25%). An agreement among panelist was reached for: 1) definition, classification, detection and differential diagnosis; 2) medical treatment; 3) surgical treatment; 4) role of OnabotA in the treatment of OAB. the consensus is broadly in line with the latest scientific evidence on OAB. The panelists believe that it is necessary to propose a change in the current definition of OAB and that it seems necessary to improve the screening tools too. Medical treatment of OAB must be tailored to each patient, staged and progressive. The use of OnabotA (Botox(®)) could imply therapeutic advantages with respect to other treatments, and positions itself as a safe and effective alternative to treat drug refractory OAB. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  9. European consensus on a competency-based virtual reality training program for basic endoscopic surgical psychomotor skills.

    Science.gov (United States)

    van Dongen, Koen W; Ahlberg, Gunnar; Bonavina, Luigi; Carter, Fiona J; Grantcharov, Teodor P; Hyltander, Anders; Schijven, Marlies P; Stefani, Alessandro; van der Zee, David C; Broeders, Ivo A M J

    2011-01-01

    Virtual reality (VR) simulators have been demonstrated to improve basic psychomotor skills in endoscopic surgery. The exercise configuration settings used for validation in studies published so far are default settings or are based on the personal choice of the tutors. The purpose of this study was to establish consensus on exercise configurations and on a validated training program for a virtual reality simulator, based on the experience of international experts to set criterion levels to construct a proficiency-based training program. A consensus meeting was held with eight European teams, all extensively experienced in using the VR simulator. Construct validity of the training program was tested by 20 experts and 60 novices. The data were analyzed by using the t test for equality of means. Consensus was achieved on training designs, exercise configuration, and examination. Almost all exercises (7/8) showed construct validity. In total, 50 of 94 parameters (53%) showed significant difference. A European, multicenter, validated, training program was constructed according to the general consensus of a large international team with extended experience in virtual reality simulation. Therefore, a proficiency-based training program can be offered to training centers that use this simulator for training in basic psychomotor skills in endoscopic surgery.

  10. Key Features of Academic Detailing: Development of an Expert Consensus Using the Delphi Method.

    Science.gov (United States)

    Yeh, James S; Van Hoof, Thomas J; Fischer, Michael A

    2016-02-01

    Academic detailing is an outreach education technique that combines the direct social marketing traditionally used by pharmaceutical representatives with unbiased content summarizing the best evidence for a given clinical issue. Academic detailing is conducted with clinicians to encourage evidence-based practice in order to improve the quality of care and patient outcomes. The adoption of academic detailing has increased substantially since the original studies in the 1980s. However, the lack of standard agreement on its implementation makes the evaluation of academic detailing outcomes challenging. To identify consensus on the key elements of academic detailing among a group of experts with varying experiences in academic detailing. This study is based on an online survey of 20 experts with experience in academic detailing. We used the Delphi process, an iterative and systematic method of developing consensus within a group. We conducted 3 rounds of online surveys, which addressed 72 individual items derived from a previous literature review of 5 features of academic detailing, including (1) content, (2) communication process, (3) clinicians targeted, (4) change agents delivering intervention, and (5) context for intervention. Nonrespondents were removed from later rounds of the surveys. For most questions, a 4-point ordinal scale was used for responses. We defined consensus agreement as 70% of respondents for a single rating category or 80% for dichotomized ratings. The overall survey response rate was 95% (54 of 57 surveys) and nearly 92% consensus agreement on the survey items (66 of 72 items) by the end of the Delphi exercise. The experts' responses suggested that (1) focused clinician education offering support for clinical decision-making is a key component of academic detailing, (2) detailing messages need to be tailored and provide feasible strategies and solutions to challenging cases, and (3) academic detailers need to develop specific skill sets

  11. Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

    Science.gov (United States)

    Sarkar, Rashmi; Aurangabadkar, Sanjeev; Salim, T; Das, Anupam; Shah, Swapnil; Majid, Imran; Singh, Mohan; Ravichandran, G; Godse, Kiran; Arsiwala, Shehnaz; Arya, Latika; Gokhale, Narendra; Sarma, Nilendu; Torsekar, R G; Sonthalia, Sidharth; Somani, V K

    2017-01-01

    Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly. PMID:29263531

  12. What is agenda setting in the clinical encounter? Consensus from literature review and expert consultation.

    Science.gov (United States)

    Gobat, Nina; Kinnersley, Paul; Gregory, John W; Robling, Michael

    2015-07-01

    To establish consensus on the core domains of agenda setting in consultations. We reviewed the healthcare literature and, using a modified Delphi technique to embrace both patient and clinician perspectives, conducted an iterative online survey, with 30 experts in health communication. Participants described agenda setting and rated the importance of proposed domains. Consensus was determined where the group median was ≥5 on a 7-point Likert-like response scale, and the interquartile range fell to within one point on this scale. Relevant publications were identified in three overlapping bodies of healthcare literature. Survey respondents considered that agenda setting involved a process whereby patients and clinicians establish a joint focus for both their conversation and their working relationship. Consensus was obtained on six core domains: identifying patient talk topics, identifying clinician talk topics, agreement of shared priorities, establishing conversational focus, collaboration and engagement. New terminology--agenda mapping and agenda navigation--is proposed. We identified core agenda setting domains that embraced patient and clinician perspectives. An integrated conceptualization of agenda setting may now be used by researchers and educators in both clinician and patient focused interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving.

    Science.gov (United States)

    Czeisler, Charles A; Wickwire, Emerson M; Barger, Laura K; Dement, William C; Gamble, Karen; Hartenbaum, Natalie; Ohayon, Maurice M; Pelayo, Rafael; Phillips, Barbara; Strohl, Kingman; Tefft, Brian; Rajaratnam, Shantha M W; Malhotra, Raman; Whiton, Kaitlyn; Hirshkowitz, Max

    2016-06-01

    This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment. The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus. A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours. There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed. Copyright © 2016. Published by Elsevier Inc.

  14. The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators.

    Science.gov (United States)

    2017-11-01

    This proceedings report presents the outcomes from an international workshop supported by the European Society of Human Reproduction and Embryology (ESHRE) and Alpha Scientists in Reproductive Medicine, designed to establish consensus on definitions and recommended values for Indicators for the assisted reproductive technology (ART) laboratory. Minimum performance-level values ('competency') and aspirational ('benchmark') values were recommended for a total of 19 Indicators, including 12 Key Performance Indicators (KPIs), five Performance Indicators (PIs), and two Reference Indicators (RIs). Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  15. Expert consensus for performing right heart catheterisation for suspected pulmonary arterial hypertension in systemic sclerosis: a Delphi consensus study with cluster analysis.

    Science.gov (United States)

    Avouac, Jérôme; Huscher, Dörte; Furst, Daniel E; Opitz, Christian F; Distler, Oliver; Allanore, Yannick

    2014-01-01

    To establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension (PH) is suspected. A three stage internet based Delphi consensus exercise involving worldwide PH experts was designed. In the first stage, a comprehensive list of domains and items combining evidence based indications and expert opinions were obtained. In the second and third stages, experts were asked to rate each item selected in the list. After each of stages 2 and 3, the number of items and criteria were reduced according to a cluster analysis. A literature search and the opinions of 47 experts participating in Delphi stage 1 provided a list of seven domains containing 142 criteria. After stages 2 and 3, these domains and tools were reduced to three domains containing eight tools: clinical (progressive dyspnoea over the past 3 months, unexplained dyspnoea, worsening of WHO dyspnoea functional class, any finding on physical examination suggestive of elevated right heart pressures and any sign of right heart failure), echocardiography (systolic pulmonary artery pressure >45 mm Hg and right ventricle dilation) and pulmonary function tests (diffusion lung capacity for carbon monoxide Delphi consensus methods. Although these indications are recommended by this expert group to be used as an interim tool, it will be necessary to formally validate the present tools in further studies.

  16. Definition of treatment goals for moderate to severe psoriasis: A European consensus

    NARCIS (Netherlands)

    U. Mrowietz (Ulrich); K. Kragballe (Knud); K. Reich (Reich, K.); P. Spuls; C.E.M. Griffiths; A. Nast (Alexander); J. Franke; A.C. Antoniou (Antonis); P. Arenberger (Petr); F. Balieva (Flora); M. Bylaite (Matilda); O. Correia; E. Daudén (Esteban); P. Gisondi (Paolo); L. Iversen; L. Kemény (Lajos); M. Lahfa (Mourad); T.E.C. Nijsten (Tamar); T. Rantanen; A. Reich; T. Rosenbach; S. Segaert (Siegfried); C. Smith; T. Talme (Toomas); B. Volc-Platzer (Beatrice); N. Yawalkar (Nikhil)

    2011-01-01

    textabstractPatients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi

  17. European consensus statement on diagnosis and treatment of adult ADHD: the European Network adult ADHD

    LENUS (Irish Health Repository)

    Kooij, Sandra JJ

    2010-09-03

    Abstract Background Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. Methods The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. Results Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? Conclusions ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

  18. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD

    Science.gov (United States)

    2010-01-01

    Background Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. Methods The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. Results Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? Conclusions ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group. PMID:20815868

  19. Nutritional support and parenteral nutrition in cancer patients: An expert consensus report.

    Science.gov (United States)

    Ocón Bretón, María Julia; Luengo Pérez, Luis Miguel; Virizuela, Juan Antonio; Álvarez Hernández, Julia; Jiménez Fonseca, Paula; Cervera Peris, Mercedes; Sendrós Madroño, María José; Grande, Enrique; Camblor Álvarez, Miguel

    2017-12-29

    Malnutrition is a common medical problem in cancer patients with a negative impact on quality of life. The aim of this study was to address different issues related to nutritional management of cancer patients in clinical practice. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Endocrinology and Nutrition prepared a list of topics related to the nutritional status of cancer patients and grouped them into three blocks: nutritional support, parenteral nutrition (PN), and home PN (HPN). A literature review was made of articles published in Spanish, English and French until April 2017. This consensus emphasizes several key elements that help physicians standardize management of the nutritional status of cancer patients in clinical practice, and establishes common guidelines for indication, monitoring, nutritional requirements, and access routes to PN. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Development of a Definition for the Alcohol Hangover: Consumer Descriptions and Expert Consensus.

    Science.gov (United States)

    van Schrojenstein Lantman, Marith; van de Loo, Aurora Jae; Mackus, Marlou; Verster, Joris C

    2017-01-01

    Up to now, there is no adequate definition of the alcohol hangover. The purpose of the current study was to develop a useful definition, and consensus among those who will use it in scientific publications. A survey was conducted among N=1099 social drinkers who recently had a hangover. They were asked to provide their definition of the alcohol hangover. Text mining and content analysis revealed 3 potential definitions. These were submitted to members of the Alcohol Hangover Research Group, who were asked to give their expert opinion on the proposed definitions. Taking into account their comments and suggestions, the following definition for the alcohol hangover was formulated: "The alcohol hangover refers to the combination of mental and physical symptoms, experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration approaches zero." Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  1. [Medical expert consensus in AH on the clinical use of triple fixed-dose antihypertensive therapy in Spain].

    Science.gov (United States)

    Mazón, P; Galve, E; Gómez, J; Gorostidi, M; Górriz, J L; Mediavilla, J D

    The opinion of experts (different specialties) on the triple fixed-dose antihypertensive therapy in clinical practice may differ. Online questionnaire with controversial aspects of the triple therapy answered by panel of experts in hypertension (HT) using two-round modified Delphi method. The questionnaire was completed by 158 experts: Internal Medicine (49), Nephrology (26), Cardiology (83). Consensus was reached (agreement) on 27/45 items (60%); 7 items showed differences statistically significant. Consensus was reached regarding: Predictive factors in the need for combination therapy and its efficacy vs. increasing the dose of a pretreatment, and advantage of triple therapy (prescription/adherence/cost/pressure control) vs. free combination. This consensus provides an overview of the clinical use of triple therapy in moderate-severe and resistant/difficult to control HT. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. European evidence based consensus on the diagnosis and management of Crohn's disease : special situations

    NARCIS (Netherlands)

    Caprilli, R; Gassull, MA; Escher, JC; Moser, G; Munkholm, P; Forbes, A; Hommes, DW; Lochs, H; Angelucci, E; Cocco, A; Vucelic, B; Hildebrand, H; Kolacek, S; Riis, L; Lukas, M; de Franchis, R; Hamilton, M; Jantschek, G; Michetti, P; O'Morain, C; Anwar, M.M.; Freitas, JL; Mouzas, IA; Baert, F; Mitchel, R; Hawkey, CJ

    This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on

  3. Fracture-related infection: A consensus on definition from an international expert group.

    Science.gov (United States)

    Metsemakers, W J; Morgenstern, M; McNally, M A; Moriarty, T F; McFadyen, I; Scarborough, M; Athanasou, N A; Ochsner, P E; Kuehl, R; Raschke, M; Borens, O; Xie, Z; Velkes, S; Hungerer, S; Kates, S L; Zalavras, C; Giannoudis, P V; Richards, R G; Verhofstad, M H J

    2017-08-24

    Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition. The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI. Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria. In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was

  4. Expert and stakeholder consensus on priorities for obesity prevention research in early care and education settings.

    Science.gov (United States)

    Ward, Dianne S; Vaughn, Amber; Story, Mary

    2013-04-01

    Early childhood is a formative period for many weight-related behaviors (diet and activity), but little obesity prevention research targeting this age group has been conducted. Early care and education settings are a useful avenue for interventions targeting young children, but the limited research provides insufficient evidence upon which to base policy decisions, practice guidelines, or mobilized efforts to improve healthy eating and physical activity, and ultimately healthy weight development in these settings. In September of 2011, prominent researchers, young investigators, and leaders in early care and education came together to examine past research and to explore challenges and priorities for future research on healthy weight development in children aged 2-5 years. During this meeting, experts presented and attendees discussed key issues around measurement of diet and physical activity, policy and environment measurement, intervention approaches, policy research, and capacity development. Following the meeting, attendees were invited to participate in an online voting exercise to select top research priorities. A total of 64 research issues were identified, and voting narrowed this list to 24 issues. Highest-rated issues included: Assessment of the quality of children's meals and snacks, use of financial incentives, interventions that include healthcare providers, the role of screen time, and need for multilevel interventions. The presentations within this meeting highlighted the importance of research to address the unique challenges for those working in early care and education settings. Expert and stakeholder consensus of priorities identified significant and innovative areas where future obesity prevention research efforts should be focused.

  5. Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel.

    Science.gov (United States)

    Gersak, Borut; Fischlein, Theodor; Folliguet, Thierry A; Meuris, Bart; Teoh, Kevin H T; Moten, Simon C; Solinas, Marco; Miceli, Antonio; Oberwalder, Peter J; Rambaldini, Manfredo; Bhatnagar, Gopal; Borger, Michael A; Bouchard, Denis; Bouchot, Olivier; Clark, Stephen C; Dapunt, Otto E; Ferrarini, Matteo; Laufer, Guenther; Mignosa, Carmelo; Millner, Russell; Noirhomme, Philippe; Pfeiffer, Steffen; Ruyra-Baliarda, Xavier; Shrestha, Malakh; Suri, Rakesh M; Troise, Giovanni; Diegeler, Anno; Laborde, Francois; Laskar, Marc; Najm, Hani K; Glauber, Mattia

    2016-03-01

    After a panel process, recommendations on the use of sutureless and rapid deployment valves in aortic valve replacement were given with special respect as an alternative to stented valves. Thirty-one international experts in both sutureless, rapid deployment valves and stented bioprostheses constituted the panel. After a thorough literature review, evidence-based recommendations were rated in a three-step modified Delphi approach by the experts. Literature research could identify 67 clinical trials, 4 guidelines and 10 systematic reviews for detailed text analysis to obtain a total of 28 recommendations. After rating by the experts, 12 recommendations were identified and degree of consensus for each was determined. Proctoring and education are necessary for the introduction of sutureless valves on an institutional basis as well as for the individual training of surgeons. Sutureless and rapid deployment should be considered as the valve prosthesis of first choice for isolated procedures in patients with comorbidities, old age, delicate aortic wall conditions such as calcified root, porcelain aorta or prior implantation of aortic homograft and stentless valves as well as for concomitant procedures and small aortic roots to reduce cross-clamp time. Intraoperative transoesophageal echocardiography is highly recommended, and in case of right anterior thoracotomy, preoperative computer tomography is strongly recommended. Suitable annular sizes are 19-27 mm. There is a contraindication for bicuspid valves only for Type 0 and for annular abscess or destruction due to infective endocarditis. Careful but complete decalcification of the aortic root is recommended to avoid paravalvular leakage; extensive decalcification should be avoided not to create annular defects. Proximal anastomoses of concomitant coronary artery bypass grafting should be placed during a single aortic cross-clamp period or alternatively with careful side clamping. Available evidence suggests that the use

  6. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016

    DEFF Research Database (Denmark)

    Garbe, Claus; Peris, Ketty; Hauschild, Axel

    2016-01-01

    Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organisation of Research...

  7. [The Chinese expert consensus on clinical practice of "medically unexplained symptoms"].

    Science.gov (United States)

    2017-02-01

    "Medically unexplained symptoms" (MUS) are commonly seen in all clinical specialties. The preliminary investigations in China show a prevalence of MUS in 4.15%-18.2% of clinical patients. Based on international and national guidelines and the most advanced studies, a Chinese expert consensus on clinical practice of MUS is reached through three rounds of discussion seminars by 25 experts from various specialties including psychiatry, internal medicine, surgery, gynecology-obstetrics, otorhinolar-yngology and traditional Chinese medicine. Clinical doctors should be alert of patients whose discomfort complaints cannot be explained by organic conditions after thorough physical examination and necessary laboratory tests. MUS should be recognized as early as possible so as to avoid complicating iatrogenic factors. A full bio-psycho-social evaluation of the patient is the basic structure of understanding MUS patients. In clinical practice, a trustful doctor-patient relationship is the first step of successful treatment. Then after a reasonable clinical evaluation, explain to the patient that it is a harmless functional symptom, communicate with the patient and reach an acceptable therapeutic goal, help the patient understand the symptoms in a psycho-somatic aspect and rebuild confidence of getting back to normal life. Patients with mild symptoms can be treated by doctors in various specialties, from whom the patient seeks help. Patients with severe symptoms need multi-disciplinary care including specific psychotherapy. Pharmaceutical treatment includes symptom alleviating drugs and antidepressants. In clinical care of patients with "MUS" , a full bio-psycho-social evaluation, a good doctor-patient relationship, a treatment plan according to the severity of symptoms, and a multi-disciplinary cooperation should be noted and practiced.

  8. Diagnostics, monitoring and outpatient care in children with suspected pulmonary hypertension/paediatric pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.

    Science.gov (United States)

    Lammers, Astrid E; Apitz, Christian; Zartner, Peter; Hager, Alfred; Dubowy, Karl-Otto; Hansmann, Georg

    2016-05-01

    Pulmonary hypertension (PH) is a condition of multiple aetiologies with underestimated prevalence and incidence. Indeed, despite access to modern therapies, pulmonary hypertensive vascular disease (PHVD) remains a progressive, usually life-limiting condition, severely impacting on the patients' well-being. We herein provide practical, expert consensus recommendations on the initial diagnostic work-up, clinical management and follow-up of children and adolescents with PH/PHVD, including a diagnostic algorithm. The major topics and methods that need to be tailored and put into context of the individual patient include PH classification, clinical signs and symptoms, basic diagnostic and advanced imaging measures (ECG, chest X-ray, transthoracic echocardiography, cardiac magnetic resonance, chest CT angiography, cardiac catheterisation, ventilation-perfusion lung scan, abdominal ultrasound), lung function tests, 6 min walk and cardiopulmonary exercise testing, sleep study (polysomnography), laboratory/immunological tests, considerations for elective surgery/ general anaesthesia, physical education and exercise, flying on commercial airplanes, vaccinations, care of central intravenous lines and palliative care. Due to the complexity of PH/PHVD, the clinical care has to be multidisciplinary and coordinated by a dedicated specialist paediatric PH centre, not only to decrease mortality but to allow children with PH/PHVD to reach a reasonable quality of life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. Therapy of psoriasis in childhood and adolescence - a German expert consensus.

    Science.gov (United States)

    Sticherling, Michael; Augustin, Matthias; Boehncke, Wolf-Henning; Christophers, Enno; Domm, Silja; Gollnick, Harald; Reich, Kristian; Mrowietz, Ulrich

    2011-10-01

    Psoriasis of childhood shows an annual prevalence of 0.71 % and accordingly has to be regarded as a frequent chronic inflammatory skin disorder of this age. The impact on the quality of life as well as development of the afflicted children and their parents is evident. On the other side, therapy is demanding with regard to the specific juvenile metabolism, physical development and skin penetration of topical drugs. Long-term treatment at an early age has to be critically judged regarding the chronicity of the disease. Topical corticosteroids, alternatively dithranol may be used first-line, followed by vitamin D derivatives. A combination with UV-light, preferably UV-B, has to be decided on an individual basis. Systemic treatment may be initiated in recalcitrant disease with methotrexate and cyclosporine where long-term experience is available from juvenile rheumatology and transplantation medicine. Alternatively fumaric acid esters or retinoids are available. Rehabilitation procedures will help the children and their parents to cope with the disease and its treatment. The different treatment options are presented here as a German expert consensus, as clinical studies are hardly available and only a few therapeutics are licensed for this age. In any case the therapy has to be individually planned and decided together with the patients and their parents to gain maximal safety, comfort and success. © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.

  10. Expert consensus on the classification of subtype in Budd-Chiari syndrome

    Directory of Open Access Journals (Sweden)

    Expert committee on Vane Cava Obstruction,Specialized CommitteeofEndovascology,ChineseMedicalDoctorAssociation

    2017-07-01

    Full Text Available From 2012 to 2015 the Department of Interventional Radiology of the Affiliated Hospital of Xuzhou Medical University undertook the clinical special research subject ”Study on the standardization of interventional diagnosis and treatment of Budd- Chiari syndrome”(No. BL2012021), a program supported by the Department of Science and Technology of Jiangsu Province. Based on the clinical results of three years research and the scientific summary of the experience from more than 2150 cases accumulated in more than 20 years, the Department of Interventional Radiology of the Affiliated Hospital of Xuzhou Medical University presided over a demonstration meeting about “the standardization of interventional diagnosis and treatment of Budd- Chiari syndrome” on January 14, 2016 in Xuzhou City of Jiangsu Province, China. The scholars from the Expert Committee on Vena Cava Obstruction of Specialized Committee of Endovascology, Chinese Medical Doctor Association, as well as the experts from the related medical fields, including interventional radiology, vascular surgery, pathology and diagnostic imaging, who have been engaged in the study of Budd- Chiari syndrome, attended the meeting, and in the meeting the participants made a full and thorough discussion on the classification and subtypes of Budd - Chiari syndrome. The scholars and experts have unanimously reached a consensus on the subtype definition of Budd- Chiari syndrome: the Budd Chiari syndrome is suggested to be classified into the hepatic vein occlusion subtype, the inferior vena cava occlusion subtype and mixed occlusion subtype, including 10 subtype entities in total. The hepatic vein occlusion subtype includes membranous occlusion of hepatic vein/accessory hepatic vein, segmental occlusion of hepatic vein, extensive occlusion of hepatic vein, and hepatic vein occlusion associated with thrombus formation. The inferior vena cava occlusion subtype

  11. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

    Science.gov (United States)

    Cecconi, Maurizio; De Backer, Daniel; Antonelli, Massimo; Beale, Richard; Bakker, Jan; Hofer, Christoph; Jaeschke, Roman; Mebazaa, Alexandre; Pinsky, Michael R; Teboul, Jean Louis; Vincent, Jean Louis; Rhodes, Andrew

    2014-12-01

    Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? Four types of statements were used: definition, recommendation, best practice and statement of fact. Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock.

  12. [Experts consensus on the management of the right heart function in critically ill patients].

    Science.gov (United States)

    Wang, X T; Liu, D W; Zhang, H M; Long, Y; Guan, X D; Qiu, H B; Yu, K J; Yan, J; Zhao, H; Tang, Y Q; Ding, X; Ma, X C; Du, W; Kang, Y; Tang, B; Ai, Y H; He, H W; Chen, D C; Chen, H; Chai, W Z; Zhou, X; Cui, N; Wang, H; Rui, X; Hu, Z J; Li, J G; Xu, Y; Yang, Y; Ouyan, B; Lin, H Y; Li, Y M; Wan, X Y; Yang, R L; Qin, Y Z; Chao, Y G; Xie, Z Y; Sun, R H; He, Z Y; Wang, D F; Huang, Q Q; Jiang, D P; Cao, X Y; Yu, R G; Wang, X; Chen, X K; Wu, J F; Zhang, L N; Yin, M G; Liu, L X; Li, S W; Chen, Z J; Luo, Z

    2017-12-01

    To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of

  13. Participation of industry experts in the elaboration of monographs and chapters of the European Pharmacopoeia.

    Science.gov (United States)

    Rose, Ulrich

    2016-10-10

    The European Pharmacopoeia represents an important element in the European regulatory system for medicines. It is elaborated in a co-operation of experts from authorities, academia and industry, assisted by scientific staff from the European Directorate for the Quality of Medicines & HealthCare (EDQM). This article describes the principles of its elaboration with particular focus on the involvement of industry experts. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear--diagnosis and management.

    Science.gov (United States)

    Carvalho, T S; Colon, P; Ganss, C; Huysmans, M C; Lussi, A; Schlueter, N; Schmalz, G; Shellis, R P; Tveit, A B; Wiegand, A

    2015-09-01

    Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the pre-disposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETW aims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies. Effective management of ETW includes screening for early signs of ETW and evaluating all etiological factors. ETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.

  15. Consensus Report of the European Federation of Conservative Dentistry: Erosive tooth wear – diagnosis and management.

    Science.gov (United States)

    Carvalho, Thiago S; Colon, Pierre; Ganss, Carolina; Huysmans, Marie-Charlotte; Lussi, Adrian; Schlueter, Nadine; Schmalz, Gottfried; Shellis, Peter R; Björg Tveit, Anne; Wiegand, Annette

    2016-01-01

    Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the predisposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETWaims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies. Effective management of ETW includes screening for early signs of ETW and evaluating all etiological factors. ETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.

  16. Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study

    Science.gov (United States)

    2011-01-01

    Background European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants. Conclusions Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus

  17. Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study.

    Science.gov (United States)

    Devillé, Walter; Greacen, Tim; Bogic, Marija; Dauvrin, Marie; Dias, Sónia; Gaddini, Andrea; Jensen, Natasja Koitzsch; Karamanidou, Christina; Kluge, Ulrike; Mertaniemi, Ritva; Riera, Rosa P i; Sárváry, Attila; Soares, Joaquim J F; Stankunas, Mindaugas; Strassmayr, Christa; Welbel, Marta; Priebe, Stefan

    2011-09-13

    European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants. Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles

  18. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    Directory of Open Access Journals (Sweden)

    Lockey David

    2011-10-01

    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  19. Helping someone with problem drinking: Mental health first aid guidelines - a Delphi expert consensus study

    Directory of Open Access Journals (Sweden)

    Hart Laura M

    2009-12-01

    Full Text Available Abstract Background Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them. This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence. Methods A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines. Results The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians, with 184 first aid strategies rated as essential or important by ≥80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency

  20. WHO Dengue Case Classification 2009 and its usefulness in practice: an expert consensus in the Americas

    Science.gov (United States)

    Horstick, Olaf; Martinez, Eric; Guzman, Maria Guadalupe; Martin, Jose Luis San; Ranzinger, Silvia Runge

    2015-01-01

    Introduction: In 2009, the new World Health Organization (WHO) dengue case classification – dengue/severe dengue (D/SD) – was introduced, replacing the 1997 WHO dengue case classification: dengue fever/dengue haemorrhagic fever/dengue shock syndrome (DF/DHF/DSS). Methods: A 2-day expert consensus meeting in La Habana/Cuba aimed to (1) share the experiences from Pan American Health Organization (PAHO) member states when applying D/SD, (2) present national and local data using D/SD, and (3) agree with the presented evidence on a list of recommendations for or against the use of D/SD for PAHO, and also globally. Results: Eight key questions were discussed, concluding: (1) D/SD is useful describing disease progression because it considers the dynamic nature of the disease, (2) D/SD helps defining dengue cases correctly for clinical studies, because it defines more precisely disease severity and allows evaluating dynamically the progression of cases, (3) D/SD describes correctly all clinical forms of severe dengue. Further standards need to be developed regionally, especially related to severe organ involvement, (4) D/SD allows for pathophysiological research identifying – in a sequential manner – the clinical manifestations of dengue related to pathophysiological events, (5) the warning signs help identifying early cases at risk of shock (children and adults), pathophysiology of the warning signs deserves further studies, (6) D/SD helps treating individual dengue cases and also the reorganization of health-care services for outbreak management, (7) D/SD helps diagnosing dengue, in presumptive diagnosis and follow-up of the disease, because of its high sensitivity and high negative predictive value (NPV), and (8) there is currently no update of the International Disease Classification10 (ICD10) to include the new classification of dengue (D/SD); therefore, there are not enough experiences of epidemiological reporting. Once D/SD has been implemented in

  1. Benchmarks for cystic fibrosis carrier screening: a European consensus document.

    Science.gov (United States)

    Castellani, Carlo; Macek, Milan; Cassiman, Jean-Jacques; Duff, Alistair; Massie, John; ten Kate, Leo P; Barton, David; Cutting, Garry; Dallapiccola, Bruno; Dequeker, Elisabeth; Girodon, Emmanuelle; Grody, Wayne; Highsmith, Edward W; Kääriäinen, Helenal; Kruip, Stephan; Morris, Michael; Pignatti, Pier Franco; Pypops, Ulrike; Schwarz, Martin; Soller, Maria; Stuhrman, Manfred; Cuppens, Harry

    2010-05-01

    This paper presents an overview of the conclusions from an international conference convened to address current issues related to the provision of Cystic Fibrosis carrier screening within Europe. Consensus was not aimed at stating whether such a programme should be implemented. Instead the focus was to provide a framework for countries and agencies who are considering or planning its establishment. The general principles and target population of Cystic Fibrosis carrier screening, advantages and disadvantages, health economics, monitoring and future evaluative and research directions were covered. A range of screening strategies have been assessed and compared: pre-conceptional and prenatal screening; individual and couple screening; sequential and simultaneous sampling or testing. Furthermore, technical issues were examined with respect to the choice of the panel of mutations, its detection rate, sensitivity, management of intermediate 'at-risk' couples, screening approach to different populations and ethnic minorities, and assurance of laboratory quality control. The consensus statement also aims to establish the benchmarks for communicating with health care providers, the general public and potential and actual participants before and after the genetic test.

  2. Expert consensus of general surgery residents' proficiency with common endocrine operations.

    Science.gov (United States)

    Phitayakorn, Roy; Kelz, Rachel R; Petrusa, Emil; Sippel, Rebecca S; Sturgeon, Cord; Patel, Kepal N; Perrier, Nancy D

    2017-01-01

    Proficiency with common endocrine operations is expected of graduating, general surgery residents. However, no expert consensus guidelines exist about these expectations. Members of the American Association of Endocrine Surgeons were surveyed about their opinions on resident proficiency with common endocrine operations. Overall response rate was 38%. A total of 92% of the respondents operate with residents. On average, they believed that the steps of a total thyroidectomy for benign disease and a well-localized parathyroidectomy could be performed by a postgraduate year 4 surgery resident. Specific steps that they thought might require more training included decisions to divide the strap muscles or leaving a drain. Approximately 66% of respondents thought that a postgraduate year 5 surgery resident could independently perform a total thyroidectomy for benign disease, but only 45% felt similarly for malignant thyroid disease; 79% thought that a postgraduate year 5 surgery resident could independently perform a parathyroidectomy. Respondents' years of experience correlated with their opinions about resident autonomy for total thyroidectomy (benign r = 0.38, P < .001; malignant r = 0.29, P = .001) but not parathyroidectomy. On multivariate analysis, sex and years of experience of the respondents were independently associated with opinions on autonomy but only for total thyroidectomy for benign disease (P = .001). Annual endocrine volume of the respondents did not correlate with beliefs in autonomy. There was general agreement among responding members of the AAES about resident proficiency and autonomy with common endocrine operations. As postgraduate year 5 residents may not be proficient in advanced endocrine operations, opportunities exist to improve training prior to the transition to independent practice for graduates that anticipate performing endocrine operations routinely. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum

    NARCIS (Netherlands)

    Velde, C.J. van de; Boelens, P.G.; Borras, J.M.; Coebergh, J.W.W.; Cervantes, A.; Blomqvist, L.; Beets-Tan, R.G.; Broek, C.B. van den; Brown, G.; Cutsem, E. van; Espin, E.; Haustermans, K.; Glimelius, B.; Iversen, L.H.; Krieken, J.H.J.M. van; Marijnen, C.A.; Henning, G.; Gore-Booth, J.; Meldolesi, E.; Mroczkowski, P.; Nagtegaal, I.D.; Naredi, P.; Ortiz, H.; Pahlman, L.; Quirke, P.; Rodel, C.; Roth, A.; Rutten, H; Schmoll, H.J.; Smith, J.J.; Tanis, P.J.; Taylor, C.; Wibe, A.; Wiggers, T.; Gambacorta, M.A.; Aristei, C.; Valentini, V.

    2014-01-01

    BACKGROUND: Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe.

  4. EURECCA colorectal : Multidisciplinary management: European consensus conference colon & rectum

    NARCIS (Netherlands)

    van de Velde, Cornelis J. H.; Boelens, Petra G.; Borras, Josep M.; Coebergh, Jan-Willem; Cervantes, Andres; Blomqvist, Lennart; Beets-Tan, Regina G. H.; van den Broek, Colette B. M.; Brown, Gina; Van Cutsem, Eric; Espin, Eloy; Haustermans, Karin; Glimelius, Bengt; Iversen, Lene H.; van Krieken, J. Han; Marijnen, Corrie A. M.; Henning, Geoffrey; Gore-Booth, Jola; Meldolesi, Elisa; Mroczkowski, Pawel; Nagtegaal, Iris; Naredi, Peter; Ortiz, Hector; Pahlman, Lars; Quirke, Philip; Roedel, Claus; Roth, Arnaud; Rutten, Harm; Schmoll, Hans J.; Smith, Jason J.; Tanis, Pieter J.; Taylor, Claire; Wibe, Arne; Wiggers, Theo; Gambacorta, Maria A.; Aristei, Cynthia; Valentini, Vincenzo

    Background: Care for patients with colon and rectal cancer has improved in the last 20 years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe.

  5. Multidisciplinary management of patients with coexisting inflammatory bowel disease and spondyloarthritis: A Delphi consensus among Italian experts.

    Science.gov (United States)

    Armuzzi, Alessandro; Felice, Carla; Lubrano, Ennio; Cantini, Fabrizio; Castiglione, Fabiana; Gionchetti, Paolo; Orlando, Ambrogio; Salvarani, Carlo; Scarpa, Raffaele; Marchesoni, Antonio; Vecchi, Maurizio; Olivieri, Ignazio

    2017-06-23

    Treatment of patients with coexisting spondyloarthritis (SpA) and inflammatory bowel disease (IBD) often requires multidisciplinary collaboration between gastroenterologists and rheumatologists. To describe the results of the first Delphi consensus to define shared therapeutic strategies for the best management of patients with coexisting SpA and IBD. A scientific steering committee of 10 Italian experts in the field of SpA and IBD developed 27 statements on 5 possible clinical scenarios and selected 40 specialists from across Italy, both gastroenterologists and rheumatologists, to vote them using a Delphi method. Each participant expressed a level of agreement on each statement using a 5-point scale (1="absolutely disagree"; 5="absolutely agree"). Total cumulative agreement was defined as the sum of the percentage of responses to items 4 ("agree") and 5 ("absolutely agree"). Total cumulative agreement ≥70% defined consensus for each statement. After the first round, positive consensus was reached for 22 statements. Statements without consensus were discussed in a plenary session before the second vote. Positive consensus was then reached in all statements, with final total cumulative agreement ranging from 80% to 100%. This is the first Delphi consensus defining specific treatment algorithms for patients with coexisting SpA and IBD. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  6. Defining consensus norms for palliative care of people with intellectual disabilities in Europe, using Delphi methods: A White Paper from the European Association of Palliative Care.

    Science.gov (United States)

    Tuffrey-Wijne, Irene; McLaughlin, Dorry; Curfs, Leopold; Dusart, Anne; Hoenger, Catherine; McEnhill, Linda; Read, Sue; Ryan, Karen; Satgé, Daniel; Straßer, Benjamin; Westergård, Britt-Evy; Oliver, David

    2016-05-01

    People with intellectual disabilities often present with unique challenges that make it more difficult to meet their palliative care needs. To define consensus norms for palliative care of people with intellectual disabilities in Europe. Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for Palliative Care reviewed and approved the final version. Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members' networks. A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents' comments, several items were modified and one item was deleted. This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice. © The Author(s) 2015.

  7. Interpretation on Expert Consensus for Diagnosis and Treatment of Melanoma in China

    Directory of Open Access Journals (Sweden)

    Fu-rong DU

    2016-09-01

    Full Text Available In recent years, melanoma has become a tumor with the fastest increase of morbidity in all malignant tumors, and its annual increase is 3%-5%. Both morbidity and mortality of melanoma are low in China, but they are showing an increasing tendency in recent years. However, the morbidity of melanoma is increasing in most European and American countries, but the mortality keeps stable and is not in an increasing tendency along with the increasing morbidity, demonstrating that there are great differences between China and Western countries in the diagnosis and treatment of melanoma. At present, melanoma has become one of the diseases that severely threaten human health. Compared with other common malignant tumors, there are significant differences in the clinical diagnosis and specific treatment of melanoma. To better adapt the rapid development of treatment for melanoma, and to make the clinical practice of melanoma more specific and internationalized in China, Expert Committee on Melanoma, Chinese Society of Clinical Oncology, has updated the Guidelines for Diagnosis and Treatment of Melanoma in China. Therefore, the editorial board of this journal interpreted this guideline in details, aiming to provide the latest and most practical evidence-based evidence for clinical oncologists in China.

  8. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment.

    Science.gov (United States)

    Mathieu, Daniel; Marroni, Alessandro; Kot, Jacek

    2017-03-01

    The tenth European Consensus Conference on Hyperbaric Medicine took place in April 2016, attended by a large delegation of experts from Europe and elsewhere. The focus of the meeting was the revision of the European Committee on Hyperbaric Medicine (ECHM) list of accepted indications for hyperbaric oxygen treatment (HBOT), based on a thorough review of the best available research and evidence-based medicine (EBM). For this scope, the modified GRADE system for evidence analysis, together with the DELPHI system for consensus evaluation, were adopted. The indications for HBOT, including those promulgated by the ECHM previously, were analysed by selected experts, based on an extensive review of the literature and of the available EBM studies. The indications were divided as follows: Type 1, where HBOT is strongly indicated as a primary treatment method, as it is supported by sufficiently strong evidence; Type 2, where HBOT is suggested as it is supported by acceptable levels of evidence; Type 3, where HBOT can be considered as a possible/optional measure, but it is not yet supported by sufficiently strong evidence. For each type, three levels of evidence were considered: A, when the number of randomised controlled trials (RCTs) is considered sufficient; B, when there are some RCTs in favour of the indication and there is ample expert consensus; C, when the conditions do not allow for proper RCTs but there is ample and international expert consensus. For the first time, the conference also issued 'negative' recommendations for those conditions where there is Type 1 evidence that HBOT is not indicated. The conference also gave consensus-agreed recommendations for the standard of practice of HBOT.

  9. European Nanotechnology Experts Visit NCL; Harmonize Best Practices for Nanomedicine Collaboration in Europe | FNLCR Staging

    Science.gov (United States)

    European nanotechnology experts visited the Nanotechnology Characterization Laboratory (NCL) to observe best practices and methods and to share their own knowledge with NCL scientists as they prepared to launch an NCL-like operation in Europe. The Eu

  10. European Nanotechnology Experts Visit NCL; Harmonize Best Practices for Nanomedicine Collaboration in Europe | FNLCR

    Science.gov (United States)

    European nanotechnology experts visited the Nanotechnology Characterization Laboratory (NCL) to observe best practices and methods and to share their own knowledge with NCL scientists as they prepared to launch an NCL-like operation in Europe. The Eu

  11. Definition of a COPD self-management intervention: International Expert Group consensus

    NARCIS (Netherlands)

    Effing, T.W.; Vercoulen, J.H.; Bourbeau, J.; Trappenburg, J.; Lenferink, A.; Cafarella, P.; Coultas, D.; Meek, P.; Valk, P. van de; Bischoff, E.W.; Bucknall, C.; Dewan, N.A.; Early, F.; Fan, V.; Frith, P.; Janssen, D.J.; Mitchell, K.; Morgan, M.; Nici, L.; Patel, I.; Walters, H.; Rice, K.L.; Singh, S.; ZuWallack, R.; Benzo, R.; Goldstein, R.; Partridge, M.R.; van der Palen, J.

    2016-01-01

    There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management

  12. Definition of a COPD self-management intervention : International Expert Group consensus

    NARCIS (Netherlands)

    Effing, Tanja W; Vercoulen, Jan H; Bourbeau, Jean; Trappenburg, Jaap; Lenferink, Anke; Cafarella, Paul; Coultas, David; Meek, Paula; van der Valk, Paul; Bischoff, Erik W M A; Bucknall, Christine; Dewan, Naresh A; Early, Frances; Fan, Vincent; Frith, Peter; Janssen, Daisy J A; Mitchell, Katy; Morgan, Mike; Nici, Linda; Patel, Irem; Walters, Haydn; Rice, Kathryn L; Singh, Sally; Zuwallack, Richard; Benzo, Roberto; Goldstein, Roger; Partridge, Martyn R; van der Palen, Job

    There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management

  13. The European Hematology Association Roadmap for European Hematology Research : A consensus document

    NARCIS (Netherlands)

    Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

    The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology

  14. The European Hematology Association Roadmap for European Hematology Research : a consensus document

    NARCIS (Netherlands)

    Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

    The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology

  15. Inhaled medication and inhalation devices for lung disease in patients with cystic fibrosis : A European consensus

    NARCIS (Netherlands)

    Heijerman, Harry; Westerman, Elsbeth; Conway, Steven; Touw, Daan; Döring, Gerd; Frijlink, Henderik

    In cystic fibrosis inhalation of drugs for the treatment of CF related lung disease has been proven to be highly effective. Consequently, an increasing number of drugs and devices have been developed for CF lung disease or are currently under development. In this European consensus document we

  16. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference

    NARCIS (Netherlands)

    Edwin, Bjørn; Sahakyan, Mushegh A.; Abu Hilal, Mohammad; Besselink, Marc G.; Braga, Marco; Fabre, Jean-Michel; Fernández-Cruz, Laureano; Gayet, Brice; Kim, Song Cheol; Khatkov, Igor E.; Baichorov, Magomet E.; de Rooij, Thijs; Genç, Cansu G.; Haugvik, Sven-Petter; Izrailov, Roman E.; Khisamov, Arthur A.; Sánchez-Cabús, Santiago; Souche, Régis; van Hilst, Jony

    2017-01-01

    Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery

  17. European expert opinion on the management of invasive candidiasis in adults

    NARCIS (Netherlands)

    Kullberg, B.J.; Verweij, P.E.; Akova, M.; Arendrup, M.C.; Bille, J.; Calandra, T.; Cuenca-Estrella, M.; Herbrecht, R.; Jacobs, F.; Kalin, M.; Kibbler, C.C.; Lortholary, O.; Martino, P.; Meis, J.F.; Munoz, P.; Odds, F.C.; Pauw, B.E. de; Rex, J.H.; Roilides, E.; Rogers, T.R.; Ruhnke, M.; Ullmann, A.J.; Uzun, O.; Vandewoude, K.; Vincent, J.L.; Donnelly, J.P.

    2011-01-01

    This report discusses the present status of antifungal therapy and treatment options for candidaemia, considered by experts in the field in Europe. A conference of 26 experts from 13 European countries was held to discuss strategies for the treatment and prevention of invasive candidiasis, with the

  18. European Society for Paediatric Endocrinology Consensus Guidelines on Screening, Diagnosis, and Management of Congenital Hypothyroidism

    Science.gov (United States)

    Léger, Juliane; Olivieri, Antonella; Donaldson, Malcolm; Torresani, Toni; Krude, Heiko; van Vliet, Guy; Polak, Michel

    2014-01-01

    Objective: The aim was to formulate practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). Evidence: A systematic literature search was conducted to identify key articles relating to the screening, diagnosis, and management of CH. The evidence-based guidelines were developed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Consensus Process: Thirty-two participants drawn from the European Society for Paediatric Endocrinology and five other major scientific societies in the field of pediatric endocrinology were allocated to working groups with assigned topics and specific questions. Each group searched the literature, evaluated the evidence, and developed a draft document. These papers were debated and finalized by each group before presentation to the full assembly for further discussion and agreement. Recommendations: The recommendations include: worldwide neonatal screening, approaches to assess the cause (including genotyping) and the severity of the disorder, the immediate initiation of appropriate L-T4 supplementation and frequent monitoring to ensure dose adjustments to keep thyroid hormone levels in the target ranges, a trial of treatment in patients suspected of transient CH, regular assessments of developmental and neurosensory functions, consulting health professionals as appropriate, and education about CH. The harmonization of diagnosis, management, and routine health surveillance would not only optimize patient outcomes, but should also facilitate epidemiological studies of the disorder. Individuals with CH require monitoring throughout their lives, particularly during early childhood and pregnancy. PMID:24446653

  19. The european hematology association roadmap for european hematology research : A consensus document

    NARCIS (Netherlands)

    A. Engert (Andreas); C.L. Balduini (Carlo); A. Brand (Anneke); B. Coiffier (Bertrand); C. Cordonnier (Charlotte); H. Döhner (Hartmut); De Wit, T.D. (Thom Duyvené); Eichinger, S. (Sabine); W.E. Fibbe (Willem); Green, T. (Tony); De Haas, F. (Fleur); A. Iolascon (Achille); T. Jaffredo (Thierry); F. Rodeghiero (Francesco); G. Salles (Gilles); J.J. Schuringa (Jan Jacob)

    2016-01-01

    textabstractThe European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European

  20. Expert consensus on precise diagnosis and treatment of hilar cholangiocarcinoma guided by three-dimensional visualization technology

    Directory of Open Access Journals (Sweden)

    Chinese Society of Digital Medicine

    2017-01-01

    Full Text Available The three-dimensional (3D visualization technology in hilar cholangiocarcinoma could offer decision-making support to preoperative diagnosis, individualized surgical planning and then proffer operative approach. In addition,the 3D printing technology helps to realize the leapfrog development from 3D image to 3D physical models and proffers better guidance of the precise surgery for patients with hilar cholangiocarcinoma. To standardize the application of 3D visualization and 3D printing technology in the precise diagnosis and treatment of hilar cholangiocarcinoma ,Chinese Society of Digital Medicine and Chinese Research Hospital Association of Digital Surgery Committee organized experts in related fields to formulate this consensus.

  1. European Society of Coloproctology consensus on the surgical management of intestinal failure in adults

    DEFF Research Database (Denmark)

    Vaizey, C J; Maeda, Y; Barbosa, E

    2016-01-01

    , statements were prepared for a modified Delphi process. The evidence for each statement was graded using Oxford Centre for Evidence-Based Medicine Levels of Evidence. The current paper contains the statements reflecting the position and practice of leading European experts in IF encompassing the general...

  2. Expert consensus on precise diagnosis and treatment of complicated liver tumor guided by three-dimensional visualization technology

    Directory of Open Access Journals (Sweden)

    Chinese Society of Digital Medicine

    2017-01-01

    Full Text Available The three-dimensional (3D visualization technology in liver tumor could offer decision-making support to preoperative diagnosis, individualized surgical planning, and choosing an operative approach. In addition, the hepatic 3D printing helps to realize the leapfrog development from 3D images to 3D physical models and provides better guidance of the precise surgery of complicated liver tumors. To standardize the application of 3D visualization and 3D printing technology in the precise diagnosis and treatment of complicated liver tumors, Chinese experts in relevant fields were organized by Chinese Society of Digital Medicine and Chinese Research Hospital Association of Digital Surgery Committee to formulate this expert consensus.

  3. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics.

    Science.gov (United States)

    Gibson, Glenn R; Hutkins, Robert; Sanders, Mary Ellen; Prescott, Susan L; Reimer, Raylene A; Salminen, Seppo J; Scott, Karen; Stanton, Catherine; Swanson, Kelly S; Cani, Patrice D; Verbeke, Kristin; Reid, Gregor

    2017-08-01

    In December 2016, a panel of experts in microbiology, nutrition and clinical research was convened by the International Scientific Association for Probiotics and Prebiotics to review the definition and scope of prebiotics. Consistent with the original embodiment of prebiotics, but aware of the latest scientific and clinical developments, the panel updated the definition of a prebiotic: a substrate that is selectively utilized by host microorganisms conferring a health benefit. This definition expands the concept of prebiotics to possibly include non-carbohydrate substances, applications to body sites other than the gastrointestinal tract, and diverse categories other than food. The requirement for selective microbiota-mediated mechanisms was retained. Beneficial health effects must be documented for a substance to be considered a prebiotic. The consensus definition applies also to prebiotics for use by animals, in which microbiota-focused strategies to maintain health and prevent disease is as relevant as for humans. Ultimately, the goal of this Consensus Statement is to engender appropriate use of the term 'prebiotic' by relevant stakeholders so that consistency and clarity can be achieved in research reports, product marketing and regulatory oversight of the category. To this end, we have reviewed several aspects of prebiotic science including its development, health benefits and legislation.

  4. Surviving critical illness: what is next? : an expert consensus statement on physical rehabilitation after hospital discharge.

    NARCIS (Netherlands)

    Major, M.E.; Kwakman, R.; Kho, M.E.; Connolly, B.; McWilliams, D.; Denehy, L.; Hanekom, S.; Patman, S.; Gosselink, R.; Jones, C.; Nollet, F.; Needham, D.M.; Engelbert, R.H.H.; van der Schaaf, M.

    2016-01-01

    BACKGROUND: The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for

  5. Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge

    NARCIS (Netherlands)

    Major, M. E.; Kwakman, R.; Kho, M. E.; Connolly, B.; McWilliams, D.; Denehy, L.; Hanekom, S.; Patman, S.; Gosselink, R.; Jones, C.; Nollet, F.; Needham, D. M.; Engelbert, R. H. H.; van der Schaaf, M.

    2016-01-01

    The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of

  6. Diagnosis and treatment of dermatofibrosarcoma protuberans. European consensus-based interdisciplinary guideline

    DEFF Research Database (Denmark)

    Saiag, Philippe; Grob, Jean-Jacques; Lebbe, Celeste

    2015-01-01

    Dermatofibrosarcoma protuberans (DFSP) is a skin fibroblastic tumour that is locally aggressive, with a tendency for local recurrence, but rarely metastasizes. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato......-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on DFSP diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is suspected clinically and confirmed by pathology. Analysis by fluorescence...... in situ hybridisation (FISH) or multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) to detect specific chromosomal translocations and fusion gene transcripts is useful to confirm a difficult DFSP diagnosis. Treatment is mainly surgical, with the aim to achieve complete resection...

  7. Expert Opinion Is Necessary: Delphi Panel Methodology Facilitates a Scientific Approach to Consensus.

    Science.gov (United States)

    Hohmann, Erik; Brand, Jefferson C; Rossi, Michael J; Lubowitz, James H

    2018-02-01

    Our current trend and focus on evidence-based medicine is biased in favor of randomized controlled trials, which are ranked highest in the hierarchy of evidence while devaluing expert opinion, which is ranked lowest in the hierarchy. However, randomized controlled trials have weaknesses as well as strengths, and no research method is flawless. Moreover, stringent application of scientific research techniques, such as the Delphi Panel methodology, allows survey of experts in a high quality and scientific manner. Level V evidence (expert opinion) remains a necessary component in the armamentarium used to determine the answer to a clinical question. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. Identifying locally advanced basal cell carcinoma eligible for treatment with vismodegib: an expert panel consensus.

    Science.gov (United States)

    Peris, Ketty; Licitra, Lisa; Ascierto, Paolo A; Corvò, Renzo; Simonacci, Marco; Picciotto, Franco; Gualdi, Giulio; Pellacani, Giovanni; Santoro, Armando

    2015-01-01

    Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Most occur on the head and neck, where cosmetic and functional outcomes are critical. BCC can be locally destructive if not diagnosed early and treated appropriately. Surgery is the treatment of choice for the majority of high-risk lesions. Aggressive, recurrent or unresectable tumors can be difficult to manage. Until recently, no approved systemic therapy was available for locally advanced or metastatic BCC inappropriate for surgery or radiotherapy. Vismodegib provides a systemic treatment option. However, a consensus definition of advanced BCC is lacking. A multidisciplinary panel with expertise in oncology, dermatology, dermatologic surgery and radiation oncology proposes a consensus definition based on published evidence and clinical experience.

  9. A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion.

    Science.gov (United States)

    Chen, Jennifer K; Jacob, Sharon E; Nedorost, Susan T; Hanifin, Jon M; Simpson, Eric L; Boguniewicz, Mark; Watsky, Kalman L; Lugo-Somolinos, Aida; Hamann, Carsten R; Eberting, Cheryl Lee; Silverberg, Jonathan I; Thyssen, Jacob P

    2016-01-01

    Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.

  10. AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Van der Linden-Van der Zwaag Henrica MJ

    2011-07-01

    Full Text Available Abstract Background In the light of both the importance and large numbers of case series and cohort studies (observational studies in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. Methods A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. Results The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Conclusions Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

  11. AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty.

    Science.gov (United States)

    Pijls, Bart G; Dekkers, Olaf M; Middeldorp, Saskia; Valstar, Edward R; van der Heide, Huub J L; Van der Linden-Van der Zwaag, Henrica M J; Nelissen, Rob G H H

    2011-07-22

    In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

  12. Key considerations for preventing suicide in older adults: consensus opinions of an expert panel

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Nordentoft, Merete; Conwell, Yeates

    2011-01-01

    BACKGROUND: The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide....... AIMS: To disseminate key considerations for interventions addressing senior suicidal behavior. METHODS: An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. RESULTS...

  13. Expert and patient consensus on a dynamic model for shared decision-making in frail older patients.

    Science.gov (United States)

    van de Pol, Marjolein H J; Fluit, Cornelia R M G; Lagro, Joep; Slaats, Yvonne H P; Olde Rikkert, Marcel G M; Lagro-Janssen, Antoine L M

    2016-06-01

    Shared decision-making (SDM) is widely recommended as a way to support patients in making healthcare choices. Due to an ageing population, the number of older patients will increase. Existing models for SDM are not sufficient for this patient group, due to their multi-morbidity, the lack of guidelines and evidence applicable to the numerous combinations of diseases. The aim of this study was to gain consensus on a model for SDM in frail older patients with multiple morbidities. We used a three-round Delphi study to reach consensus on a model for SDM in older patients with multiple morbidities. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1-3). In round 1, the SDM model was introduced, rounds 2 and 3 were used to validate the importance and feasibility of the SDM model. Consensus for the proposed SDM model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement). SDM in older patients with multiple morbidities is a dynamic process. It requires a continuous counselling dialogue between professional and patient or proxy decision maker. The developed model for SDM in clinical practice may help professionals to apply SDM in the complex situation of the care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Polyanalgesic Consensus Conference 2003: an update on the management of pain by intraspinal drug delivery-- report of an expert panel.

    Science.gov (United States)

    Hassenbusch, Samuel J; Portenoy, Russell K; Cousins, Michael; Buchser, Eric; Deer, Timothy R; Du Pen, Stuart L; Eisenach, James; Follett, Kenneth A; Hildebrand, Keith R; Krames, Elliot S; Levy, Robert M; Palmer, Pamela P; Rathmell, James P; Rauck, Richard L; Staats, Peter S; Stearns, Lisa; Willis, K Dean

    2004-06-01

    Intraspinal drug infusion using fully implantable pump and catheter systems is a safe and effective therapy for selected patients with chronic pain. The options for this approach are increasing, as drugs that are commercially available for systemic administration are adapted to this use and other drugs that are in development specifically for intraspinal administration become available. In 2000 a Polyanalgesic Consensus Conference was organized to evaluate the existing literature and develop guidelines for drug selection. The major outcome of this effort, an algorithm for drug selection, was based on the best available evidence at the time. Rapid changes have occurred in the science and practice of intraspinal infusion and a Polyanalgesic Consensus Conference 2003 was organized to pursue the following goals: 1) to review the literature on intraspinal drug infusion since 1999, 2) to revise the 2000 drug-selection algorithm, 3) to develop guidelines for optimizing drug dosage and concentration, 4) to create a process for documenting minimum evidence supporting the use of a drug for intraspinal infusion, and 5) to clarify issues pertaining to compounding of drugs. Based on the best available evidence and expert opinion, consensus recommendations were developed in all these areas. The panel's conclusions may provide a foundation for clinical practice and a rational basis for new research.

  15. [A consensus statement on the diagnosis and treatment of cardiovascular diseases combined with insomnia from Chinese experts].

    Science.gov (United States)

    2017-04-01

    Recent years have seen a large amount of research indicating a high morbidity and mortality of cardiovascular disease (CVD) combined with insomnia, which leads to increasing attentions in studying the association between insomnia and CVD, such as coronary heart diseases, hypertension, heart failure, psycho-cardiology diseases and so on. Sufficient evidence shows that patients suffering from CVD are much more likely to get involved in insomnia than healthy persons. Furthermore, causing great troubles to patients with CVD, insomnia seriously influences the treatment process and prognosis of CVD. However, there is a lack of pragmatic direction for the diagnosis and treatment of this comorbidity. As a result, a specialized consensus statement offering guidance in diagnosing and treating CVD combined with insomnia, is in exigent need. This consensus, which is made by experienced experts from various relevant professional fields including cardiology, psychiatry, neurology, psychology and so forth, has summarized the recommendations for the concepts, epidemiology, pathophysiology mechanisms, diagnosis, management and the special approaches of traditional Chinese medicine in this comorbid conditions. In conclusion, it's certain that this consensus will contribute to the practitioners in managing CVD accompanied with insomnia.

  16. Clinical Guidelines for Management of Bone Health in Rett Syndrome Based on Expert Consensus and Available Evidence

    Science.gov (United States)

    Jefferson, Amanda; Leonard, Helen; Siafarikas, Aris; Woodhead, Helen; Fyfe, Sue; Ward, Leanne M.; Munns, Craig; Motil, Kathleen; Tarquinio, Daniel; Shapiro, Jay R.; Brismar, Torkel; Ben-Zeev, Bruria; Bisgaard, Anne-Marie; Coppola, Giangennaro; Ellaway, Carolyn; Freilinger, Michael; Geerts, Suzanne; Humphreys, Peter; Jones, Mary; Lane, Jane; Larsson, Gunilla; Lotan, Meir; Percy, Alan; Pineda, Mercedes; Skinner, Steven; Syhler, Birgit; Thompson, Sue; Weiss, Batia; Witt Engerström, Ingegerd; Downs, Jenny

    2016-01-01

    Objectives We developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. Methods An initial guidelines draft was created which included statements based upon literature review and 11 open-ended questions where literature was lacking. The international expert panel reviewed the draft online using a 2-stage Delphi process to reach consensus agreement. Items describe the clinical assessment of bone health, bone mineral density assessment and technique, and pharmacological and non-pharmacological interventions. Results Agreement was reached on 39 statements which were formulated from 41 statements and 11 questions. When assessing bone health in Rett syndrome a comprehensive assessment of fracture history, mutation type, prescribed medication, pubertal development, mobility level, dietary intake and biochemical bone markers is recommended. A baseline densitometry assessment should be performed with accommodations made for size, with the frequency of surveillance determined according to individual risk. Lateral spine x-rays are also suggested. Increasing physical activity and initiating calcium and vitamin D supplementation when low are the first approaches to optimizing bone health in Rett syndrome. If individuals with Rett syndrome meet the ISCD criterion for osteoporosis in children, the use of bisphosphonates is recommended. Conclusion A clinically significant history of fracture in combination with low bone densitometry findings is necessary for a diagnosis of osteoporosis. These evidence and consensus-based guidelines have the potential to improve bone health in those with Rett syndrome, reduce the frequency of fractures, and stimulate further research that aims to ameliorate the impacts of this serious comorbidity. PMID:26849438

  17. Clinical Guidelines for Management of Bone Health in Rett Syndrome Based on Expert Consensus and Available Evidence.

    Science.gov (United States)

    Jefferson, Amanda; Leonard, Helen; Siafarikas, Aris; Woodhead, Helen; Fyfe, Sue; Ward, Leanne M; Munns, Craig; Motil, Kathleen; Tarquinio, Daniel; Shapiro, Jay R; Brismar, Torkel; Ben-Zeev, Bruria; Bisgaard, Anne-Marie; Coppola, Giangennaro; Ellaway, Carolyn; Freilinger, Michael; Geerts, Suzanne; Humphreys, Peter; Jones, Mary; Lane, Jane; Larsson, Gunilla; Lotan, Meir; Percy, Alan; Pineda, Mercedes; Skinner, Steven; Syhler, Birgit; Thompson, Sue; Weiss, Batia; Witt Engerström, Ingegerd; Downs, Jenny

    2016-01-01

    We developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. An initial guidelines draft was created which included statements based upon literature review and 11 open-ended questions where literature was lacking. The international expert panel reviewed the draft online using a 2-stage Delphi process to reach consensus agreement. Items describe the clinical assessment of bone health, bone mineral density assessment and technique, and pharmacological and non-pharmacological interventions. Agreement was reached on 39 statements which were formulated from 41 statements and 11 questions. When assessing bone health in Rett syndrome a comprehensive assessment of fracture history, mutation type, prescribed medication, pubertal development, mobility level, dietary intake and biochemical bone markers is recommended. A baseline densitometry assessment should be performed with accommodations made for size, with the frequency of surveillance determined according to individual risk. Lateral spine x-rays are also suggested. Increasing physical activity and initiating calcium and vitamin D supplementation when low are the first approaches to optimizing bone health in Rett syndrome. If individuals with Rett syndrome meet the ISCD criterion for osteoporosis in children, the use of bisphosphonates is recommended. A clinically significant history of fracture in combination with low bone densitometry findings is necessary for a diagnosis of osteoporosis. These evidence and consensus-based guidelines have the potential to improve bone health in those with Rett syndrome, reduce the frequency of fractures, and stimulate further research that aims to ameliorate the impacts of this serious comorbidity.

  18. Clinical Guidelines for Management of Bone Health in Rett Syndrome Based on Expert Consensus and Available Evidence.

    Directory of Open Access Journals (Sweden)

    Amanda Jefferson

    Full Text Available We developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians.An initial guidelines draft was created which included statements based upon literature review and 11 open-ended questions where literature was lacking. The international expert panel reviewed the draft online using a 2-stage Delphi process to reach consensus agreement. Items describe the clinical assessment of bone health, bone mineral density assessment and technique, and pharmacological and non-pharmacological interventions.Agreement was reached on 39 statements which were formulated from 41 statements and 11 questions. When assessing bone health in Rett syndrome a comprehensive assessment of fracture history, mutation type, prescribed medication, pubertal development, mobility level, dietary intake and biochemical bone markers is recommended. A baseline densitometry assessment should be performed with accommodations made for size, with the frequency of surveillance determined according to individual risk. Lateral spine x-rays are also suggested. Increasing physical activity and initiating calcium and vitamin D supplementation when low are the first approaches to optimizing bone health in Rett syndrome. If individuals with Rett syndrome meet the ISCD criterion for osteoporosis in children, the use of bisphosphonates is recommended.A clinically significant history of fracture in combination with low bone densitometry findings is necessary for a diagnosis of osteoporosis. These evidence and consensus-based guidelines have the potential to improve bone health in those with Rett syndrome, reduce the frequency of fractures, and stimulate further research that aims to ameliorate the impacts of this serious comorbidity.

  19. Expert consensus on gender criteria for assessment in medical communication education

    NARCIS (Netherlands)

    Dielissen, P.; Verdonk, P.; Kramer, A.; Bottema, B.; Lagro-Janssen, T.

    2012-01-01

    Objective: The aim of this study is to develop gender criteria that can be included in communication skills assessment in medical education. Methods: A three-round Delphi study was conducted. The invited 59 participants were experts in the field of gender medicine education (n=28) and doctor-patient

  20. Expert consensus on gender criteria for assessment in medical communication education.

    NARCIS (Netherlands)

    Dielissen, P.; Verdonk, P.; Bottema, B.; Kramer, A.; Lagro-Janssen, T.

    2012-01-01

    OBJECTIVE: The aim of this study is to develop gender criteria that can be included in communication skills assessment in medical education. METHODS: A three-round Delphi study was conducted. The invited 59 participants were experts in the field of gender medicine education (n=28) and doctor-patient

  1. European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis.

    Science.gov (United States)

    Werner, R N; Nikkels, A F; Marinović, B; Schäfer, M; Czarnecka-Operacz, M; Agius, A M; Bata-Csörgő, Z; Breuer, J; Girolomoni, G; Gross, G E; Langan, S; Lapid-Gortzak, R; Lesser, T H; Pleyer, U; Sellner, J; Verjans, G M; Wutzler, P; Dressler, C; Erdmann, R; Rosumeck, S; Nast, A

    2017-01-01

    Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction of the incidence of postherpetic neuralgia and other complications. The guideline development followed a structured and predefined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this first part of the guideline, diagnostic means have been evaluated. The expert panel formally consented recommendations for the management of patients with (suspected) HZ, referring to the assessment of HZ patients, considering various specific clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national

  2. European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: Treatment.

    Science.gov (United States)

    Werner, R N; Nikkels, A F; Marinović, B; Schäfer, M; Czarnecka-Operacz, M; Agius, A M; Bata-Csörgő, Z; Breuer, J; Girolomoni, G; Gross, G E; Langan, S; Lapid-Gortzak, R; Lesser, T H; Pleyer, U; Sellner, J; Verjans, G M; Wutzler, P; Dressler, C; Erdmann, R; Rosumeck, S; Nast, A

    2017-01-01

    Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different

  3. Statistical challenges in nursing education and research: an expert panel consensus.

    Science.gov (United States)

    Hayat, Matthew J; Higgins, Melinda; Schwartz, Todd A; Staggs, Vincent S

    2015-01-01

    This article summarizes an expert panel discussion, "Statistical Challenges in Nursing Research," conducted at the 2013 Joint Statistical Meetings. The panel consisted of doctorally prepared statisticians with faculty appointments in United States-based academic nursing programs. The discussion centered on challenges concerning the use of statistics in nursing education and research. Five domains were identified, including perceptions about statistics, statisticians' roles and responsibilities, interdisciplinary collaboration between statisticians and nurse investigators, statistics education, and the use of statistics in the nursing literature.

  4. Informed consent in clinical research: Consensus recommendations for reform identified by an expert interview panel.

    Science.gov (United States)

    Lorell, Beverly H; Mikita, J Stephen; Anderson, Annick; Hallinan, Zachary P; Forrest, Annemarie

    2015-12-01

    Informed consent is the cornerstone for protection of human subjects in clinical trials. However, a growing body of evidence suggests that reform of the informed consent process in the United States is needed. The Clinical Trials Transformation Initiative conducted interviews with 25 experienced observers of the informed consent process to identify limitations and actionable recommendations for change. There was broad consensus that current practices often fail to meet the ethical obligation to inform potential research participants during the informed consent process. The most frequent single recommendation, which would affect all participants in federally regulated clinical research, was reform of the informed consent document. The interviews also identified the need for reform of clinical research review by institutional review boards, including transitioning to a single institutional review board for multi-site trials. The consensus recommendations from the interviewees provide a framework for meaningful change in the informed consent process. Although some proposed changes are feasible for rapid implementation, others such as substantive reform of the informed consent document may require change in federal regulations. © The Author(s) 2015.

  5. Prevention of communication disorders--screening pre-school and school-age children for problems with hearing, vision and speech: European Consensus Statement.

    Science.gov (United States)

    Skarżyński, Henryk; Piotrowska, Anna

    2012-04-01

    Communication is an integral part of human behaviour. Communication disorders are associated mainly with impairment in hearing, vision, and/or speech, which influences the ability to receive, comprehend, produce, and express verbal, nonverbal, and graphic information. When unrecognized and unmanaged, these very often "invisible" conditions can have a significant detrimental effect on a child's development, affecting educational, social, and psychological progress. A panel of experts discussed the screening of pre-school and school-age children for problems with hearing, vision, and speech during the 10th Congress of the European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on 22 June, 2011. The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children was the result of the scientific discussions. It was endorsed by experts in audiology, otolaryngology, phoniatry, ophthalmology, and speech language pathology from throughout Europe. Key elements of the consensus, as described herein, are: 1) defining the role of screening programmes in the identification and treatment of communication disorders; 2) identifying the target population; 3) promoting general awareness about the consequences of communication disorders; 4) recognizing the need for a quality control system in screening programmes; 5) encouraging cooperation among European countries to provide a high level of public health services for the prevention, identification, and treatment of communication disorders. The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children will encourage the appropriate authorities of the various countries involved to initiate screening for communication disorders in pre-school and school-age children.

  6. The Alpha consensus meeting on cryopreservation key performance indicators and benchmarks: proceedings of an expert meeting.

    Science.gov (United States)

    2012-08-01

    This proceedings report presents the outcomes from an international workshop designed to establish consensus on: definitions for key performance indicators (KPIs) for oocyte and embryo cryopreservation, using either slow freezing or vitrification; minimum performance level values for each KPI, representing basic competency; and aspirational benchmark values for each KPI, representing best practice goals. This report includes general presentations about current practice and factors for consideration in the development of KPIs. A total of 14 KPIs were recommended and benchmarks for each are presented. No recommendations were made regarding specific cryopreservation techniques or devices, or whether vitrification is 'better' than slow freezing, or vice versa, for any particular stage or application, as this was considered to be outside the scope of this workshop. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Allergic respiratory disease (ARD), setting forth the basics: proposals of an expert consensus report.

    Science.gov (United States)

    Navarro, Ana M; Delgado, Julio; Muñoz-Cano, Rosa M; Dordal, M Teresa; Valero, Antonio; Quirce, Santiago

    2017-01-01

    The variability of symptoms observed in patients with respiratory allergy often hampers classification based on the criteria proposed in guidelines on rhinitis and asthma. We assessed specific aspects of allergic respiratory disease (ARD) that are not explicitly addressed in the guidelines in order to issue specific recommendations and thus optimize clinical practice. Using the Delphi technique, 40 Spanish allergists were surveyed to reach consensus on 71 items related to ARD. Consensus was achieved for 95.7% of the items. These included the following: the clinical manifestations of ARD are heterogeneous and individual airborne allergens can be related to specific clinical profiles; the optimal approach in patients with ARD is based on the global assessment of rhinoconjunctivitis and asthma; aeroallergens are largely responsible for the clinical features and severity of the disease; and clinical expression is associated with the period of environmental exposure to the allergen. Pharmacological treatment of ARD is often based on the intensity of symptoms recorded during previous allergen exposures and cannot always be administered following a step-up approach, as recommended in clinical practice guidelines. Allergen immunotherapy (AIT) is the only option for overall treatment of respiratory symptoms using an etiological approach. AIT can modify the prognosis of ARD and should therefore be considered a valuable first-line treatment. The present study highlights gaps in current asthma and rhinitis guidelines and addresses specific aspects of ARD, such as global assessment of both asthma and rhinitis or the specific role of variable allergen exposure in the clinical expression of the disease.

  8. The AGNP-TDM expert group consensus guidelines: therapeutic drug monitoring in psychiatry.

    Science.gov (United States)

    Baumann, P; Hiemke, C; Ulrich, S; Eckermann, G; Gaertner, I; Gerlach, M; Kuss, H-J; Laux, G; Müller-Oerlinghausen, B; Rao, M L; Riederer, P; Zernig, G

    2004-11-01

    Therapeutic Drug Monitoring (TDM) is a valid tool to optimise pharmacotherapy. It enables the clinician to adjust the dosage of drugs according to the characteristics of the individual patient. In psychiatry, TDM is an established procedure for lithium, some antidepressants and antipsychotics. In spite of its obvious advantages, however, the use of TDM in everyday clinical practice is far from optimal. The interdisciplinary TDM group of the Arbeitsgemeinschaft fur Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) has therefore worked out consensus guidelines to assist psychiatrists and laboratories involved in psychotropic drug analysis to optimise the use of TDM of psychotropic drugs. Five research-based levels of recommendation were defined with regard to routine monitoring of plasma concentrations for dose titration of 65 psychoactive drugs: (1) strongly recommended, (2) recommended, (3) useful, (4) probably useful and (5) not recommended. A second approach defined indications to use TDM, e. g. control of compliance, lack of clinical response or adverse effects at recommended doses, drug interactions, pharmacovigilance programs, presence of a genetic particularity concerning the drug metabolism, children, adolescents and elderly patients. Indications for TDM are relevant for all drugs either with or without validated therapeutic ranges. When studies on therapeutic ranges are lacking, target ranges should be plasma concentrations that are normally observed at therapeutic doses of the drug. Therapeutic ranges of plasma concentrations that are considered to be optimal for treatment are proposed for those drugs, for which the evaluation of the literature demonstrated strong evidence. Moreover, situations are defined when pharmacogenetic (phenotyping or genotyping) tests are informative in addition to TDM. Finally, practical instructions are given how to use TDM. They consider preparation of TDM, analytical procedures, reporting and interpretation of results

  9. The AGNP-TDM Expert Group Consensus Guidelines: focus on therapeutic monitoring of antidepressants.

    Science.gov (United States)

    Baumann, Pierre; Ulrich, Sven; Eckermann, Gabriel; Gerlach, Manfred; Kuss, Hans-Joachim; Laux, Gerd; Müller-Oerlinghausen, Bruno; Rao, Marie Luise; Riederer, Peter; Zernig, Gerald; Hiemke, Christoph

    2005-01-01

    Therapeutic drug monitoring (TDM) of psychotropic drugs such as antidepressants has been widely introduced for optimization of pharmacotherapy in psychiatric patients. The interdisciplinary TDM group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) has worked out consensus guidelines with the aim of providing psychiatrists and TDM laboratories with a tool to optimize the use of TDM. Five research-based levels of recommendation were defined with regard to routine monitoring of drug plasma concentrations: (i) strongly recommended; (ii) recommended; (iii) useful; (iv) probably useful; and (v) not recommended. In addition, a list of indications that justify the use of TDM is presented, eg, control of compliance, lack of clinical response or adverse effects at recommended doses, drug interactions, pharmacovigilance programs, presence of a genetic particularity concerning drug metabolism, and children, adolescents, and elderly patients. For some drugs, studies on therapeutic ranges are lacking, but target ranges for clinically relevant plasma concentrations are presented for most drugs, based on pharmacokinetic studies reported in the literature. For many antidepressants, a thorough analysis of the literature on studies dealing with the plasma concentration-clinical effectiveness relationship allowed inclusion of therapeutic ranges of plasma concentrations. In addition, recommendations are made with regard to the combination of pharmacogenetic (phenotyping or genotyping) tests with TDM. Finally, practical instructions are given for the laboratory practitioners and the treating physicians how to use TDM: preparation of TDM, drug analysis, reporting and interpretation of results, and adequate use of information for patient treatment TDM is a complex process that needs optimal interdisciplinary coordination of a procedure implicating patients, treating physicians, clinical pharmacologists, and clinical laboratory specialists. These

  10. Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement.

    Science.gov (United States)

    van Hest, N A; Aldridge, R W; de Vries, G; Sandgren, A; Hauer, B; Hayward, A; Arrazola de Oñate, W; Haas, W; Codecasa, L R; Caylà, J A; Story, A; Antoine, D; Gori, A; Quabeck, L; Jonsson, J; Wanlin, M; Orcau, Å; Rodes, A; Dedicoat, M; Antoun, F; van Deutekom, H; Keizer, St; Abubakar, I

    2014-03-06

    In low-incidence countries in the European Union (EU), tuberculosis (TB) is concentrated in big cities, especially among certain urban high-risk groups including immigrants from TB high-incidence countries, homeless people, and those with a history of drug and alcohol misuse. Elimination of TB in European big cities requires control measures focused on multiple layers of the urban population. The particular complexities of major EU metropolises, for example high population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions, not efficient in the general population, to be effective or cost effective. Lessons can be learnt from across the EU and this consensus statement on TB control in big cities and urban risk groups was prepared by a working group representing various EU big cities, brought together on the initiative of the European Centre for Disease Prevention and Control. The consensus statement describes general and specific social, educational, operational, organisational, legal and monitoring TB control interventions in EU big cities, as well as providing recommendations for big city TB control, based upon a conceptual TB transmission and control model.

  11. Expert panel consensus recommendations for home blood pressure monitoring in Asia: the Hope Asia Network.

    Science.gov (United States)

    Park, Sungha; Buranakitjaroen, Peera; Chen, Chen-Huan; Chia, Yook-Chin; Divinagracia, Romeo; Hoshide, Satoshi; Shin, Jinho; Siddique, Saulat; Sison, Jorge; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Tay, Jam Chin; Turana, Yuda; Wang, Ji-Guang; Zhang, Yuqing; Kario, Kazuomi

    2018-01-31

    Hypertension is the leading cause of mortality throughout Asia. Home blood pressure monitoring has the potential to improve hypertension control and is a useful adjunct to conventional office blood pressure measurements due to its diagnostic accuracy and prognostic value in predicting cardiovascular outcomes. At present, there are no region-specific guidelines addressing the use of home blood pressure monitoring in Asia. Therefore, an expert panel was convened to address the use of home blood pressure monitoring and develop key recommendations to help guide clinical practice throughout the Asia region. The resulting recommendations support the use of home blood pressure monitoring with a validated device as an accurate adjunct for diagnosing hypertension and predicting cardiovascular outcome. Diagnosis and treatment of hypertension should still be guided by conventional office/clinic blood pressure measurements. The expert panel encourages the incorporation of home blood pressure monitoring into local clinical guidelines and offers practical recommendations to ensure continuity of care where a validated home blood pressure device is not available.

  12. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel.

    Science.gov (United States)

    James, Andra H; Kouides, Peter A; Abdul-Kadir, Rezan; Dietrich, Jennifer E; Edlund, Mans; Federici, Augusto B; Halimeh, Susan; Kamphuisen, Pieter Willem; Lee, Christine A; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Philipp, Claire; Wilkinson, Jeffrey; Winikoff, Rochelle

    2011-10-01

    Acute menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology reached consensus on recommendations regarding the management of acute menorrhagia in women without a diagnosed bleeding disorder, as well as in patients with von Willebrand disease, platelet function disorders and other rare hemostatic disorders. The causes and predictors of acute menorrhagia are discussed and special consideration is given for the treatment of women on anticoagulation therapy. This review and accompanying recommendations will provide guidance for healthcare practitioners in the emergency management of acute menorrhagia. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  13. Clinical Guidelines for Management of Bone Health in Rett Syndrome Based on Expert Consensus and Available Evidence

    DEFF Research Database (Denmark)

    Jefferson, Amanda; Leonard, Helen; Siafarikas, Aris

    2016-01-01

    OBJECTIVES: We developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. METHODS: An initial guidelines draft was created which included statements based upon literature review and 11 open......-pharmacological interventions. RESULTS: Agreement was reached on 39 statements which were formulated from 41 statements and 11 questions. When assessing bone health in Rett syndrome a comprehensive assessment of fracture history, mutation type, prescribed medication, pubertal development, mobility level, dietary intake...... and vitamin D supplementation when low are the first approaches to optimizing bone health in Rett syndrome. If individuals with Rett syndrome meet the ISCD criterion for osteoporosis in children, the use of bisphosphonates is recommended. CONCLUSION: A clinically significant history of fracture in combination...

  14. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association

    National Research Council Canada - National Science Library

    McLaughlin, Vallerie V; Archer, Stephen L; Badesch, David B; Barst, Robyn J; Farber, Harrison W; Lindner, Jonathan R; Mathier, Michael A; McGoon, Michael D; Park, Myung H; Rosenson, Robert S; Rubin, Lewis J; Tapson, Victor F; Varga, John

    2009-01-01

      A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association Developed in Collaboration With the American College of Chest Physicians...

  15. Inhaled medication and inhalation devices for lung disease in patients with cystic fibrosis: A European consensus

    DEFF Research Database (Denmark)

    Heijerman, Harry; Westerman, Elsbeth; Conway, Steven

    2009-01-01

    review the current status of inhaled medication in CF, including the mechanisms of action of the various drugs, their modes of administration and indications, their effects on lung function, exacerbation rates, survival and quality of life, as well as side effects. Specifically we address antibiotics......In cystic fibrosis inhalation of drugs for the treatment of CF related lung disease has been proven to be highly effective. Consequently, an increasing number of drugs and devices have been developed for CF lung disease or are currently under development. In this European consensus document we...

  16. Medical management of melasma: A review with consensus recommendations by Indian pigmentary expert group

    Directory of Open Access Journals (Sweden)

    Rashmi Sarkar

    2017-01-01

    Full Text Available Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS in a collaborative discussion called South Asian Pigmentary Forum (SPF.

  17. Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.

    Science.gov (United States)

    Sarkar, Rashmi; Gokhale, Narendra; Godse, Kiran; Ailawadi, Pallavi; Arya, Latika; Sarma, Nilendu; Torsekar, R G; Somani, V K; Arora, Pooja; Majid, Imran; Ravichandran, G; Singh, Mohan; Aurangabadkar, Sanjeev; Arsiwala, Shehnaz; Sonthalia, Sidharth; Salim, T; Shah, Swapnil

    2017-01-01

    Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).

  18. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD

    OpenAIRE

    Kooij Sandra JJ; Bejerot Susanne; Blackwell Andrew; Caci Herve; Casas-Brugué Miquel; Carpentier Pieter J; Edvinsson Dan; Fayyad John; Foeken Karin; Fitzgerald Michael; Gaillac Veronique; Ginsberg Ylva; Henry Chantal; Krause Johanna; Lensing Michael B

    2010-01-01

    Abstract Background Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. Methods The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve...

  19. SCAI expert consensus statement for advanced training programs in pediatric and congenital interventional cardiac catheterization.

    Science.gov (United States)

    Armsby, Laurie; Beekman, Robert H; Benson, Lee; Fagan, Thomas; Hagler, Donald J; Hijazi, Ziyad M; Holzer, Ralf; Ing, Frank; Kreutzer, Jacqueline; Lang, Peter; Levi, Daniel S; Latson, Larry; Moore, Phillip; Mullins, Charles; Ruiz, Carlos; Vincent, Robert

    2014-11-01

    Pediatric and Congenital Interventional Cardiology is the practice of catheter-based techniques that improve cardiac physiology and circulation through the treatment of heart disease in children and adults with congenital or acquired heart defects. Over the last decade, and since last published training guidelines for pediatric cardiac catheterization and interventional cardiology were published in 2005 [1] the field of Pediatric and Congenital Cardiac Catheterization has evolved into a predominantly interventional discipline. As there is no sub-specialty certification for interventional cardiac catheterization in pediatrics, the Congenital Heart Disease Committee of the Society of Cardiovascular Angiography and Interventions has put together this consensus statement for advanced training in pediatric and congenital interventional cardiac catheterization. The statement puts forth recommendations for program infrastructure in terms of teaching, personnel, equipment, facilities, conferences, patient volume and trainee assessment. This is meant to set a standard for training programs as well as giving applicants a basis on which to judge and compare programs. © 2014 Wiley Periodicals, Inc.

  20. Delphi consensus on the physical health of patients with schizophrenia: evaluation of the recommendations of the Spanish Societies of Psychiatry and Biological Psychiatry by a panel of experts.

    Science.gov (United States)

    Bobes-García, Julio; Saiz-Ruiz, Jerónimo; Bernardo-Arroyo, Miquel; Caballero-Martínez, Fernando; Gilaberte-Asín, Inmaculada; Ciudad-Herrera, Antonio

    2012-01-01

    Available data from scientific literature show that patients with schizophrenia have higher rates of physical comorbidity and excess mortality due to other physical pathologies. The growing interest to investigate and improve the health of these patients has led a group of Spanish experts to publish in 2008 a "Consensus on physical health of patients with schizophrenia from the Spanish Societies of Psychiatry and Biological Psychiatry" (2008 Consensus). These recommendations imply a significant change to the present model of medical attention. To gauge the level of agreement of a group of expert psychiatrists on the clinical criteria and recommendations collected from the scientific literature and the 2008 Consensus on the physical health of patients with schizophrenia. The process involved four phases: 1) Scientific Committee established to manage the study and to define the 66-item questionnaire; 2) Panel of 15 experts in psychiatry is established; 3) Submission of questionnaire to the Expert Panel in two consecutive rounds, with an intermediate processing and sharing of results; 4) Evaluation of results, discussion and conclusions between Scientific Committee and Expert Panel. All items, as set by the Scientific Committee and aligned with the recommendations published in the 2008 Consensus, achieved consensus on agreement from the Expert Panel, except 5 items, for which most of the answers were placed in the indeterminate position rate. The expert criteria shown in this study indicate a global agreement with regard to clinical criteria on the physical health of patients with schizophrenia, as well as with the present recommendations to improve the health of patients having, or at risk to have, other concomitant pathologies. The need to incorporate new intervention guidelines that facilitate a better control and improvement of the physical health of patients with schizophrenia must be disseminated in the psychiatric providers' collectives.

  1. First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy.

    Science.gov (United States)

    Adams, David; Suhr, Ole B; Hund, Ernst; Obici, Laura; Tournev, Ivailo; Campistol, Josep M; Slama, Michel S; Hazenberg, Bouke P; Coelho, Teresa

    2016-02-01

    Early and accurate diagnosis of transthyretin familial amyloid polyneuropathy (TTR-FAP) represents one of the major challenges faced by physicians when caring for patients with idiopathic progressive neuropathy. There is little consensus in diagnostic and management approaches across Europe. The low prevalence of TTR-FAP across Europe and the high variation in both genotype and phenotypic expression of the disease means that recognizing symptoms can be difficult outside of a specialized diagnostic environment. The resulting delay in diagnosis and the possibility of misdiagnosis can misguide clinical decision-making and negatively impact subsequent treatment approaches and outcomes. This review summarizes the findings from two meetings of the European Network for TTR-FAP (ATTReuNET). This is an emerging group comprising representatives from 10 European countries with expertise in the diagnosis and management of TTR-FAP, including nine National Reference Centres. The current review presents management strategies and a consensus on the gold standard for diagnosis of TTR-FAP as well as a structured approach to ongoing multidisciplinary care for the patient. Greater communication, not just between members of an individual patient's treatment team, but also between regional and national centres of expertise, is the key to the effective management of TTR-FAP.

  2. European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH).

    Science.gov (United States)

    Cenzato, Marco; Boccardi, Edoardo; Beghi, Ettore; Vajkoczy, Peter; Szikora, Istvan; Motti, Enrico; Regli, Luca; Raabe, Andreas; Eliava, Shalva; Gruber, Andreas; Meling, Torstein R; Niemela, Mika; Pasqualin, Alberto; Golanov, Andrey; Karlsson, Bengt; Kemeny, Andras; Liscak, Roman; Lippitz, Bodo; Radatz, Matthias; La Camera, Alessandro; Chapot, René; Islak, Civan; Spelle, Laurent; Debernardi, Alberto; Agostoni, Elio; Revay, Martina; Morgan, Michael K

    2017-06-01

    In December of 2016, a Consensus Conference on unruptured AVM treatment, involving 24 members of the three European societies dealing with the treatment of cerebral AVMs (EANS, ESMINT, and EGKS) was held in Milan, Italy. The panel made the following statements and general recommendations: (1) Brain arteriovenous malformation (AVM) is a complex disease associated with potentially severe natural history; (2) The results of a randomized trial (ARUBA) cannot be applied equally for all unruptured brain arteriovenous malformation (uBAVM) and for all treatment modalities; (3) Considering the multiple treatment modalities available, patients with uBAVMs should be evaluated by an interdisciplinary neurovascular team consisting of neurosurgeons, neurointerventionalists, radiosurgeons, and neurologists experienced in the diagnosis and treatment of brain AVM; (4) Balancing the risk of hemorrhage and the associated restrictions of everyday activities related to untreated unruptured AVMs against the risk of treatment, there are sufficient indications to treat unruptured AVMs grade 1 and 2 (Spetzler-Martin); (5) There may be indications for treating patients with higher grades, based on a case-to-case consensus decision of the experienced team; (6) If treatment is indicated, the primary strategy should be defined by the multidisciplinary team prior to the beginning of the treatment and should aim at complete eradication of the uBAVM; (7) After having considered the pros and cons of a randomized trial vs. a registry, the panel proposed a prospective European Multidisciplinary Registry.

  3. Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People's Republic of China

    Directory of Open Access Journals (Sweden)

    Cai BQ

    2014-04-01

    disease progression and death, and causes huge medical expenditures. This consensus statement represents a description of clinical features of AECOPD in the People's Republic of China and a set of recommendations. It is intended to provide clinical guidelines for community physicians, pulmonologists and other health care providers for the prevention, diagnosis, and treatment of AECOPD. Keywords: COPD, AECOPD, recommendations, guidelines

  4. Expert consensus on an in vitro approach to assess pulmonary fibrogenic potential of aerosolized nanomaterials.

    Science.gov (United States)

    Clippinger, Amy J; Ahluwalia, Arti; Allen, David; Bonner, James C; Casey, Warren; Castranova, Vincent; David, Raymond M; Halappanavar, Sabina; Hotchkiss, Jon A; Jarabek, Annie M; Maier, Monika; Polk, William; Rothen-Rutishauser, Barbara; Sayes, Christie M; Sayre, Phil; Sharma, Monita; Stone, Vicki

    2016-07-01

    The increasing use of multi-walled carbon nanotubes (MWCNTs) in consumer products and their potential to induce adverse lung effects following inhalation has lead to much interest in better understanding the hazard associated with these nanomaterials (NMs). While the current regulatory requirement for substances of concern, such as MWCNTs, in many jurisdictions is a 90-day rodent inhalation test, the monetary, ethical, and scientific concerns associated with this test led an international expert group to convene in Washington, DC, USA, to discuss alternative approaches to evaluate the inhalation toxicity of MWCNTs. Pulmonary fibrosis was identified as a key adverse outcome linked to MWCNT exposure, and recommendations were made on the design of an in vitro assay that is predictive of the fibrotic potential of MWCNTs. While fibrosis takes weeks or months to develop in vivo, an in vitro test system may more rapidly predict fibrogenic potential by monitoring pro-fibrotic mediators (e.g., cytokines and growth factors). Therefore, the workshop discussions focused on the necessary specifications related to the development and evaluation of such an in vitro system. Recommendations were made for designing a system using lung-relevant cells co-cultured at the air-liquid interface to assess the pro-fibrogenic potential of aerosolized MWCNTs, while considering human-relevant dosimetry and NM life cycle transformations. The workshop discussions provided the fundamental design components of an air-liquid interface in vitro test system that will be subsequently expanded to the development of an alternative testing strategy to predict pulmonary toxicity and to generate data that will enable effective risk assessment of NMs.

  5. Expert and Advocacy Group Consensus Findings on the Horizon of Public Health Genetic Testing

    Directory of Open Access Journals (Sweden)

    Stephen M. Modell

    2016-01-01

    Full Text Available Description: Among the two leading causes of death in the United States, each responsible for one in every four deaths, heart disease costs Americans $300 billion, while cancer costs Americans $216 billion per year. They also rank among the top three causes of death in Europe and Asia. In 2012 the University of Michigan Center for Public Health and Community Genomics and Genetic Alliance, with the support of the Centers for Disease Control and Prevention Office of Public Health Genomics, hosted a conference in Atlanta, Georgia to consider related action strategies based on public health genomics. The aim of the conference was consensus building on recommendations to implement genetic screening for three major heritable contributors to these mortality and cost figures: hereditary breast and ovarian cancer (HBOC, familial hypercholesterolemia (FH, and Lynch syndrome (LS. Genetic applications for these three conditions are labeled with a “Tier 1” designation by the U.S. Centers for Disease Control and Prevention because they have been fully validated and clinical practice guidelines based on systematic review support them. Methodology: The conference followed a deliberative sequence starting with nationally recognized clinical and public health presenters for each condition, followed by a Patient and Community Perspectives Panel, working group sessions for each of the conditions, and a final plenary session. The 74 conference participants represented disease research and advocacy, public health, medicine and nursing, genetics, governmental health agencies, and industry. Participants drew on a public health framework interconnecting policy, clinical intervention, surveillance, and educational functions for their deliberations. Results: Participants emphasized the importance of collaboration between clinical, public health, and advocacy groups in implementing Tier 1 genetic screening. Advocacy groups could help with individual and institutional

  6. A Reliable and Valid Objective Structured Assessment of Technical Skill for the Application of a Pavlik Harness Based on International Expert Consensus.

    Science.gov (United States)

    Bradley, Catharine S; Moktar, Joel; Maxwell, Alexandra; Wedge, John H; Murnaghan, Michael L; Kelley, Simon P

    2016-01-01

    The use of competency-based training is increasing in medical education as it offers individualized learning opportunities to master required skills. Inherent to this method of teaching is the need for standardized and objective assessments of skill mastery. In orthopaedic surgery, educational programs have focused on surgical skills with lesser emphasis on nonoperative techniques. Accordingly, formal evaluation tools specific to Pavlik Harness application do not exist, despite its widespread use and potential complications from inappropriate application. This study sought to develop a reliable and valid evaluation tool based on international expert consensus to standardize and evaluate Pavlik Harness application for developmental dysplasia of the hip. Consensus was sought from 10 content experts using Delphi methodology. Resulting items formed the Objective Structured Assessment of Technical Skill (OSATS). Thirty-five participants were selected into 3 a priori groups (expert, intermediate and novice) based on Pavlik Harness experience. On 2 occasions, 3 content experts assessed randomized and deidentified videotapes of each participant applying a Pavlik Harness to an infant model using the OSATS and global rating scales (GRS). The reliability and validity of the OSATS was determined with intraclass (ICC) and Pearson correlations and analysis of variance (ANOVA). Consensus was obtained after 2 rounds of structured surveying and resulted in a 25-item OSATS. The reliability of the OSATS was excellent with an ICC of 0.96 for interrater and 0.98 for test-retest reliability. Construct validity was excellent with high correlations between OSATS and GRS (>0.90). In addition, the OSATS discriminated between expert, intermediate, and novice users. We have developed a competency-based evaluation tool for Pavlik Harness application based on consensus from international experts. The OSATS has been shown to be a reliable and valid method for assessing Pavlik Harness application

  7. The usefulness of in vitro models to predict the bioavailability of iron and zinc: A consensus statement from the HarvestPlus expert consultation

    NARCIS (Netherlands)

    Fairweather-Tait, S.; Lynch, S.; Hotz, C.; Hurrell, R.; Abrahamse, L.; Beebe, S.; Bering, S.; Bukhave, K.; Glahn, R.; Hambidge, M.; Hunt, J.; Lonnerdal, B.; Miller, D.; Mohktar, N.; Nestel, P.; Reddy, M.; Sandberg, A.S.; Sharp, P.; Teucher, B.; Trinidad, T.P.

    2005-01-01

    A combination of dietary and host-related factors determines iron and zinc absorption, and several in vitro methods have been developed as preliminary screening tools for assessing bioavailability. An expert committee has reviewed evidence for their usefulness and reached a consensus. Dialyzability

  8. Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis: A Delphi method consensus initiative among experts in Italy

    Directory of Open Access Journals (Sweden)

    Marco Paoloni

    2015-06-01

    Full Text Available OBJECTIVE: The aim of the study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile, as well as the medico-legal and organizational aspects of intra-articular injection therapies for osteoarthritis. METHODS: A committee of 10 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Fifty-two clinicians from a large number of Italian medical centers specialized in intra-articular injection therapy took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical device choice; treatment efficacy; and appropriate setting. CONCLUSIONS: The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat osteoarthritis patients by means of intra-articular injection therapies.

  9. Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey.

    Science.gov (United States)

    Rothermundt, Christian; Fischer, Galina F; Bauer, Sebastian; Blay, Jean-Yves; Grünwald, Viktor; Italiano, Antoine; Kasper, Bernd; Kollár, Attila; Lindner, Lars H; Miah, Aisha; Sleijfer, Stefan; Stacchiotti, Silvia; Putora, Paul Martin

    2017-11-30

    The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre- and postoperative chemotherapy is unclear and debated among experts. Medical oncology experts of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group were asked to participate in this survey on the use of pre- and postoperative chemotherapy in STS. Experts from 12 centers in Belgium, France, Germany, Great Britain, Italy, Switzerland, and The Netherlands agreed to participate and provided their treatment algorithm. Answers were converted into decision trees based on the objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies. Several criteria used for decision-making in extremity STS were identified: chemosensitivity, fitness, grading, location, and size. In addition, resectability and resection status were relevant in the pre- and postoperative setting, respectively. Preoperative chemotherapy is considered in most centers for marginally resectable tumors only. Yet, in some centers, neoadjuvant chemotherapy is used routinely and partially combined with hyperthermia. Although most centers do not recommend postoperative chemotherapy, some offer this treatment on a regular basis. Radiotherapy is an undisputed treatment modality in extremity STS. Due to lacking evidence on the utility of pre- and postoperative chemotherapy in localized extremity STS, treatment strategies vary considerably among European experts. The majority recommended neoadjuvant chemotherapy for marginally resectable grade 2-3 tumors; the majority did not recommend postoperative chemotherapy in any setting. The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre- and postoperative chemotherapy is unclear and debated among experts. This study analyzed the decision-making process among 12 European experts on systemic therapy for STS. A wide range of

  10. Communication in Health Professions: A European consensus on inter- and multi-professional learning objectives in German.

    Science.gov (United States)

    Bachmann, Cadja; Kiessling, Claudia; Härtl, Anja; Haak, Rainer

    2016-01-01

    Communication is object of increasing attention in the health professions. Teaching communication competencies should already begin in undergraduate education or pre-registration training. The aim of this project was to translate the Health Professions Core Communication Curriculum (HPCCC), an English catalogue of learning objectives, into German to make its content widely accessible in the German-speaking countries. This catalogue lists 61 educational objectives and was agreed on by 121 international communication experts. A European reference framework for inter- and multi-professional curriculum development for communication in the health professions in German-speaking countries should be provided. The German version of the HPCCC was drafted by six academics and went through multiple revisions until consensus was reached. The learning objectives were paired with appropriate teaching and assessment tools drawn from the database of the teaching Committee of the European Association for Communication Health Care (tEACH). The HPCCC learning objectives are now available in German and can be applied for curriculum planning and development in the different German-speaking health professions, the educational objectives can also be used for inter-professional purposes. Examples for teaching methods and assessment tools are given for using and implementing the objectives. The German version of the HPCCC with learning objectives for communication in health professions can contribute significantly to inter- and multi-professional curriculum development in the health care professions in the German-speaking countries. Examples for teaching methods and assessment tools from the materials compiled by tEACH supplement the curricular content and provide suggestions for practical implementation of the learning objectives in teaching and assessment. The relevance of the German HPCCC to the processes of curriculum development for the various health professions and inter

  11. How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting

    Science.gov (United States)

    Breckenridge, Kate; Bekker, Hillary L.; Gibbons, Elizabeth; van der Veer, Sabine N.; Abbott, Denise; Briançon, Serge; Cullen, Ron; Garneata, Liliana; Jager, Kitty J.; Lønning, Kjersti; Metcalfe, Wendy; Morton, Rachael L.; Murtagh, Fliss E.M.; Prutz, Karl; Robertson, Susan; Rychlik, Ivan; Schon, Steffan; Sharp, Linda; Speyer, Elodie; Tentori, Francesca; Caskey, Fergus J.

    2015-01-01

    Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF

  12. Developing an internationally-applicable service specification for continence care: systematic review, evidence synthesis and expert consensus.

    Directory of Open Access Journals (Sweden)

    Adrian S Wagg

    Full Text Available Global demographic trends suggest that the incidence of both urinary and faecal incontinence will rise in the coming years, bringing significant health and economic implications for both patients and payers. There is limited organisational evidence to guide payers and providers about service configuration which will deliver efficient guideline-compliant, high-quality patient care.To create, using evidence from a systematic review, qualitative data and expert consensus an internationally applicable service specification for continence care.Evidence was obtained from a systematic and grey literature review of published randomised controlled trials and quasi-experimental studies reporting efficacy of continence service design at the level of the community dwelling patient with either bladder or bowel incontinence, governmental reports and policy frameworks supplemented by data from 47 semi-structured interviews with clinicians, patients, patient-representatives and policy experts from four geographies broadly representative of different healthcare systems.A number of themes related to current and potential future organisation of continence care were identified from the data. A modular service specification with eight core components was created including case detection, initial assessment and treatment, case co-ordination, caregiver support, community-based support, specialist assessment and treatment, use of containment products, and use of technology. Within this framework important key recommendations are: ensure robust referral pathways, shift assessment for case coordination to nurses specializing in continence care, promote self-management and technology, use comprehensive assessment tools and service performance targets based on outcome and operational measures.This study has defined practice gaps in the provision of continence services and described eight core components of a service specification for incontinence that commissioners and

  13. Expert Panel Workshop Consensus Statement on the Role of the Environment in the Development of Autoimmune Disease

    Directory of Open Access Journals (Sweden)

    Christine G. Parks

    2014-08-01

    Full Text Available Autoimmune diseases include 80 or more complex disorders characterized by self-reactive, pathologic immune responses in which genetic susceptibility is largely insufficient to determine disease onset. In September 2010, the National Institute of Environmental Health Sciences (NIEHS organized an expert panel workshop to evaluate the role of environmental factors in autoimmune diseases, and the state of the science regarding relevant mechanisms, animal models, and human studies. The objective of the workshop was to analyze the existing data to identify conclusions that could be drawn regarding environmental exposures and autoimmunity and to identify critical knowledge gaps and areas of uncertainty for future study. This consensus document summarizes key findings from published workshop monographs on areas in which “confident” and “likely” assessments were made, with recommendations for further research. Transcribed notes and slides were reviewed to synthesize an overview on exposure assessment and questions addressed by interdisciplinary panels. Critical advances in the field of autoimmune disease research have been made in the past decade. Collaborative translational and interdisciplinary research is needed to elucidate the role of environmental factors in autoimmune diseases. A focus on exposure assessment methodology is needed to improve the effectiveness of human studies, and more experimental studies are needed to focus on causal mechanisms underlying observed associations of environmental factors with autoimmune disease in humans.

  14. Expert Panel Workshop Consensus Statement on the Role of the Environment in the Development of Autoimmune Disease

    Science.gov (United States)

    Parks, Christine G.; Miller, Frederick W.; Pollard, Kenneth Michael; Selmi, Carlo; Germolec, Dori; Joyce, Kelly; Rose, Noel R.; Humble, Michael C.

    2014-01-01

    Autoimmune diseases include 80 or more complex disorders characterized by self-reactive, pathologic immune responses in which genetic susceptibility is largely insufficient to determine disease onset. In September 2010, the National Institute of Environmental Health Sciences (NIEHS) organized an expert panel workshop to evaluate the role of environmental factors in autoimmune diseases, and the state of the science regarding relevant mechanisms, animal models, and human studies. The objective of the workshop was to analyze the existing data to identify conclusions that could be drawn regarding environmental exposures and autoimmunity and to identify critical knowledge gaps and areas of uncertainty for future study. This consensus document summarizes key findings from published workshop monographs on areas in which “confident” and “likely” assessments were made, with recommendations for further research. Transcribed notes and slides were reviewed to synthesize an overview on exposure assessment and questions addressed by interdisciplinary panels. Critical advances in the field of autoimmune disease research have been made in the past decade. Collaborative translational and interdisciplinary research is needed to elucidate the role of environmental factors in autoimmune diseases. A focus on exposure assessment methodology is needed to improve the effectiveness of human studies, and more experimental studies are needed to focus on causal mechanisms underlying observed associations of environmental factors with autoimmune disease in humans. PMID:25196523

  15. Juvenile psoriasis and its clinical management: a European expert group consensus.

    NARCIS (Netherlands)

    Stahle, M.; Atakan, N.; Boehncke, W.H.; Chimenti, S.; Dauden, E.; Giannetti, A.; Hoeger, P.; Joly, P.; Katsambas, A.; Kragballe, K.; Lambert, J.; Ortonne, J.P.; Prinz, J.C.; Puig, L.; Seyger, M.; Strohal, R.; Kerkhof, P.C.M. van de; Sterry, W.

    2010-01-01

    BACKGROUND: Psoriasis, an inflammatory disorder of the skin, can significantly impact on a patient's quality of life, affecting their daily activities and families. The onset of psoriasis in childhood is quite common; however, the treatment of moderate-to-severe disease in this population is

  16. Optimal management of metastatic castration-resistant prostate cancer: Highlights from a European Expert Consensus Panel

    NARCIS (Netherlands)

    J.M. Fitzpatrick (John); J. Bellmunt (Joaquim); K. Fizazi (Karim); A. Heidenreich (Axel); C.N. Sternberg (Cora); B. Tombal (Bertrand); A. Alcaraz (Antonio); A. Bahl (Amit); S. Bracarda (Sergio); G. Di Lorenzo (Giuseppe); E. Efstathiou (Eleni); S.P. Finn (Stephen); S.D. Fossa (Sophie); S. Gillessen (Silke); P.-L. Kellokumpu-Lehtinen (Pirkko-Liisa); F.E. Lecouvet (Frédéric); S. Oudard (Stéphane); T.M. de Reijke (Theo); C.N. Robson (Craig); M. de Santis (Maria); B. Seruga (Bostjan); R. de Wit (Ronald)

    2014-01-01

    textabstractThe exponential growth of novel therapies for the treatment of metastatic castration-resistant prostate cancer (mCRPC) over the last decade has created an acute need for education and guidance of clinicians regarding optimal strategies for patient management. A multidisciplinary panel of

  17. Expert consensus document

    DEFF Research Database (Denmark)

    Brioude, Frédéric; Kalish, Jennifer M; Mussa, Alessandro

    2018-01-01

    Beckwith-Wiedemann syndrome (BWS), a human genomic imprinting disorder, is characterized by phenotypic variability that might include overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycaemia, lateralized overgrowth and predisposition to embryonal tumours. Delineation of the molecu...

  18. Expert consensus document

    DEFF Research Database (Denmark)

    Boehm, Ulrich; Bouloux, Pierre-Marc; Dattani, Mehul T

    2015-01-01

    migration of GnRH-synthesizing neurons. CHH can be challenging to diagnose, particularly when attempting to differentiate it from constitutional delay of puberty. A timely diagnosis and treatment to induce puberty can be beneficial for sexual, bone and metabolic health, and might help minimize some...

  19. A probabilistic characterization of the relationship between fine particulate matter and mortality: elicitation of European experts.

    Science.gov (United States)

    Cooke, Roger M; Wilson, Andrew M; Tuomisto, Jouni T; Morales, Oswaldo; Tainio, Marko; Evans, John S

    2007-09-15

    In support of an assessment of the mortality impacts of the Kuwait Oil Fires we interviewed six European experts in epidemiology and toxicology using formal procedures for elicitation of expert judgment. While the primary focus of the elicitations was to characterize the public health impacts of the fires, the experts provided quantitative estimates of the mortality impacts of hypothetical changes in the levels of ambient fine particulate matter (PM2.5) in both the United States and Europe. Uncertainty was assessed by asking each expert to provide the 5th, 25th, 50th, 75th, and 90th percentiles of their subjective cumulative probability density function for each quantity of interest. The results suggest that many regulatory risk assessments underestimate the impacts of PM2.5 mortality; confirm that only a small fraction of the mortality impact occurs within the first few months after exposure; and indicate that it may be important to better address the differential toxicities of particles from various source classes. By providing quantitative estimates of the uncertainty in current estimates of PM2.5 mortality risks, the study facilitates structured analysis of the value of further research on PM2.5 and its impacts.

  20. Bridging the gap between content and context: establishing expert consensus on the content of an exercise training program to prevent lower-limb injuries.

    Science.gov (United States)

    Donaldson, Alex; Cook, Jill; Gabbe, Belinda; Lloyd, David G; Young, Warren; Finch, Caroline F

    2015-05-01

    To achieve expert consensus on the content of an exercise training program (known as FootyFirst) to prevent lower-limb injuries. Three-round online Delphi consultation process. Community Australian Football (AF). Members of the Australian Football Leagues' Medical Officers (n = 94), physiotherapists (n = 50), and Sports Science (n = 19) Associations were invited to participate through e-mail. Five people with more general expertise in sports-related lower-limb injury prevention were also invited to participate. The primary outcome measure was the level of agreement on the appropriateness of the proposed exercises and progressions for inclusion in FootyFirst. Consensus was reached when ≥75% of experts who responded to each item agreed and strongly agreed, or disagreed and strongly disagreed, that an exercise or its progressions were appropriate to include in FootyFirst. Fifty-five experts participated in at least 1 Delphi round. In round 1, consensus was achieved that the proposed warm-up (run through and dynamic stretches) and the exercises and progressions for hamstring strength and for balance, landing, and changing direction were appropriate to include in FootyFirst. There was also consensus in round 1 that progressions for hip/core strength should be included in FootyFirst. Consensus was reached in round 2 that the revised groin strength and hip strength exercises should be included in FootyFirst. Consensus was reached for the progression of the groin strength exercises in round 3. The formal consensus development process has resulted in an evidence-informed, researcher-developed, exercise-based sports injury prevention program that is expert endorsed and specific to the context of AF. Lower-limb injuries are common in running, kicking, and contact sports like AF. These injuries are often costly to treat, and many have high rates of recurrence, making them challenging to treat clinically. Reducing these injuries is a high priority for players, teams, and

  1. US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis: executive summary.

    Science.gov (United States)

    Floto, R Andres; Olivier, Kenneth N; Saiman, Lisa; Daley, Charles L; Herrmann, Jean-Louis; Nick, Jerry A; Noone, Peadar G; Bilton, Diana; Corris, Paul; Gibson, Ronald L; Hempstead, Sarah E; Koetz, Karsten; Sabadosa, Kathryn A; Sermet-Gaudelus, Isabelle; Smyth, Alan R; van Ingen, Jakko; Wallace, Richard J; Winthrop, Kevin L; Marshall, Bruce C; Haworth, Charles S

    2016-01-01

    Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with pre-existing inflammatory lung disease, such as cystic fibrosis (CF). Pulmonary disease (PD) caused by NTM has emerged as a major threat to the health of individuals with CF, but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened a panel of 19 experts to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM-PD in individuals with CF. PICO (population, intervention, comparison, outcome) methodology and systematic literature reviews were employed to inform draft recommendations, which were then modified to achieve consensus and subsequently circulated for public consultation within the USA and European CF communities. We have thus generated a series of pragmatic, evidence-based recommendations as an initial step in optimising management for this challenging condition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis.

    Science.gov (United States)

    Floto, R Andres; Olivier, Kenneth N; Saiman, Lisa; Daley, Charles L; Herrmann, Jean-Louis; Nick, Jerry A; Noone, Peadar G; Bilton, Diana; Corris, Paul; Gibson, Ronald L; Hempstead, Sarah E; Koetz, Karsten; Sabadosa, Kathryn A; Sermet-Gaudelus, Isabelle; Smyth, Alan R; van Ingen, Jakko; Wallace, Richard J; Winthrop, Kevin L; Marshall, Bruce C; Haworth, Charles S

    2016-01-01

    Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with pre-existing inflammatory lung disease such as cystic fibrosis (CF). Pulmonary disease caused by NTM has emerged as a major threat to the health of individuals with CF but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened an expert panel of specialists to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM pulmonary disease in individuals with CF. Nineteen experts were invited to participate in the recommendation development process. Population, Intervention, Comparison, Outcome (PICO) methodology and systematic literature reviews were employed to inform draft recommendations. An anonymous voting process was used by the committee to reach consensus. All committee members were asked to rate each statement on a scale of: 0, completely disagree, to 9, completely agree; with 80% or more of scores between 7 and 9 being considered 'good' agreement. Additionally, the committee solicited feedback from the CF communities in the USA and Europe and considered the feedback in the development of the final recommendation statements. Three rounds of voting were conducted to achieve 80% consensus for each recommendation statement. Through this process, we have generated a series of pragmatic, evidence-based recommendations for the screening, investigation, diagnosis and treatment of NTM infection in individuals with CF as an initial step in optimising management for this challenging condition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Enzyme Replacement Therapy and/or Hematopoietic Stem Cell Transplantation at diagnosis in patients with Mucopolysaccharidosis type I: results of a European consensus procedure

    LENUS (Irish Health Repository)

    de Ru, Minke H

    2011-08-10

    Abstract Background Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disorder that results in the accumulation of glycosaminoglycans causing progressive multi-organ dysfunction. Its clinical spectrum is very broad and varies from the severe Hurler phenotype (MPS I-H) which is characterized by early and progressive central nervous system (CNS) involvement to the attenuated Scheie phenotype (MPS I-S) with no CNS involvement. Indication, optimal timing, safety and efficacy of the two available treatment options for MPS I, enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT), are subject to continuing debate. A European consensus procedure was organized to reach consensus about the use of these two treatment strategies. Methods A panel of specialists, including 8 specialists for metabolic disorders and 7 bone marrow transplant physicians, all with acknowledged expertise in MPS I, participated in a modified Delphi process to develop consensus-based statements on MPS I treatment. Fifteen MPS I case histories were used to initiate the discussion and to anchor decisions around either treatment mode. Before and at the meeting all experts gave their opinion on the cases (YES\\/NO transplantation) and reasons for their decisions were collected. A set of draft statements on MPS I treatment options composed by a planning committee were discussed and revised during the meeting until full consensus. Results Full consensus was reached on several important issues, including the following: 1) The preferred treatment for patients with MPS I-H diagnosed before age 2.5 yrs is HSCT; 2) In individual patients with an intermediate phenotype HSCT may be considered if there is a suitable donor. However, there are no data on efficacy of HSCT in patients with this phenotype; 3) All MPS I patients including those who have not been transplanted or whose graft has failed may benefit significantly from ERT; 4) ERT should be started at diagnosis and may be

  4. Enzyme replacement therapy and/or hematopoietic stem cell transplantation at diagnosis in patients with mucopolysaccharidosis type I: results of a European consensus procedure

    Directory of Open Access Journals (Sweden)

    Sykora Karl-Walter

    2011-08-01

    Full Text Available Abstract Background Mucopolysaccharidosis type I (MPS I is a lysosomal storage disorder that results in the accumulation of glycosaminoglycans causing progressive multi-organ dysfunction. Its clinical spectrum is very broad and varies from the severe Hurler phenotype (MPS I-H which is characterized by early and progressive central nervous system (CNS involvement to the attenuated Scheie phenotype (MPS I-S with no CNS involvement. Indication, optimal timing, safety and efficacy of the two available treatment options for MPS I, enzyme replacement therapy (ERT and hematopoietic stem cell transplantation (HSCT, are subject to continuing debate. A European consensus procedure was organized to reach consensus about the use of these two treatment strategies. Methods A panel of specialists, including 8 specialists for metabolic disorders and 7 bone marrow transplant physicians, all with acknowledged expertise in MPS I, participated in a modified Delphi process to develop consensus-based statements on MPS I treatment. Fifteen MPS I case histories were used to initiate the discussion and to anchor decisions around either treatment mode. Before and at the meeting all experts gave their opinion on the cases (YES/NO transplantation and reasons for their decisions were collected. A set of draft statements on MPS I treatment options composed by a planning committee were discussed and revised during the meeting until full consensus. Results Full consensus was reached on several important issues, including the following: 1 The preferred treatment for patients with MPS I-H diagnosed before age 2.5 yrs is HSCT; 2 In individual patients with an intermediate phenotype HSCT may be considered if there is a suitable donor. However, there are no data on efficacy of HSCT in patients with this phenotype; 3 All MPS I patients including those who have not been transplanted or whose graft has failed may benefit significantly from ERT; 4 ERT should be started at diagnosis and

  5. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline.

    Science.gov (United States)

    Stratigos, Alexander; Garbe, Claus; Lebbe, Celeste; Malvehy, Josep; del Marmol, Veronique; Pehamberger, Hubert; Peris, Ketty; Becker, Jürgen C; Zalaudek, Iris; Saiag, Philippe; Middleton, Mark R; Bastholt, Lars; Testori, Alessandro; Grob, Jean-Jacques

    2015-09-01

    Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in Caucasian populations, accounting for 20% of all cutaneous malignancies. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on cSCC diagnosis and management, based on a critical review of the literature, existing guidelines and the expert's experience. The diagnosis of cSCC is primarily based on clinical features. A biopsy or excision and histologic confirmation should be performed in all clinically suspicious lesions in order to facilitate the prognostic classification and correct management of cSCC. The first line treatment of cutaneous SCC is complete surgical excision with histopathological control of excision margins. The EDF-EADO-EORTC consensus group recommends a standardised minimal margin of 5 mm even for low-risk tumours. For tumours, with histological thickness of >6 mm or in tumours with high risk pathological features, e.g. high histological grade, subcutaneous invasion, perineural invasion, recurrent tumours and/or tumours at high risk locations an extended margin of 10 mm is recommended. As lymph node involvement by cSCC increases the risk of recurrence and mortality, a lymph node ultrasound is highly recommended, particularly in tumours with high-risk characteristics. In the case of clinical suspicion or positive findings upon imaging, a histologic confirmation should be sought either by fine needle aspiration or by open lymph node biopsy. In large infiltrating tumours with signs of involvement of underlying structures, additional imaging tests, such as CT or MRI imaging may be required to accurately assess the extent of the tumour and the presence of metastatic spread. Current staging systems for cSCC are not optimal, as they have been developed for head and neck

  6. European Experimental Re-Entry Testbed EXPERT: Qualification of Payloads for Flight

    Science.gov (United States)

    Ratti, F.; Gavira, J.; Thirkettle, A. C.; Erba, F.; Muylaert, J.-M.; Walpot, L.; Rembiasz, J. M.

    2009-01-01

    The European Experimental Re-entry Test-bed EXPERT is developed by the European Space Agency (ESA) as part of its General Technological Research Program (GSTP). The aim of EXPERT is to improve the understanding of critical aero-thermodynamic phenomena associated with hypersonic re-entry flights. The EXPERT project provides an opportunity to the scientific community and industries throughout Europe to propose and perform experiments in order to obtain aero-thermodynamic data for the validation of numerical models and of ground to flight extrapolation methodologies. During the last years an intense activity has been performed at ESA in order to select the most suitable experiments, bring them to a mature design, manufacture the qualification model and qualify the experiments for flight. ESA staffs coordinated and supported the work of the principal investigators of the experiments from European institutions and industrial organizations in order to maximize the scientific output in compliance with the budget resources made available to the EXPERT project and the programmatic constraints. EXPERT is a re-entry capsule having the shape of a blunted cone. The front part consists of a nose made of ceramic material developed at DLR Stuttgart. No ablative material is implemented so as not to contaminate the specific measurements of Payloads on board. The ceramic nose hosts a set of experiments: the Flush Air Data System (FADS) developed by HTG aiming at collecting free flow data required for post flight analysis, the pyrometer PYREX developed at IRS in Stuttgart collecting data on the temperature and heat flux of the ceramic nose, and the IRS spectrometer RESPECT aiming at resolving the different species generated in the plasma region during re-entry. The sides of the blunted cone are protected by a metallic thermal protection system in which several experiments are located. Two Payloads developed by IRS and VKI are dedicated to the measurement of catalytic effects. One aims

  7. Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel

    NARCIS (Netherlands)

    James, Andra H.; Kouides, Peter A.; Abdul-Kadir, Rezan; Edlund, Mans; Federici, Augusto B.; Halimeh, Susan; Kamphuisen, Pieter W.; Konkle, Barbara A.; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Winikoff, Rochelle

    2009-01-01

    Reproductive tract bleeding in women is a naturally occurring event during menstruation and childbirth. In women with menorrhagia, however, congenital bleeding disorders historically have been underdiagnosed. This consensus is intended to allow physicians to better recognize bleeding disorders as a

  8. The view of European experts regarding health economics for medical nutrition in disease-related malnutrition.

    Science.gov (United States)

    Freijer, K; Lenoir-Wijnkoop, I; Russell, C A; Koopmanschap, M A; Kruizenga, H M; Lhachimi, S K; Norman, K; Nuijten, M J C; Schols, J M G A

    2015-05-01

    Health-care systems are currently facing tremendous budget constraints resulting in growing pressure on decision makers and health-care providers to obtain the maximum possible health benefits of the resources available. Choices have to be made, and health economics can help in allocating limited health-care resources among unlimited wants and needs. Attempts to achieve cost reductions often focus on severe pathologies and chronic diseases as they commonly represent high health-care expenditures. In this context, awareness of the considerable financial burden caused by disease-related malnutrition (DRM) is lacking. Possibilities of reducing costs by optimising the management of DRM through medical nutrition will mostly not even be taken into account. During a European expert meeting, the total evaluation of medical nutrition was viewed and discussed. The aim of this meeting was to gain an experts' outline of the key issues relating to the health economic assessment of the use of medical nutrition. This article provides a summary of the observations per discussed item and describes the next steps suggested.

  9. European Crohn's and Colitis Organisation Topical Review on Treatment Withdrawal ('Exit Strategies') in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Doherty, Glen; Katsanos, Konstantinos H; Burisch, Johan

    2017-01-01

    reduction or stopping of treatment. A consensus expert panel convened by the European Crohn's and Colitis Organisation (ECCO) reviewed the published literature and agreed a series of consensus practice points. The objective of the expert consensus is to provide evidence-based guidance for clinical practice...

  10. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer

    Science.gov (United States)

    Colombo, Nicoletta; Creutzberg, Carien; Amant, Frederic; Bosse, Tjalling; González-Martín, Antonio; Ledermann, Jonathan; Marth, Christian; Nout, Remi; Querleu, Denis; Mirza, Mansoor Raza; Sessa, Cristiana

    2016-01-01

    Abstract The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article. PMID:26645990

  11. Delphi consensus of an expert committee in oncogeriatrics regarding comprehensive geriatric assessment in seniors with cancer in Spain.

    Science.gov (United States)

    Molina-Garrido, Maria-Jose; Guillén-Ponce, Carmen; Blanco, Remei; Saldaña, Juana; Feliú, Jaime; Antonio, Maite; López-Mongil, Rosa; Ramos Cordero, Primitivo; Gironés, Regina

    2017-12-13

    The aim of this work was to reach a national consensus in Spain regarding the Comprehensive Geriatric Assessment (CGA) domains in older oncological patients and the CGA scales to be used as a foundation for widespread use. The Delphi method was implemented to attain consensus. Representatives of the panel were chosen from among the members of the Oncogeriatric Working Group of the Spanish Society of Medical Oncology (SEOM). Consensus was defined as ≥66.7% coincidence in responses and by the stability of said coincidence (changes ≤15% between rounds). The study was conducted between July and December 2016. Of the 17 people invited to participate, 16 agreed. The panel concluded by consensus that the following domains should be included in the CGA:(and the scales to evaluate them): functional (Barthel Index, Lawton-Brody scale, gait speed), cognitive (Pfeiffer questionnaire), nutritional (Mini Nutritional Assessment - MNA), psychological/mood (Yesavage scale), social-familial (Gijon scale), comorbidity (Charlson index), medications, and geriatric syndromes (urinary and/or fecal incontinence, low auditory and/or visual acuity, presence of falls, pressure sores, insomnia, and abuse). Also by consensus, the CGA should be administered to older patients with cancer for whom there is a subsequent therapeutic intent and who scored positive on a previous frailty-screening questionnaire. After 3 rounds, consensus was reached regarding CGA domains to be used in older patients with cancer, the scales to be administered for each of these domains, as well as the timeline to be followed during consultation. Copyright © 2017. Published by Elsevier Ltd.

  12. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus.

    Science.gov (United States)

    Dejaco, Christian; Duftner, Christina; Cimmino, Marco A; Dasgupta, Bhaskar; Salvarani, Carlo; Crowson, Cynthia S; Maradit-Kremers, Hilal; Hutchings, Andrew; Matteson, Eric L; Schirmer, Michael

    2011-03-01

    To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus. Relevant studies including definitions of PMR remission and relapse were identified by literature search in PubMed. The questionnaire used for the Delphi survey included clinical (n=33), laboratory (n=54) and imaging (n=7) parameters retrieved from a literature search. Each item was assessed for importance and availability/practicability, and limits were considered for metric parameters. Consensus was defined by an agreement rate of ≥80%. Out of 6031 articles screened, definitions of PMR remission and relapse were available in 18 and 34 studies, respectively. Parameters used to define remission and/or relapse included history and clinical assessment of pain and synovitis, constitutional symptoms, morning stiffness (MS), physician's global assessment, headache, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count, fibrinogen and/or corticosteroid therapy. In the Delphi exercise a consensus was obtained on the following parameters deemed essential for definitions of remission and relapse: patient's pain assessment, MS, ESR, CRP, shoulder and hip pain on clinical examination, limitation of upper limb elevation, and assessment of corticosteroid dose required to control symptoms. Assessment of patient's pain, MS, ESR, CRP, shoulder pain/limitation on clinical examination and corticosteroid dose are considered to be important in current available definitions of PMR remission and relapse and the present expert consensus. The high relevance of clinical assessment of hips was unique to this study and may improve specificity and sensitivity of definitions for remission and relapse in PMR.

  13. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease

    Science.gov (United States)

    2013-01-01

    Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed. PMID:23763839

  14. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel

    NARCIS (Netherlands)

    James, Andra H.; Kouides, Peter A.; Abdul-Kadir, Rezan; Dietrich, Jennifer E.; Edlund, Mans; Federici, Augusto B.; Halimeh, Susan; Kamphuisen, Pieter Willem; Lee, Christine A.; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Philipp, Claire; Wilkinson, Jeffrey; Winikoff, Rochelle

    2011-01-01

    Acute menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology

  15. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

    NARCIS (Netherlands)

    Stroes, Erik S.; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; de Backer, Guy; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; Hegele, Robert A.; Hovingh, G. Kees; Leiter, Lawrence A.; Mach, Francois; März, Winfried; Newman, Connie B.; Wiklund, Olov; Jacobson, Terry A.; Catapano, Alberico L.; Chapman, M. John; Ginsberg, Henry N.; Leiter, Lawrence

    2015-01-01

    Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of

  16. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

    NARCIS (Netherlands)

    Trenkwalder, Claudia; Chaudhuri, K. Ray; Garcia Ruiz, Pedro J.; LeWitt, Peter; Katzenschlager, Regina; Sixel-Doering, Friederike; Henriksen, Tove; Sesar, Angel; Poewe, Werner; Baker, Mary; Ceballos-Baumann, Andres; Deuschl, Guenther; Drapier, Sophie; Ebersbach, Georg; Evans, Andrew; Fernandez, Hubert; Isaacson, Stuart; van Laar, Teus; Lees, Andrew; Lewis, Simon; Martinez Castrillo, Juan Carlos; Martinez-Martin, Pablo; Odin, Per; O'Sullivan, John; Tagaris, Georgios; Wenzel, Karoline

    Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical

  17. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up

    National Research Council Canada - National Science Library

    Colombo, Nicoletta; Creutzberg, Carien; Amant, Frederic; Bosse, Tjalling; González-Martín, Antonio; Ledermann, Jonathan; Marth, Christian; Nout, Remi; Querleu, Denis; Mirza, Mansoor Raza; Sessa, Cristiana

    2015-01-01

    ...) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer...

  18. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up

    National Research Council Canada - National Science Library

    Colombo, N; Creutzberg, C; Amant, F; Bosse, T; González-Martín, A; Ledermann, J; Marth, C; Nout, R; Querleu, D; Mirza, M R; Sessa, C

    2016-01-01

    ...) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer...

  19. Revised guidelines for the clinical management of Lynch syndrome (HNPCC) : Recommendations by a group of European experts

    NARCIS (Netherlands)

    Vasen, Hans F. A.; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P.; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M.; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J.; Hodgson, Shirley V.; Karagiannis, John A.; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Moller, Pal; Myrhoj, Torben; Nagengast, Fokko M.; Parc, Yann; de Leon, Maurizio Ponz; Renkonen-Sinisalo, Laura; Sampson, Julian R.; Stormorken, Astrid; Sijmons, Rolf H.; Tejpar, Sabine; Thomas, Huw J. W.; Rahner, Nils; Wijnen, Juul T.; Jaervinen, Heikki Juhani; Moeslein, Gabriela; Jarvinen, H.J.; Moslein, G.

    Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for

  20. Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis : a European consensus

    NARCIS (Netherlands)

    Döring, G; Conway, S P; Heijerman, H G; Hodson, M E; Høiby, N; Smyth, A; Touw, D J

    2000-01-01

    Cystic fibrosis (CF) is the most common lethal hereditary disorder with autosomal recessive heredity in caucasians. The majority of CF patients suffer from chronic respiratory infection with the opportunistic bacterial pathogen Pseudomonas aeruginosa. No consensus among clinicians has been reached

  1. A European consensus on outcome measures for psychosocial intervention research in dementia care

    NARCIS (Netherlands)

    Moniz-Cook, E.; Vernooy-Dassen, M.J.F.J.; Woods, R.; Verhey, F.; Chattat, R.; Vugt, M. de; Mountain, G.; O'Connell, M.; Harrison, J.; Vasse, E.; Droes, R.M.; Orrell, M.

    2008-01-01

    Psychosocial intervention makes a vital contribution to dementia care. However, the lack of consensus about which outcome measures to use to evaluate effectiveness prevents meaningful comparisons between different studies and interventions. This study used an iterative collaborative, evidence-based

  2. Management of intrathecal catheter-tip inflammatory masses: an updated 2007 consensus statement from an expert panel.

    Science.gov (United States)

    Deer, Timothy; Krames, Elliot S; Hassenbusch, Samuel; Burton, Allen; Caraway, David; Dupen, Stuart; Eisenach, James; Erdek, Michael; Grigsby, Eric; Kim, Phillip; Levy, Robert; McDowell, Gladstone; Mekhail, Nagy; Panchal, Sunil; Prager, Joshua; Rauck, Richard; Saulino, Michael; Sitzman, Todd; Staats, Peter; Stanton-Hicks, Michael; Stearns, Lisa; Dean Willis, K; Witt, William; Follett, Kenneth; Huntoon, Mark; Liem, Leong; Rathmell, James; Wallace, Mark; Buchser, Eric; Cousins, Michael; Ver Donck, Ann

    2008-04-01

    Background.  Expert panel of physicians and nonphysicians, all expert in intrathecal (IT) therapies, convened in the years 2000 and 2003 to make recommendations for the rational use of IT analgesics based on the preclinical and clinical literature known up to those times, presentations of the expert panel, discussions on current practice and standards, and the result of surveys of physicians using IT agents. An expert panel of physicians and convened in 2007 to review previous recommendations and to form recommendations for the rational use of IT agents as they pertain to new scientific and clinical information regarding the etiology, prevention and treatment for IT granuloma. Method.  A review of preclinical and clinical literature from 2000 to 2006 was undertaken and disseminated to an expert panel of physicians. Focused discussions concerning the rational use of IT agents and its relationship to the etiology of, prevention of, and treatment of IT granuloma were held. Results.  This report presents here new knowledge of the etiology of catheter tip granuloma and guidelines for its prevention and treatment. © 2008 International Neuromodulation Society.

  3. Core elements of epilepsy diagnosis and management: expert consensus from the Leadership in Epilepsy, Advocacy, and Development (LEAD) faculty.

    Science.gov (United States)

    Glauser, Tracy A; Sankar, Raman

    2008-12-01

    Although epilepsy is relatively common, only a limited number of specialized epilepsy centers exist in the United States. Therefore, epilepsy diagnosis and management frequently occur in the community setting. This can complicate patient management and suboptimal care is a potential concern. Delayed recognition and inadequate treatment increase the risk of subsequent seizures, brain damage, disability, and death from seizure-related injuries. To identify core elements of epilepsy management that should be offered to all patients, the Leadership in Epilepsy, Advocacy, and Development (LEAD) faculty assessed current practical issues and identified practices to improve patient care and outcomes. This paper presents a consensus opinion formed from a survey of 26 current LEAD faculty members, who answered 105 questions about epilepsy diagnosis and patient evaluation, treatment decisions, lifelong monitoring, and the management of special patient subgroups. Consensus agreement was concluded when >or=50% of the faculty provided the same answer. The results were compiled and areas of consensus are included in this report. The recommendations provided in this commentary are limited by the scope of the survey. Consensus was reached on several minimum standard patient management practices. Primary among these minimum standards of care is the need for diagnosis including a detailed medical history, neurological examination, discussions with caregivers, and diagnostic tests including electroencephalograms and magnetic resonance imaging. As the overall goals of therapy include seizure freedom, minimizing side effects, and improving quality of life and long-term safety, therapy decisions should consider parameters that affect these goals, including potential adverse effects of therapy. Antiepileptic drug selection should consider coexisting conditions for possible exacerbation of disease and potential drug-drug interactions. The core elements of epilepsy management identified

  4. Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus.

    Science.gov (United States)

    Young, Susan; Absoud, Michael; Blackburn, Carolyn; Branney, Polly; Colley, Bill; Farrag, Emad; Fleisher, Susan; Gregory, Ges; Gudjonsson, Gisli H; Kim, Keira; O'Malley, Kieran D; Plant, Moira; Rodriguez, Alina; Ozer, Susan; Takon, Inyang; Woodhouse, Emma; Mukherjee, Raja

    2016-09-22

    The association of attention deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorders (FASD) results in a complex constellation of symptoms that complicates the successful diagnosis and treatment of the affected individual. Current literature lacks formal guidelines, randomized control trials, and evidence-based treatment plans for individuals with ADHD and associated FASD. Therefore, a meeting of professional experts was organized with the aim of producing a consensus on identification and treatment guidelines that will aid clinicians in caring for this unique patient population. Experts from multiple disciplines in the fields of ADHD and FASD convened in London, United Kingdom, for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.UKADHD.com ) in June 2015. The meeting provided the opportunity to address the complexities of ADHD and FASD from different perspectives and included presentations, discussions, and group work. The attendees worked towards producing a consensus for a unified approach to ADHD and associated FASD. The authors successfully came to consensus and produced recommended guidelines with specific regards to identification and assessment, interventions and treatments, and multiagency liaisons and care management, highlighting that a lifespan approach to treatment needs to be adopted by all involved. Included in the guidelines are: 1) unique 'red flags', which when identified in the ADHD population can lead to an accurate associated FASD diagnosis, 2) a treatment decision tree, and 3) recommendations for multiagency care management. While clinically useful guidelines were achieved, more research is still needed to contribute to the knowledge base about the diagnosis, treatment, and management of those with ADHD and associated FASD.

  5. Crisis checklists for in-hospital emergencies: expert consensus, simulation testing and recommendations for a template determined by a multi-institutional and multi-disciplinary learning collaborative.

    Science.gov (United States)

    Subbe, Christian P; Kellett, John; Barach, Paul; Chaloner, Catriona; Cleaver, Hayley; Cooksley, Tim; Korsten, Erik; Croke, Eilish; Davis, Elinor; De Bie, Ashley Jr; Durham, Lesley; Hancock, Chris; Hartin, Jilian; Savijn, Tracy; Welch, John

    2017-05-08

    'Failure to rescue' of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology. A scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use. Safety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. 'Check In'), a list of prompts regarding common omissions (i.e. 'Stop & Think'), and, a list of items required for the safe "handover" of patients that remain on the general ward (i.e. 'Check Out'). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients. Emergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are

  6. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

    DEFF Research Database (Denmark)

    Trenkwalder, Claudia; Chaudhuri, K Ray; García Ruiz, Pedro J

    2015-01-01

    Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical...... fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep...

  7. Reviewing and addressing the link between mass media and the increase in obesity among European children: The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement.

    Science.gov (United States)

    Mazur, Artur; Caroli, Margherita; Radziewicz-Winnicki, Igor; Nowicka, Paulina; Weghuber, Daniel; Neubauer, David; Dembiński, Łukasz; Crawley, Francis P; White, Martin; Hadjipanayis, Adamos

    2017-11-22

    This study reviewed the link between social media and the growing epidemic of childhood obesity in Europe. A task force from the European Academy of Paediatrics and the European Childhood Obesity Group searched published literature and developed a consensus statement. It found that there was evidence of a strong link between obesity levels across European countries and childhood media exposure and that parents and society needed a better understanding of the influence of social media on dietary habits. Health policies in Europe must take account of the range of social media influences that promote the development of childhood obesity. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  8. Maintaining success, reducing treatment burden, focusing on survivorship : highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer

    NARCIS (Netherlands)

    Beyer, J.; Albers, P.; Altena, R.; Aparicio, J.; Bokemeyer, C.; Busch, J.; Cathomas, R.; Cavallin-Stahl, E.; Clarke, N. W.; Classen, J.; Cohn-Cedermark, G.; Dahl, A. A.; Daugaard, G.; De Giorgi, U.; De Santis, M.; De Wit, M.; De Wit, R.; Dieckmann, K. P.; Fenner, M.; Fizazi, K.; Flechon, A.; Fossa, S. D.; Germa Lluch, J. R.; Gietema, J. A.; Gillessen, S.; Giwercman, A.; Hartmann, J.T.; Heidenreich, A.; Hentrich, M.; Honecker, F.; Horwich, A.; Huddart, R. A.; Kliesch, S.; Kollmannsberger, C.; Krege, S.; Laguna, M. P.; Looijenga, L. H. J.; Lorch, A.; Lotz, J. P.; Mayer, F.; Necchi, A.; Nicolai, N.; Nuver, J.; Oechsle, K.; Oldenburg, J.; Oosterhuis, J.W.; Powles, T.; Rajpert-De Meyts, E.; Rick, O.; Rosti, G.; Salvioni, R.; Schrader, M.; Schweyer, S.; Sedlmayer, F.; Sohaib, A.; Souchon, R.; Tandstad, T.; Wittekind, C.; Winter, E.

    In November 2011, the Third European Consensus Conference on Diagnosis and Treatment of Germ-Cell Cancer (GCC) was held in Berlin, Germany. This third conference followed similar meetings in 2003 (Essen, Germany) and 2006 (Amsterdam, The Netherlands) [Schmoll H-J, Souchon R, Krege S et al. European

  9. International Committee on Mental Health in Cystic Fibrosis: Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety.

    Science.gov (United States)

    Quittner, Alexandra L; Abbott, Janice; Georgiopoulos, Anna M; Goldbeck, Lutz; Smith, Beth; Hempstead, Sarah E; Marshall, Bruce; Sabadosa, Kathryn A; Elborn, Stuart

    2016-01-01

    Studies measuring psychological distress in individuals with cystic fibrosis (CF) have found high rates of both depression and anxiety. Psychological symptoms in both individuals with CF and parent caregivers have been associated with decreased lung function, lower body mass index, worse adherence, worse health-related quality of life, more frequent hospitalisations and increased healthcare costs. To identify and treat depression and anxiety in CF, the CF Foundation and the European CF Society invited a panel of experts, including physicians, psychologists, psychiatrists, nurses, social workers, a pharmacist, parents and an individual with CF, to develop consensus recommendations for clinical care. Over 18 months, this 22-member committee was divided into four workgroups: Screening; Psychological Interventions; Pharmacological Treatments and Implementation and Future Research, and used the Population, Intervention, Comparison, Outcome methodology to develop questions for literature search and review. Searches were conducted in PubMed, PsychINFO, ScienceDirect, Google Scholar, Psychiatry online and ABDATA by a methodologist at Dartmouth. The committee reviewed 344 articles, drafted statements and set an 80% acceptance for each recommendation statement as a consensus threshold prior to an anonymous voting process. Fifteen guideline recommendation statements for screening and treatment of depression and anxiety in individuals with CF and parent caregivers were finalised by vote. As these recommendations are implemented in CF centres internationally, the process of dissemination, implementation and resource provision should be closely monitored to assess barriers and concerns, validity and use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Requirements, Strengths and Weaknesses of Inhaler Devices for COPD Patients from the Expert Prescribers' Point of View: Results of the EPOCA Delphi Consensus.

    Science.gov (United States)

    García-Río, Francisco; Soler-Cataluña, Juan J; Alcazar, Bernardino; Viejo, José L; Miravitlles, Marc

    2017-12-01

    The study aimed to assess the preferences of expert physicians about the requirements for inhalation devices for patients with chronic obstructive pulmonary disease (COPD) and to identify the most relevant advantages and disadvantages to their prescription. In a two-round Delphi survey, 96 Spanish COPD-expert pulmonologists completed an internet-based questionnaire to evaluate the degree of importance of the characteristics of the inhaler devices in their choice for COPD. The requirements needed for use in COPD were that the device permits a high pulmonary deposit of the drug, allowed its dispensation at low inspiratory flows, did not require hand-mouth coordination, generated an exact and reproducible dose, its operation was easy to teach, provided the perception of a correct inhalation, had an intuitive use mechanism and security mechanisms to prevent overdosing and generates a reduced oropharyngeal deposit (very good consensus). Modulite®, Respimat® and NEXThaler® were associated with high pulmonary deposit, and Respimat® showed correct dispensation at low inspiratory flows. All dry-powder inhaler devices were associated with the advantage of not requiring coordination, and Respimat® was the only device considered as difficult to teach by more than 50% of the experts. Breezhaler® and Genuair® were positively associated with patients' awareness of correct inhalation, whereas Spiromax® stood out for its intuitive use mechanism. In conclusion, our study contributes to defining the inhaler device properties required for their use in patients with COPD, and to identify the devices that, in the opinion of experts, best meet each requirement.

  11. Expert Perspectives on Management of Moderate-to-Severe Atopic Dermatitis: A Multidisciplinary Consensus Addressing Current and Emerging Therapies.

    Science.gov (United States)

    Boguniewicz, Mark; Alexis, Andrew F; Beck, Lisa A; Block, Julie; Eichenfield, Lawrence F; Fonacier, Luz; Guttman-Yassky, Emma; Paller, Amy S; Pariser, David; Silverberg, Jonathan I; Lebwohl, Mark

    2017-09-29

    Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects children and adults. Until recently, the only Food and Drug Administration-approved systemic treatment option for patients with moderate-to-severe AD was systemic steroids, which are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants, which can have serious adverse effects. A significant number of these patients go untreated. Research on the immunopathogenesis of AD has paved the way for new, targeted, systemic therapies for moderate-to-severe AD. In early 2017, the Food and Drug Administration approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. Although the national guidelines can be very helpful to clinicians, the process for updating them does not allow for timely incorporation of novel therapies. A steering committee of AD experts, including dermatologists, allergists, and a patient advocacy group representative, developed recommendations on the basis of a literature review and expert opinion to help clinicians understand how new therapies fit into the current treatment paradigm and to provide practical recommendations for assessing AD severity, treatment response, and treatment failure. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Diagnosis and treatment of late-onset Pompe disease in the Middle East and North Africa region: consensus recommendations from an expert group.

    Science.gov (United States)

    Al Jasmi, Fatma; Al Jumah, Mohammed; Alqarni, Fatimah; Al-Sanna'a, Nouriya; Al-Sharif, Fawziah; Bohlega, Saeed; Cupler, Edward J; Fathalla, Waseem; Hamdan, Mohamed A; Makhseed, Nawal; Nafissi, Shahriar; Nilipour, Yalda; Selim, Laila; Shembesh, Nuri; Sunbul, Rawda; Tonekaboni, Seyed Hassan

    2015-10-15

    Pompe disease is a rare autosomal recessive disorder caused by a deficiency of the lysosomal enzyme alpha-glucosidase responsible for degrading glycogen. Late-onset Pompe disease has a complex multisystem phenotype characterized by a range of symptoms. An expert panel from the Middle East and North Africa (MENA) region met to create consensus-based guidelines for the diagnosis and treatment of late-onset Pompe disease for the MENA region, where the relative prevalence of Pompe disease is thought to be high but there is a lack of awareness and diagnostic facilities. These guidelines set out practical recommendations and include algorithms for the diagnosis and treatment of late-onset Pompe disease. They detail the ideal diagnostic workup, indicate the patients in whom enzyme replacement therapy should be initiated, and provide guidance on appropriate patient monitoring. These guidelines will serve to increase awareness of the condition, optimize patient diagnosis and treatment, reduce disease burden, and improve patient outcomes.

  13. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

    DEFF Research Database (Denmark)

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico

    2017-01-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoper......The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care......, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium. Considering that many medical disciplines are involved in the treatment of surgical patients, a team-based approach should be implemented into daily practice. This guideline...

  14. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease.

    Science.gov (United States)

    van der Woude, C J; Ardizzone, S; Bengtson, M B; Fiorino, G; Fraser, G; Katsanos, K; Kolacek, S; Juillerat, P; Mulders, A G M G J; Pedersen, N; Selinger, C; Sebastian, S; Sturm, A; Zelinkova, Z; Magro, F

    2015-02-01

    Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. In this updated consensus on the reproduction and pregnancy in inflammatory bowel disease reproductive issues including fertility, the safety of drugs during pregnancy and lactation are discussed.

  15. Clinical Strategy for Optimal Traditional Chinese Medicine (TCM) Herbal Dose Selection in Disease Therapeutics: Expert Consensus on Classic TCM Herbal Formula Dose Conversion.

    Science.gov (United States)

    Zha, Lin-Hua; He, Li-Sha; Lian, Feng-Mei; Zhen, Zhong; Ji, Hang-Yu; Xu, Li-Peng; Tong, Xiao-Lin

    2015-01-01

    The clinical therapeutics of traditional Chinese medicine (TCM) constitutes a complicated process which involves theory, diagnosis, and formula prescription with specific herbal dosage. Zhang Zhong-Jing's classic work, Treatise on Febrile and Miscellaneous Diseases, has been influencing TCM practice for almost 2000 years. However, during this extended period of time in Chinese history, the Chinese weight measurement system experienced noticeable changes. This change in the weight measurement system inevitably, and perhaps even negatively, affected TCM herbal dosage determination and treatment outcome. Thus, in modern society, a full understanding of the accuracy of herbal dose selection has a critical importance in the TCM daily practice of delivering the best treatment to the patients suffering from different illnesses. In the 973 Project of the Chinese National Basic Research Program, expert consensus on classic TCM formula dose conversion has been reached based on extensive literature review and discussion on the dose-effect relationship of classic TCM formulas. One "liang" in classic TCM formulas is equivalent to 13.8 g. However, based on many TCM basic and clinical studies of variable herbal formula prescriptions and herbal drug preparations, the rule of one liang equals 13.8 g should be adjusted according to different disease conditions. Recommended by the committee on TCM formula dose-effect relationship of the China Association of Chinese Medicine and the World Federation of Chinese Medicine Societies, the following expert consensus has been reached: (i) One liang converts to 6-9 g for the severely and critically ill patients. (ii) One liang converts to 3-6 g for the patients suffering from chronic diseases. (iii) One liang converts to 1-3 g in preventive medicine. The above conversions should be used as a future TCM practice guideline. Using this recommended guideline should enhance the effectiveness of daily TCM practice.

  16. Quantitative angiography methods for bifurcation lesions: a consensus statement update from the European Bifurcation Club

    NARCIS (Netherlands)

    Collet, Carlos; Onuma, Yoshinobu; Cavalcante, Rafael; Grundeken, Maik; Généreux, Philippe; Popma, Jeffrey; Costa, Ricardo; Stankovic, Goran; Tu, Shengxian; Reiber, Johan H. C.; Aben, Jean-Paul; Lassen, Jens Flensted; Louvard, Yves; Lansky, Alexandra; Serruys, Patrick W.

    2017-01-01

    Bifurcation lesions represent one of the most challenging lesion subsets in interventional cardiology. The European Bifurcation Club (EBC) is an academic consortium whose goal has been to assess and recommend the appropriate strategies to manage bifurcation lesions. The quantitative coronary

  17. Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel

    Science.gov (United States)

    Graham, Stephen M.; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E.; Gale, Marianne; Gie, Robert P.; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C.; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J.; McNeeley, David F.; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R.; Swaminathan, Soumya; Wingfield, Claire

    2012-01-01

    There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. PMID:22448023

  18. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

    Science.gov (United States)

    Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

    2012-05-15

    There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

  19. Assessing Risk of Disease Progression and Pharmacological Management of Autosomal Dominant Polycystic Kidney Disease: A Canadian Expert Consensus.

    Science.gov (United States)

    Soroka, Steven; Alam, Ahsan; Bevilacqua, Micheli; Girard, Louis-Philippe; Komenda, Paul; Loertscher, Rolf; McFarlane, Philip; Pandeya, Sanjaya; Tam, Paul; Bichet, Daniel G

    2017-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disorder worldwide. The disease is characterized by renal cysts and progressive renal failure due to progressive enlargement of cysts and renal fibrosis. An estimated 45% to 70% of patients with ADPKD progress to end-stage renal disease by age 65 years. Although both targeted and nontargeted therapies have been tested in patients with ADPKD, tolvaptan is currently the only pharmacological therapy approved in Canada for the treatment of ADPKD. The purpose of this consensus recommendation is to develop an evidence-informed recommendation for the optimal management of adult patients with ADPKD. This document focuses on the role of genetic testing, the role of renal imaging, predicting the risk of disease progression, and pharmacological treatment options for ADPKD. These areas of focus were derived from 2 national surveys that were disseminated to nephrologists and patients with ADPKD with the aim of identifying unmet needs in the management of ADPKD in Canada. Specific recommendations are provided for the treatment of ADPKD with tolvaptan.

  20. Exploring experts' views and perspectives on the enhancement of Strategic Environmental Assessment in European small islands

    Energy Technology Data Exchange (ETDEWEB)

    Polido, Alexandra, E-mail: a.polido@campus.fct.unl.pt [CENSE, Center for Environmental and Sustainability Research, Departamento de Ciências e Engenharia do Ambiente, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Campus da Caparica, 2829-516 Caparica (Portugal); João, Elsa, E-mail: elsa.joao@strath.ac.uk [Department of Civil and Environmental Engineering, University of Strathclyde, Level 5, James Weir Building, 75 Montrose Street, Glasgow G1 1XJ, Scotland (United Kingdom); Ramos, Tomás B., E-mail: tabr@fct.unl.pt [CENSE, Center for Environmental and Sustainability Research, Departamento de Ciências e Engenharia do Ambiente, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Campus da Caparica, 2829-516 Caparica (Portugal)

    2016-04-15

    Small islands have the attention of the international community because they are territories with unique features, and a pressing need for the enhancement of sustainability. Strategic Environmental Assessment (SEA) has characteristics that may promote the development and improvement of sustainability in these territories: (i) changing the mind-set, and the decision-making and institutional paradigm, (ii) facilitating cooperation and coordination between different stakeholders, and (iii) providing a framework for good governance and community empowerment. The scientific literature suggests that there may be a need for context-specific SEA in these territories. However, SEA studies often do not incorporate local contextual information, including intuitive knowledge and sense of place. Therefore, there is a possible gap between what is found in the literature and what local communities think, including different stakeholders and experts. Hence, the main goal of this research was to gain an insight into the views and perspectives of small islands SEA experts about issues related to SEA in European small islands, including context-specific approaches, as well as the contribution of SEA for sustainability in these territories. To achieve the research aim, exploratory research using a questionnaire-based survey was designed, aimed at experts on SEA in European small islands. Findings showed regional cooperation networks may have a fundamental role when developing SEA-specific approaches in these territories. This is because SEA-specific approaches encourage a joint effort among islands within one region to improve SEA capacity-building, develop and share a baseline information system, and to share and exchange resources, overall. Also, guidelines are preferred among experts over more legal frameworks and regulations. Finally, the research showed that experts view SEA as a way to enhance sustainability in small islands. This study highlights the importance of integrating

  1. Diagnosis and treatment of latent tuberculosis in patients with multiple sclerosis, expert consensus. On behalf of the Colombian Association of Neurology, Committee of Multiple Sclerosis.

    Science.gov (United States)

    Navas, Carlos; Torres-Duque, Carlos A; Munoz-Ceron, Joe; Álvarez, Carlos; García, Juan R; Zarco, Luis; Vélez, Lázaro A; Awad, Carlos; Castro, Carlos Alberto

    2018-01-01

    Multiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis. The purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis. A panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed. Tuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease. Latent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.

  2. Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseases on management of gestational trophoblastic diseases.

    Science.gov (United States)

    Bolze, Pierre-Adrien; Attia, Jocelyne; Massardier, Jérôme; Seckl, Michael J; Massuger, Leon; van Trommel, Nienke; Niemann, Isa; Hajri, Touria; Schott, Anne-Marie; Golfier, François

    2015-09-01

    Gestational trophoblastic disease (GTD) is a spectrum of cellular proliferations arising from trophoblast. Their invasive and metastatic potential sometimes requires chemotherapy and/or surgery. Current management is generally associated with favourable prognosis. Therefore, treatments must be chosen according to the desire for further childbearing of each patient. The European Organisation for Treatment of Trophoblastic Diseases (EOTTD) is dedicated to optimise diagnosis, treatment, follow-up and research in GTD by bringing together knowledge of clinicians and researchers from 29 countries working in the field of GTD in Europe. This study assessed the level of agreement among an expert panel of the EOTTD in order to rationalise the management of patients in Europe. The RAND/UCLA Appropriateness Method was used to combine the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history and test results. There was an agreement for 54 statements while the experts showed a disagreement for two statements. As there is little evidence from randomised trials on which to base recommendations about management of GTD, many of these recommendations are based on expert opinion derived from changes in management fact that have improved outcomes from nearly 100% fatality to nearly 100% cure rates. However, a large agreement among experts is invaluable to the individual clinician who is struggling to decide whether a fertility-sparing treatment of hydatidiform mole or a low-risk GTN can be chosen and how it must be conducted. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence.

    Science.gov (United States)

    Chapple, Christopher R; Cruz, Francisco; Deffieux, Xavier; Milani, Alfredo L; Arlandis, Salvador; Artibani, Walter; Bauer, Ricarda M; Burkhard, Fiona; Cardozo, Linda; Castro-Diaz, David; Cornu, Jean Nicolas; Deprest, Jan; Gunnemann, Alfons; Gyhagen, Maria; Heesakkers, John; Koelbl, Heinz; MacNeil, Sheila; Naumann, Gert; Roovers, Jan-Paul W R; Salvatore, Stefano; Sievert, Karl-Dietrich; Tarcan, Tufan; Van der Aa, Frank; Montorsi, Francesco; Wirth, Manfred; Abdel-Fattah, Mohamed

    2017-09-01

    Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). A consensus review of existing data based on published meta-analyses and reviews. This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. Synthetic slings can be safely used

  4. The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery.

    Science.gov (United States)

    2017-03-01

    The Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery provides this professional society perspective on resuscitation in patients who arrest after cardiac surgery. This document was created using a multimodal methodology for evidence generation and includes information from existing guidelines, from the International Liaison Committee on Resuscitation, from our own structured literature reviews on issues particular to cardiac surgery, and from an international survey on resuscitation hosted by CTSNet. In gathering evidence for this consensus paper, searches were conducted using the MEDLINE keywords "cardiac surgery," "resuscitation," "guideline," "thoracic surgery," "cardiac arrest," and "cardiac massage." Weight was given to clinical studies in humans, although some case studies, mannequin simulations of potential protocols, and animal models were also considered. Consensus was reached using a modified Delphi method consisting of two rounds of voting until 75% agreement on appropriate wording and strength of the opinions was reached. The Society of Thoracic Surgeons Workforce on Critical Care was enlisted in this process to provide a wider variety of experiences and backgrounds in an effort to reinforce the opinions provided. We start with the premise that external massage is ineffective for an arrest due to tamponade or hypovolemia (bleeding), and therefore these subsets of patients will receive inadequate cerebral perfusion during cardiac arrest in the absence of resternotomy. Because these two situations are common causes for an arrest after cardiac surgery, the inability to provide effective external cardiopulmonary resuscitation highlights the importance of early emergency resternotomy within 5 minutes. In addition, because internal massage is more effective than external massage, it should be used preferentially if other quickly reversible causes are not found. We present a protocol for the cardiac arrest situation that

  5. Expert consensus statement on diagnosis and treatment of cancer-related depressed mood state based on Chinese medicine

    Directory of Open Access Journals (Sweden)

    Shaodan Tian

    2015-10-01

    Full Text Available This consensus statement is organized into six parts: 1 Definitions: cancer-related depressed mood state is defined as a group of depressive symptoms, rather than major depressive disorder. Thus, “cancer-related depression” or “depressed mood state” is introduced as standard terminology and associated with the Chinese medicine concept of “yu zheng” (depression syndrome. 2 Pathogenesis: factors including psychological stress, cancer pain, cancer fatigue, sleep disorders, surgery trauma, chemotherapy, and radiation therapy are strongly associated with cancer-related depressed mood state. Crucial elements of pathogenesis are cancer caused by depression, depression caused by cancer, and the concurrence of phlegm, dampness, and stasis from constrained liver-qi and spleen deficiency. 3 Symptoms: these include core symptoms, psychological symptoms, and somatic symptoms. Depressed mood and loss of interest are the main criteria for diagnosis. 4 Clinical evaluation: based on the Mini-International Neuropsychiatric Interview and a numeric rating scale, and taking mood changes during cancer diagnosis and treatment into consideration, a questionnaire can be drafted to distinguish between major depressive disorder and cancer-related depression. The aim is to assist oncology clinicians to identify, treat, and refer patients with cancer-related depression. 5 Diagnosis: diagnosis should be based on the Chinese Classification for Mental Disorders (CCMD-3, taking patients' mood changes during diagnosis and treatment into consideration. 6 Treatment: treatments for cancer-related depression must be performed concurrently with cancer treatment. For mild depression, non-pharmacologic comprehensive therapies, including psychological intervention, music therapy, patient education, physical activity, and acupuncture, are recommended; for moderate depression, classical Chinese herbal formulas based on syndrome pattern differentiation combined with

  6. Consensus and variations in opinions on delirium care: a survey of European delirium specialists

    NARCIS (Netherlands)

    Morandi, A.; Davis, D.; Taylor, J. K.; Bellelli, G.; Olofsson, B.; Kreisel, S.; Teodorczuk, A.; Kamholz, B.; Hasemann, W.; Young, J.; Agar, M.; de Rooij, S. E.; Meagher, D.; Trabucchi, M.; Maclullich, A. M.

    2013-01-01

    There are still substantial uncertainties over best practice in delirium care. The European Delirium Association (EDA) conducted a survey of its members and other interested parties on various aspects of delirium care. The invitation to participate in the online survey was distributed among the EDA

  7. Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2).

    NARCIS (Netherlands)

    Valentini, V.; Aristei, C.; Glimelius, B.; Minsky, B.D.; Beets-Tan, R.G.; Borras, J.M.; Haustermans, K.; Maingon, P.; Overgaard, J.; Pahlman, L.; Quirke, P.; Schmoll, H.J.; Sebag-Montefiore, D.; Taylor, I.; Cutsem, E. van; Velde, C. van de; Cellini, N.; Latini, P.

    2009-01-01

    BACKGROUND AND PURPOSE: During the first decade of the 21st century a number of important European randomized studies were published. In order to help shape clinical practice based on best scientific evidence from the literature, the International Conference on 'Multidisciplinary Rectal Cancer

  8. Guidelines for the management of vitiligo: the European Dermatology Forum consensus

    NARCIS (Netherlands)

    Taieb, A.; Alomar, A.; Böhm, M.; Dell'anna, M. L.; de Pase, A.; Eleftheriadou, V.; Ezzedine, K.; Gauthier, Y.; Gawkrodger, D. J.; Jouary, T.; Leone, G.; Moretti, S.; Nieuweboer-Krobotova, L.; Olsson, M. J.; Parsad, D.; Passeron, T.; Tanew, A.; van der Veen, W.; van Geel, N.; Whitton, M.; Wolkerstorfer, A.; Picardo, M.

    2013-01-01

    The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and

  9. Genetic linkage maps of Japanese and European pears aligned to the apple consensus map

    NARCIS (Netherlands)

    Yamamoto, T.; Kimura, T.; Saito, T.; Kotobuki, K.; Matsuta, N.; Liebhard, R.; Gessler, C.; Weg, van de W.E.; Hayashi, T.

    2004-01-01

    Genetic linkage maps of the Japanese pear (Pyrus pyrifolia Nakai) cultivar `Housui¿ and the European pear (Pyrus communis L.) cultivar `Bartlett¿ were constructed based on Amplified Fragment Length Polymorphism markers (AFLPs), Simple Sequence Repeat markers (SSRs) (from pear, apple and Prunus),

  10. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations.

    Science.gov (United States)

    Gionchetti, Paolo; Dignass, Axel; Danese, Silvio; Magro Dias, Fernando José; Rogler, Gerhard; Lakatos, Péter Laszlo; Adamina, Michel; Ardizzone, Sandro; Buskens, Christianne J; Sebastian, Shaji; Laureti, Silvio; Sampietro, Gianluca M; Vucelic, Boris; van der Woude, C Janneke; Barreiro-de Acosta, Manuel; Maaser, Christian; Portela, Francisco; Vavricka, Stephan R; Gomollón, Fernando

    2017-02-01

    This paper is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease [CD] and concerns the surgical management of CD as well as special situations including management of perianal CD and extraintestinal manifestations. Diagnostic approaches and medical management of CD of this ECCO Consensus are covered in the first paper [Gomollon et al JCC 2016]. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  11. Prioritisation of wildlife pathogens to be targeted in European surveillance programmes: Expert-based risk analysis focus on ruminants.

    Science.gov (United States)

    Ciliberti, Alexandre; Gavier-Widén, Dolores; Yon, Lisa; Hutchings, Mike R; Artois, Marc

    2015-03-01

    This study attempted to develop a list of priority pathogens. It is part of a European Union (EU) project dedicated to the surveillance of emerging or re-emerging pathogens of wildlife. Partners of the consortium established an initial list of 138 pathogens of concern, which was reduced to a smaller list of 65 pathogens likely to affect ruminants (i.e., the most costly animal group in the EU over the last 15 years). These 65 pathogens underwent a two-step, expert-based risk analysis: 92 experts graded them with respect to their global importance for animal welfare, species conservation, trade/economic impacts and public health. In step 2, the top 15 pathogens from step 1 were assessed by 69 experts considering seven weighted epidemiological criteria (pathogen variability, host specificity, potential for contagion, speed of spread, presence in Europe, difficulty of surveillance in wildlife and persistence in the environment) for which four options were possible. The responses concerned a wide geographic coverage. The resulting top-list pathogens were ranked as follows: 1. Salmonella enterica, 2. Coxiella burnetii, 3. foot-and-mouth disease virus, 4. Mycobacterium bovis, 5. bluetongue virus, and 6. European tick-borne encephalitis virus. The influence of the characteristics of the respondents, the importance of the levels of uncertainty/variability and the implication of the results are discussed. This work highlights the relevance of developing such lists for preparedness. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Management of crizotinib therapy for ALK-rearranged non-small cell lung carcinoma: an expert consensus.

    Science.gov (United States)

    Cappuzzo, Federico; Moro-Sibilot, Denis; Gautschi, Oliver; Boleti, Ekaterini; Felip, Enriqueta; Groen, Harry J M; Germonpré, Paul; Meldgaard, Peter; Arriola, Edurne; Steele, Nicola; Fox, Jesme; Schnell, Patrick; Engelsberg, Arne; Wolf, Jürgen

    2015-02-01

    Within 4 years of the discovery of anaplastic lymphoma kinase (ALK) rearrangements in non-small cell lung cancer (NSCLC), the ALK inhibitor crizotinib gained US and European approval for the treatment of advanced ALK-positive NSCLC. This was due to the striking response data observed with crizotinib in phase I and II trials in patients with ALK-positive NSCLC, as well as the favorable tolerability and safety profile observed. Recently published phase III data established crizotinib as a new standard of care for this NSCLC molecular subset. A consequence of such rapid approval, however, is the limited clinical experience and relative paucity of information concerning optimal therapy management. In this review, we discuss the development of crizotinib and the clinical relevance of its safety profile, examining crizotinib-associated adverse events in detail and making specific management recommendations. Crizotinib-associated adverse events were mostly mild to moderate in severity in clinical studies, and appropriate monitoring and supportive therapies are considered effective in avoiding the need for dose interruption or reduction in most cases. Therapy management of patients following disease progression on crizotinib is also discussed. Based on available clinical data, it is evident that patients may have prolonged benefit from crizotinib after Response Evaluation Criteria in Solid Tumors-defined disease progression, and crizotinib should be continued for as long as the patient derives benefit. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  13. Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multinational, multi-disciplinary expert groups

    NARCIS (Netherlands)

    Iliffe, S.; De Lepeleire, J.; van Hout, H.P.J.; Kenny, G.; Lewis, A.; Vernooij-Dassen, M.J.F.J.

    2005-01-01

    Experts from eight European countries (Belgium, France, The Netherlands, Ireland, Italy, Portugal, Spain and the United Kingdom) and the disciplines of clinical psychology, general practice, geriatric medicine, old age psychiatry, medical sociology, nursing and voluntary body organisation met in

  14. Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel.

    Science.gov (United States)

    Akers, Amy; Al-Shahi Salman, Rustam; A Awad, Issam; Dahlem, Kristen; Flemming, Kelly; Hart, Blaine; Kim, Helen; Jusue-Torres, Ignacio; Kondziolka, Douglas; Lee, Cornelia; Morrison, Leslie; Rigamonti, Daniele; Rebeiz, Tania; Tournier-Lasserve, Elisabeth; Waggoner, Darrel; Whitehead, Kevin

    2017-05-01

    Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. To develop guidelines for CCM management. The Angioma Alliance ( www.angioma.org ), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was

  15. Aflibercept treatment for neovascular AMD beyond the first year: consensus recommendations by a UK expert roundtable panel, 2017 update

    Directory of Open Access Journals (Sweden)

    Patel PJ

    2017-11-01

    Full Text Available Praveen J Patel,1 Helen Devonport,2 Sobha Sivaprasad,1 Adam H Ross,3 Gavin Walters,4 Richard P Gale,5 Andrew J Lotery,6 Sajjad Mahmood,7 James S Talks,8 Jackie Napier9 1National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; 2The Ophthalmology Department, Bradford Royal Infirmary, Bradford, UK; 3The Ophthalmology Department, Bristol Eye Hospital, Bristol, UK; 4Department of Ophthalmology, Harrogate District Hospital, Harrogate, UK; 5The Ophthalmology Department, The York Hospital and Department of Health Sciences, University of York, York, UK; 6Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; 7Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; 8Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK; 9Medical Affairs, Bayer plc, Reading, Berkshire, UK Abstract: National recommendations on continued administration of aflibercept solution for injection after the first year of treatment for neovascular age-related macular degeneration (nAMD have been developed by an expert panel of UK retina specialists, based on clinician experience and treatment outcomes seen in year 2. The 2017 update reiterates that the treatment goal is to maintain or improve the macular structural and functional gains achieved in year 1 while attempting to reduce or minimize the treatment burden, recognizing the need for ongoing treatment. At the end of year 1 (ie, the decision visit at month 11, two treatment options should be considered: do not extend the treatment interval and maintain fixed 8-weekly dosing, or extend the treatment interval using a treat-and-extend regimen up to a maximum 12 weeks. Criteria for considering not extending the treatment interval are persistent macular fluid with stable

  16. The European Union's four-man team of experts attending a demonstration of the DataGrid Project at CERN in early February.

    CERN Multimedia

    2003-01-01

    The DataGrid Project is reviewed by a team of European experts on a yearly basis. At the beginning of February it passed the second of these reviews with flying colours, the four experts issuing enthusiastic statements on the latest progress made, which was quite considerable in 2002.

  17. Diagnosis and treatment of Merkel Cell Carcinoma. European consensus-based interdisciplinary guideline

    DEFF Research Database (Denmark)

    Lebbe, Celeste; Becker, Jürgen C; Grob, Jean-Jacques

    2015-01-01

    Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on MCC diagnosis and management, based on a critical review of the literature, existing guidelines and expert's experience. Clinical features of the cutaneous/subcutaneous nodules hardly contribute to the diagnosis...... should be excised with 1-2cm margins. In patients without clinical evidence of regional lymph node involvement, sentinel node biopsy is recommended, if possible, and will be taken into account in a new version of the AJCC classification. In patients with regional lymph node involvement radical...... lymphadenectomy is recommended. Adjuvant radiotherapy might be considered in patients with multiple affected lymph nodes of extracapsular extension. In unresectable metastatic MCC mono- or poly-chemotherapy achieve high remission rates. However, responses are usually short lived. Treatment within clinical trials...

  18. Target Product Profile for a Diagnostic Assay to Differentiate between Bacterial and Non-Bacterial Infections and Reduce Antimicrobial Overuse in Resource-Limited Settings: An Expert Consensus.

    Directory of Open Access Journals (Sweden)

    Sabine Dittrich

    Full Text Available Acute fever is one of the most common presenting symptoms globally. In order to reduce the empiric use of antimicrobial drugs and improve outcomes, it is essential to improve diagnostic capabilities. In the absence of microbiology facilities in low-income settings, an assay to distinguish bacterial from non-bacterial causes would be a critical first step. To ensure that patient and market needs are met, the requirements of such a test should be specified in a target product profile (TPP. To identify minimal/optimal characteristics for a bacterial vs. non-bacterial fever test, experts from academia and international organizations with expertise in infectious diseases, diagnostic test development, laboratory medicine, global health, and health economics were convened. Proposed TPPs were reviewed by this working group, and consensus characteristics were defined. The working group defined non-severely ill, non-malaria infected children as the target population for the desired assay. To provide access to the most patients, the test should be deployable to community health centers and informal health settings, and staff should require 90% and >80% for sensitivity and specificity, respectively. Other key characteristics, to account for the challenging environment at which the test is targeted, included: i time-to-result <10 min (but maximally <2 hrs; ii storage conditions at 0-40°C, ≤90% non-condensing humidity with a minimal shelf life of 12 months; iii operational conditions of 5-40°C, ≤90% non-condensing humidity; and iv minimal sample collection needs (50-100μL, capillary blood. This expert approach to define assay requirements for a bacterial vs. non-bacterial assay should guide product development, and enable targeted and timely efforts by industry partners and academic institutions.

  19. Expert Consensus Statement on achieving self-sufficiency in safe blood and blood products, based on voluntary non-remunerated blood donation (VNRBD).

    Science.gov (United States)

    2012-11-01

    All countries face challenges in making sufficient supplies of blood and blood products available and sustainable, while also ensuring the quality and safety of these products in the face of known and emerging threats to public health. Since 1975, the World Health Assembly (WHA) has highlighted the global need for blood safety and availability. WHA resolutions 63·12, 58·13 and 28·72, The Melbourne Declaration on 100% Voluntary Non-Remunerated Donation of Blood and Blood Components and WHO Global Blood Safety Network recommendations have reaffirmed the achievement of 'Self-sufficiency in blood and blood products based on voluntary non-remunerated blood donation (VNRBD)' as the important national policy direction for ensuring a safe, secure and sufficient supply of blood and blood products, including labile blood components and plasma-derived medicinal products. Despite some successes, self-sufficiency is not yet a reality in many countries. A consultation of experts, convened by the World Health Organization (WHO) in September 2011 in Geneva, Switzerland, addressed the urgent need to establish strategies and mechanisms for achieving self-sufficiency. Information on the current situation, and country perspectives and experiences were shared. Factors influencing the global implementation of self-sufficiency, including safety, ethics, security and sustainability of supply, trade and its potential impact on public health, availability and access for patients, were analysed to define strategies and mechanisms and provide practical guidance on achieving self-sufficiency. Experts developed a consensus statement outlining the rationale and definition of self-sufficiency in safe blood and blood products based on VNRBD and made recommendations to national health authorities and WHO. © 2012 World Health Organization. Vox Sanguinis © 2012 International Society of Blood Transfusion.

  20. [Stability of home based care arrangements for people with dementia : Development of a consensus definition of stability using expert focus groups].

    Science.gov (United States)

    von Kutzleben, Milena; Köhler, Kerstin; Dreyer, Jan; Holle, Bernhard; Roes, Martina

    2017-04-01

    The majority of people with dementia in Germany live at home. These informal care arrangements, which are mostly coordinated by informal carers, are the backbone of home-based dementia care. Creating and maintaining stability is an underlying theme in informal care; however, a definition of the complex phenomenon of 'stability' in this context is still lacking. The aim was to develop a working definition of stability of home-based care arrangements for people with dementia, which can be applied in current and future research projects at the German Center for Neurodegenerative Diseases in Witten (DZNE Witten) and others. Ensuing from prior research a preliminary version of the definition was formulated. This definition was discussed in a focus group of scientific experts with expertise in dementia research and care (n = 8). After data analysis using content analysis, the definition was revised during a scientific colloquium (n = 18) and a consensus was finally reached. There were four major themes which were considered by the experts as being relevant for the definition of stability: (1) creating and maintaining stability as a continuous adaptation process, (2) a qualitative component of stability, (3) persons with dementia and informal carers as pivotal players and (4) transitions to residential care. The working definition introduced in this article reflects the authors' understanding of the phenomenon of stability of home-based care arrangements for people with dementia. In times of increasing need for evidence-based interventions it is necessary to develop elaborated definitions of complex phenomena in order to be able to systematically evaluate the efficacy of interventions on the basis of a common understanding.

  1. Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries.

    Science.gov (United States)

    Broda, Anja; Bieber, Anja; Meyer, Gabriele; Hopper, Louise; Joyce, Rachael; Irving, Kate; Zanetti, Orazio; Portolani, Elisa; Kerpershoek, Liselot; Verhey, Frans; Vugt, Marjolein de; Wolfs, Claire; Eriksen, Siren; Røsvik, Janne; Marques, Maria J; Gonçalves-Pereira, Manuel; Sjölund, Britt-Marie; Woods, Bob; Jelley, Hannah; Orrell, Martin; Stephan, Astrid

    2017-08-03

    As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

  2. Target Product Profile for a Diagnostic Assay to Differentiate between Bacterial and Non-Bacterial Infections and Reduce Antimicrobial Overuse in Resource-Limited Settings: An Expert Consensus.

    Science.gov (United States)

    Dittrich, Sabine; Tadesse, Birkneh Tilahun; Moussy, Francis; Chua, Arlene; Zorzet, Anna; Tängdén, Thomas; Dolinger, David L; Page, Anne-Laure; Crump, John A; D'Acremont, Valerie; Bassat, Quique; Lubell, Yoel; Newton, Paul N; Heinrich, Norbert; Rodwell, Timothy J; González, Iveth J

    2016-01-01

    Acute fever is one of the most common presenting symptoms globally. In order to reduce the empiric use of antimicrobial drugs and improve outcomes, it is essential to improve diagnostic capabilities. In the absence of microbiology facilities in low-income settings, an assay to distinguish bacterial from non-bacterial causes would be a critical first step. To ensure that patient and market needs are met, the requirements of such a test should be specified in a target product profile (TPP). To identify minimal/optimal characteristics for a bacterial vs. non-bacterial fever test, experts from academia and international organizations with expertise in infectious diseases, diagnostic test development, laboratory medicine, global health, and health economics were convened. Proposed TPPs were reviewed by this working group, and consensus characteristics were defined. The working group defined non-severely ill, non-malaria infected children as the target population for the desired assay. To provide access to the most patients, the test should be deployable to community health centers and informal health settings, and staff should require 90% and >80% for sensitivity and specificity, respectively. Other key characteristics, to account for the challenging environment at which the test is targeted, included: i) time-to-result vs. non-bacterial assay should guide product development, and enable targeted and timely efforts by industry partners and academic institutions.

  3. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

    DEFF Research Database (Denmark)

    Abu-Omar, Yasir; Kocher, Gregor J; Bosco, Paolo

    2017-01-01

    Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lung...

  4. Management goals for type 1 Gaucher disease: An expert consensus document from the European working group on Gaucher disease

    NARCIS (Netherlands)

    Biegstraaten, M.; Cox, T. M.; Belmatoug, N.; Berger, M. G.; Collin-Histed, T.; vom Dahl, S.; Di Rocco, M.; Fraga, C.; Giona, F.; Giraldo, P.; Hasanhodzic, M.; Hughes, D. A.; Iversen, P. O.; Kiewiet, A. I.; Lukina, E.; Machaczka, M.; Marinakis, T.; Mengel, E.; Pastores, G. M.; Plöckinger, U.; Rosenbaum, H.; Serratrice, C.; Symeonidis, A.; Szer, J.; Timmerman, J.; Tylki-Szymańska, A.; Weisz Hubshman, M.; Zafeiriou, D. I.; Zimran, A.; Hollak, C. E. M.

    2018-01-01

    Gaucher Disease type 1 (GD1) is a lysosomal disorder that affects many systems. Therapy improves the principal manifestations of the condition and, as a consequence, many patients show a modified phenotype which reflects manifestations of their disease that are refractory to treatment. More

  5. Consensus guidelines for microarray gene expression analyses in leukemia from three European leukemia networks.

    Science.gov (United States)

    Staal, F J T; Cario, G; Cazzaniga, G; Haferlach, T; Heuser, M; Hofmann, W-K; Mills, K; Schrappe, M; Stanulla, M; Wingen, L U; van Dongen, J J M; Schlegelberger, B

    2006-08-01

    A plethora of studies have documented that gene expression profiling using DNA microarrays for various types of hematological malignancies provides novel information, which may have diagnostic and prognostic implications. However, to successfully use microarrays for this purpose, the quality and reproducibility of the whole procedure need to be guaranteed. Critical steps of the method are handling, processing and storage of the leukemic sample, purification of tumor cells (or lack thereof), RNA extraction methods, quality control of RNA, labeling techniques, hybridization, washing, scanning, spot filtering, normalization and initial interpretation, and finally the biostatistical analysis. These items have been extensively discussed and evaluated in different multi-center quality rounds within the three networks, that is, I-BFM-SG, the German Competence Network 'Acute and Chronic Leukemias' and the European LeukemiaNet. Based on the exchange of knowledge and experience between the three networks over the last few years, we have formulated guidelines for performing microarray experiments in leukemia. We confine ourselves to leukemias, but many of these requirements also apply to lymphomas or other clinical samples, including solid tumors.

  6. Epidemic Threats to the European Union: Expert Views on Six Virus Groups

    NARCIS (Netherlands)

    Kelly, L.; Brouwer, A.; Wilson, A.; Gale, P.; Snary, E.; Ross, D.; Vos, de C.J.

    2013-01-01

    In recent years, several animal disease epidemics have occurred within the European Union (EU). At the 4th Annual Meeting of the EPIZONE network (7-10 June 2010, St. Malo, France), an interactive session was run to elicit the opinions of delegates on a pre-defined list of epidemic threats to the EU.

  7. ESMO-ESGO-ESTRO consensus conference on endometrial cancer

    DEFF Research Database (Denmark)

    Colombo, Nicoletta; Creutzberg, Carien; Amant, Frederic

    2015-01-01

    The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary...... panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: Prevention and screening, surgery, adjuvant treatment and advanced and recurrent...

  8. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease

    DEFF Research Database (Denmark)

    Ruemmele, F M; Veres, G; Kolho, K L

    2014-01-01

    -onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn's and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition...

  9. European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome - Update 2017

    DEFF Research Database (Denmark)

    Trautinger, Franz; Eder, Johanna; Assaf, Chalid

    2017-01-01

    In order to provide a common standard for the treatment of mycosis fungoides (MF) and Sézary syndrome (SS), the European Organisation for Research and Treatment of Cancer-Cutaneous Lymphoma Task Force (EORTC-CLTF) published in 2006 its consensus recommendations for the stage-adapted selection...... the original recommendations bearing in mind that there are still only a limited number of controlled studies to support treatment decisions for MF/SS and that often treatment is determined by institutional experience and availability. This consensus on treatment recommendations was established among...

  10. Comparison of the Berlin definition with the American European consensus definition for acute respiratory distress syndrome in burn patients.

    Science.gov (United States)

    Bordes, Julien; Lacroix, Guillaume; Esnault, Pierre; Goutorbe, Philippe; Cotte, Jean; Dantzer, Eric; Meaudre, Eric

    2014-06-01

    Acute respiratory distress syndrome (ARDS) is a leading cause of mortality in burn patients. Smoke inhalation, pneumonia and inflammation process are the major causes of ARDS in burn patients. The American European Consensus Conference (AECC) definition proposed in 1994 has recently been revised by the Berlin definition. Our objective was to describe the epidemiology of ARDS comparing the Berlin definition with the AECC definition in a retrospective cohort of burn patients. We reviewed admitted burn adult patients for a two year period, and investigated patient who received mechanical ventilation for more than 48 h and in whom pneumonia was diagnosed. 40 patients were analyzed. According to the AECC definition, 11 patients met criteria for ALI (27.5%), and 29 patients for ARDS (72.5%). According to the Berlin definition, all patients met criteria for ARDS: 4 (10%) for a severe ARDS, 25 (62.5%) for a moderate ARDS, 11 (27.5%) for a mild ARDS. Inhalation injury was diagnosed in 10 patients (25%). Categorizing patients with the Berlin definition showed statistically significative difference of mortality within the three groups, but not with the AECC definition. The Berlin definition seems to be more accurate than the AECC definition to assess the severity of ARDS in term of outcome in burn patients. This definition may facilitate prompt recognition of ARDS in burn patients, and promote protective ventilation strategy to a larger number of patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  11. Symptoms dermatologists should look for in daily practice to improve detection of psoriatic arthritis in psoriasis patients: an expert group consensus.

    Science.gov (United States)

    Villani, A P; Rouzaud, M; Sevrain, M; Barnetche, T; Paul, C; Richard, M-A; Beylot-Barry, M; Misery, L; Joly, P; Aractingi, S; Aubin, F; Le Maître, M; Cantagrel, A; Ortonne, J-P; Jullien, D

    2014-08-01

    Up to 29% of patients with psoriasis seen by dermatologists have undiagnosed psoriatic arthritis (PsA). As early detection of PsA may be associated with improved joint and skin outcomes, it is essential for dermatologists to improve their ability to diagnose PsA. Skin and nail features of psoriasis associated with PsA are well known to dermatologists but they may feel less confortable assessing other symptoms and they rarely use PsA screening questionnaires. To develop a limited list of clinical signs and symptoms that a dermatologist should be looking for in a psoriasis patient in addition to specific skin features and nail involvement, to improve PsA detection. A systematic search was performed in Pubmed, Cochrane and Embase databases to identify clinical key symptoms associated with PsA. It yielded 27 studies in which we extracted a list of clinical signs and symptoms observed in PsA and submitted it to a panel of dermatology experts through a DELPHI selection process. The experts had to determine which minimal set of signs and symptoms dermatologists should look for in daily practice to improve detection of PsA in patients with psoriasis. The four items that received a score higher than 90% in the DELPHI process were finally selected. Those items were as follows: peripheral inflammatory pain (100%), axial inflammatory pain (95.3%), dactylitis (93%), buttock and sciatic pain (90.7%). The remaining items: distal interphalangeal joints (DIPs) involvement (83.7%), Talalgia (79.1%), swollen Achille's tendon (41.9%), costo-chondral involvement (32.6%), uveitis (7%), mouth ulcerations (2.3%), were not retained. We propose a set of four items to screen psoriasis patients for psoriatic arthritis for routine clinical use by dermatologists. © 2014 European Academy of Dermatology and Venereology.

  12. How did the public respond to the 2015 expert consensus public health guidance statement on workplace sedentary behaviour? A qualitative analysis

    Directory of Open Access Journals (Sweden)

    Benjamin Gardner

    2017-02-01

    Full Text Available Abstract Background In June 2015, an expert consensus guidance statement was published recommending that office workers accumulate 2–4 h of standing and light activity daily and take regular breaks from prolonged sitting. This paper describes public responses to media coverage of the guidance, so as to understand public acceptability of the recommendations within the guidance, and perceptions of sitting and standing as health behaviours. Methods UK news media websites that had reported on the sedentary workplace guidance statement, and permitted viewers to post comments responding to the story, were identified. 493 public comments, posted in a one-month period to one of six eligible news media websites, were thematically analysed. Results Three themes were extracted: (1 challenges to the credibility of the sedentary workplace guidance; (2 challenges to the credibility of public health; and (3 the guidance as a spur to knowledge exchange. Challenges were made to the novelty of the guidance, the credibility of its authors, the strength of its evidence base, and its applicability to UK workplaces. Public health was commonly mistrusted and viewed as a tool for controlling the public, to serve a paternalistic agenda set by a conspiracy of stakeholders with hidden non-health interests. Knowledge exchanges focused on correcting others’ misinterpretations, raising awareness of historical or scientific context, debating current workplace health policies, and sharing experiences around sitting and standing. Conclusions The guidance provoked exchanges of health-promoting ideas among some, thus demonstrating the potential for sitting reduction messages to be translated into everyday contexts by lay champions. However, findings also demonstrated confusion, misunderstanding and misapprehension among some respondents about the health value of sitting and standing. Predominantly unfavourable, mistrusting responses reveal significant hostility towards

  13. How did the public respond to the 2015 expert consensus public health guidance statement on workplace sedentary behaviour? A qualitative analysis.

    Science.gov (United States)

    Gardner, Benjamin; Smith, Lee; Mansfield, Louise

    2017-02-02

    In June 2015, an expert consensus guidance statement was published recommending that office workers accumulate 2-4 h of standing and light activity daily and take regular breaks from prolonged sitting. This paper describes public responses to media coverage of the guidance, so as to understand public acceptability of the recommendations within the guidance, and perceptions of sitting and standing as health behaviours. UK news media websites that had reported on the sedentary workplace guidance statement, and permitted viewers to post comments responding to the story, were identified. 493 public comments, posted in a one-month period to one of six eligible news media websites, were thematically analysed. Three themes were extracted: (1) challenges to the credibility of the sedentary workplace guidance; (2) challenges to the credibility of public health; and (3) the guidance as a spur to knowledge exchange. Challenges were made to the novelty of the guidance, the credibility of its authors, the strength of its evidence base, and its applicability to UK workplaces. Public health was commonly mistrusted and viewed as a tool for controlling the public, to serve a paternalistic agenda set by a conspiracy of stakeholders with hidden non-health interests. Knowledge exchanges focused on correcting others' misinterpretations, raising awareness of historical or scientific context, debating current workplace health policies, and sharing experiences around sitting and standing. The guidance provoked exchanges of health-promoting ideas among some, thus demonstrating the potential for sitting reduction messages to be translated into everyday contexts by lay champions. However, findings also demonstrated confusion, misunderstanding and misapprehension among some respondents about the health value of sitting and standing. Predominantly unfavourable, mistrusting responses reveal significant hostility towards efforts to displace workplace sitting with standing, and towards public

  14. Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts.

    Science.gov (United States)

    van Riet Paap, Jasper; Vernooij-Dassen, Myrra; Dröes, Rose-Marie; Radbruch, Lukas; Vissers, Kris; Engels, Yvonne

    2014-09-17

    Large numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators (QIs) have been developed to monitor and improve the organisation of palliative care for patients with cancer and those with dementia in various settings in different European countries. A multidisciplinary, international panel of professionals participated in a modified RAND Delphi procedure to compose a set of palliative care QIs based on existing sets of QIs on the organisation of palliative care. Panellists participated in three written rounds, one feedback round and one meeting. The panel's median votes were used to identify the final set of QIs. The Delphi procedure resulted in 23 useful QIs. These QIs represent key elements of the organisation of good clinical practice, such as the availability of palliative care teams, the availability of special facilities to provide palliative care for patients and their relatives, and the presence of educational interventions for professionals. The final set also includes QIs that are related to the process of palliative care, such as documentation of pain and other symptoms, communication with patients in need of palliative care and their relatives, and end-of-life decisions. International experts selected a set of 23 QIs for the organisation of palliative care. Although we particularly focused on the organisation of cancer and dementia palliative care, most QIs are generic and are applicable for other types of diseases as well.

  15. European Crohn's and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn's Disease

    NARCIS (Netherlands)

    Rieder, Florian; Latella, Giovanni; Magro, Fernando; Yuksel, Elif S.; Higgins, Peter D. R.; Di Sabatino, Antonio; de Bruyn, Jessica R.; Rimola, Jordi; Brito, Jorge; Bettenworth, Dominik; van Assche, Gert; Bemelman, Willem; D'Hoore, Andre; Pellino, Gianluca; Dignass, Axel U.

    2016-01-01

    This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practice

  16. Results of a consensus meeting on the use of argatroban in patients with heparin-induced thrombocytopenia requiring antithrombotic therapy - a European Perspective

    DEFF Research Database (Denmark)

    Alatri, Adriano; Armstrong, Anna-Elina; Greinacher, Andreas

    2012-01-01

    Argatroban has been introduced as an alternative parenteral anticoagulant for HIT-patients in several European countries in 2005. In 2009 a panel of experts discussed their clinical experience with argatroban balancing risks and benefits of argatroban treatment in managing the highly procoagulant...

  17. Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

    Science.gov (United States)

    Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

    2017-10-27

    Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality.

  18. Detailed and exhaustive study of the authentication of European virgin olive oils by SEXIA expert system

    Directory of Open Access Journals (Sweden)

    Aparicio, R.

    1994-08-01

    Full Text Available The authentication of extra virgin olive oils from different regions of Spain, Italy and Portugal, by means of their fatty acids, alcohols, sterols, methyl sterols and hydrocarbons content, has been investigated. Multivariate statistical methods and Evidence's Theory were applied. The comparative study shows greater predictive ability using this theory than the traditional statistical methods or expert systems that do not implement the possibility theory. A detailed and exhaustive study of Italian (Tuscany and Basilicata, Portuguese and Spanish virgin olive oils has been made. Geographically coloured maps of the studied regions are shown to strengthen the numerical results.

    Se ha estudiado la autentificación de aceites de oliva virgen de diferentes regiones de España, Italia y Portugal, por su contenido en ácidos grasos, alcoholes, esteroles, metil esteroles e hidrocarburos. Se aplicaron métodos estadísticos multivariantes junto a la Teoría de la Evidencia. El estudio mostró una mejora en la capacidad predictiva utilizando esta teoría frente a otros métodos o sistemas expertos que no implementan la teoría de la posibilidad. Se ha realizado un estudio detallado y exhaustivo con aceites de oliva virgen italianos (Toscana y Basilicata, portugueses y españoles. Los resultados numéricos se muestran sobre mapas geográficos de las diferentes regiones estudiadas.

  19. The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, S.A.; Torkzad, M.R.; Bhatnagar, G. [University College London, Centre for Medical Imaging, London (United Kingdom); Avni, F. [Lille University Hospitals, Department of Paediatric Imaging, Jeanne de Flandre Hospital, Lille (France); Cronin, C.G. [Mater Misericordiae University Hospital, Department of Radiology, Dublin (Ireland); Hoeffel, C. [Hopital Robert Debre, Department of Radiology, Reims (France); Kim, S.H. [Inje University College of Medicine, Haeundae Paik Hospital, Department of Radiology, Busan (Korea, Republic of); Laghi, A. [Sapienza University of Rome, I.C.O.T. Hospital, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy); Napolitano, M. [V. Buzzi Children' s Hospital, Department of Radiology and Neuroradiology, Milan (Italy); Petit, P. [Timone Enfant Hospital, Department of Paediatric Radiology, Marseille (France); Rimola, J. [University of Barcelona, Radiology Department, Hospital Clinic Barcelona, Catalonia (Spain); Tolan, D.J. [St James' s University Hospital, Leeds Teaching Hospitals NHS Trust (United Kingdom); Zappa, M. [Hopital Beaujon, AP-HP, Universite Paris 7, INSERM CRI U1149, Department of Radiology, Clichy (France); Puylaert, C.A.J.; Stoker, J. [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands)

    2017-06-15

    To develop guidelines describing a standardised approach to patient preparation and acquisition protocols for magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) of the small bowel and colon, with an emphasis on imaging inflammatory bowel disease. An expert consensus committee of 13 members from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Paediatric Radiology (ESPR) undertook a six-stage modified Delphi process, including a detailed literature review, to create a series of consensus statements concerning patient preparation, imaging hardware and image acquisition protocols. One hundred and fifty-seven statements were scored for agreement by the panel of which 129 statements (82 %) achieved immediate consensus with a further 19 (12 %) achieving consensus after appropriate modification. Nine (6 %) statements were rejected as consensus could not be reached. These expert consensus recommendations can be used to help guide cross-sectional radiological practice for imaging the small bowel and colon. (orig.)

  20. The European Hematology Association Roadmap for European Hematology Research

    DEFF Research Database (Denmark)

    Engert, Andreas; Balduini, Carlo; Brand, Anneke

    2016-01-01

    research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness...

  1. Photodynamic therapy for actinic keratosis: Is the European consensus protocol for daylight PDT superior to conventional protocol for Aktilite CL 128 PDT?

    Science.gov (United States)

    Vignion-Dewalle, Anne-Sophie; Baert, Gregory; Thecua, Elise; Vicentini, Claire; Mortier, Laurent; Mordon, Serge

    2017-09-01

    Topical photodynamic therapy (PDT) is an established treatment modality for various dermato-oncologic conditions. In Europe, initially requiring irradiation with red light, PDT of actinic keratosis (AK) can now also be carried out with exposure to daylight that has been clinically proven to be as effective as and less painful than red light. In this paper, we propose a comparison between the conventional protocol for Aktilite CL 128 (red light source) PDT and the European consensus protocol for daylight PDT - with the exposure is assumed to be performed during either a clear sunny day or an overcast day - in the treatment of AK with methyl aminolevulinate through a mathematical modeling. This already published modeling that is based on an iterative procedure alternating determination of the local fluence rate and updating of the local optical properties enables to estimate the local damage induced by the therapy. The European consensus protocol for daylight PDT during a sunny day and an overcast day provides, on average, 6.50 and 1.79 times higher PDT local damages at the end of the treatment than those obtained using the conventional protocol for Aktilite CL 128 PDT, respectively. Results analysis shows that, even performed during an overcast day, the European consensus protocol for daylight PDT leads to higher PDT local damages than the efficient conventional protocol for Aktilite CL 128. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Epidemic threats to the European Union: expert views on six virus groups.

    Science.gov (United States)

    Kelly, L; Brouwer, A; Wilson, A; Gale, P; Snary, E; Ross, David; de Vos, C J

    2013-08-01

    In recent years, several animal disease epidemics have occurred within the European Union (EU). At the 4th Annual Meeting of the EPIZONE network (7-10 June 2010, St. Malo, France), an interactive session was run to elicit the opinions of delegates on a pre-defined list of epidemic threats to the EU. Responses from over 190 delegates, to questions relating to impact and likelihood, were used to rank six virus groups with respect to their perceived threat now (2010) and in 2020. The combined opinions of all delegates suggested that, from the pre-selected list of virus groups, foot-and-mouth disease and influenza are currently of most concern. Delegates thought that influenza would be less of a threat and zoonotic arboviruses would be more of a threat in 2020. Although the virus group rankings should not be taken as definitive, the results could be used in conjunction with experimental and field data, by scientists, policy-makers and stakeholders when assessing and managing risks associated with these virus groups. © 2012 Blackwell Verlag GmbH.

  3. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society - first revision

    NARCIS (Netherlands)

    van den Bergh, P. Y. K.; Hadden, R. D. M.; Bouche, P.; Cornblath, D. R.; Hahn, A.; Illa, I.; Koski, C. L.; Léger, J.-M.; Nobile-Orazio, E.; Pollard, J.; Sommer, C.; van Doorn, P. A.; van Schaik, I. N.

    2010-01-01

    Consensus guidelines on the definition, investigation, and treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have been previously published in European Journal of Neurology and Journal of the Peripheral Nervous System. To revise these guidelines. Disease experts,

  4. Executive Summary: European Heart Rhythm Association Consensus Document on the Management of Supraventricular Arrhythmias: Endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE).

    Science.gov (United States)

    Katritsis, Demosthenes G; Boriani, Giuseppe; Cosio, Francisco G; Jais, Pierre; Hindricks, Gerhard; Josephson, Mark E; Keegan, Roberto; Knight, Bradley P; Kuck, Karl-Heinz; Lane, Deirdre A; Lip, Gregory Yh; Malmborg, Helena; Oral, Hakan; Pappone, Carlo; Themistoclakis, Sakis; Wood, Kathryn A; Young-Hoon, Kim; Lundqvist, Carina Blomström

    2016-01-01

    This paper is an executive summary of the full European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, published in Europace . It summarises developments in the field and provides recommendations for patient management, with particular emphasis on new advances since the previous European Society of Cardiology guidelines. The EHRA consensus document is available to read in full at http://europace.oxfordjournals.org.

  5. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts.

    Science.gov (United States)

    Vasen, Hans F A; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J; Hodgson, Shirley V; Karagiannis, John A; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Møller, Pal; Myrhoj, Torben; Nagengast, Fokko M; Parc, Yann; Ponz de Leon, Maurizio; Renkonen-Sinisalo, Laura; Sampson, Julian R; Stormorken, Astrid; Sijmons, Rolf H; Tejpar, Sabine; Thomas, Huw J W; Rahner, Nils; Wijnen, Juul T; Järvinen, Heikki Juhani; Möslein, Gabriela

    2013-06-01

    Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for the clinical management of LS. Since then substantial new information has become available necessitating an update of the guidelines. In 2011 and 2012 workshops were organised in Palma de Mallorca. A total of 35 specialists from 13 countries participated in the meetings. The first step was to formulate important clinical questions. Then a systematic literature search was performed using the Pubmed database and manual searches of relevant articles. During the workshops the outcome of the literature search was discussed in detail. The guidelines described in this paper may be helpful for the appropriate management of families with LS. Prospective controlled studies should be undertaken to improve further the care of these families.

  6. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts

    Science.gov (United States)

    Vasen, Hans F A; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J; Hodgson, Shirley V; Karagiannis, John A; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Møller, Pal; Myrhoj, Torben; Nagengast, Fokko M; Parc, Yann; Ponz de Leon, Maurizio; Renkonen-Sinisalo, Laura; Sampson, Julian R; Stormorken, Astrid; Sijmons, Rolf H; Tejpar, Sabine; Thomas, Huw J W; Rahner, Nils; Wijnen, Juul T; Järvinen, Heikki Juhani; Möslein, Gabriela

    2013-01-01

    Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for the clinical management of LS. Since then substantial new information has become available necessitating an update of the guidelines. In 2011 and 2012 workshops were organised in Palma de Mallorca. A total of 35 specialists from 13 countries participated in the meetings. The first step was to formulate important clinical questions. Then a systematic literature search was performed using the Pubmed database and manual searches of relevant articles. During the workshops the outcome of the literature search was discussed in detail. The guidelines described in this paper may be helpful for the appropriate management of families with LS. Prospective controlled studies should be undertaken to improve further the care of these families. PMID:23408351

  7. Consensus building on the development of a stress-based indicator for LCA-based impact assessment of water consumption: outcome of the expert workshops

    Science.gov (United States)

    The WULCA group, active since 2007 on Water Use in LCA, commenced the development of consensus-based indicators in January 2014. This activity is planned to last 2 years and covers human health, ecosystem quality, and a stress-based indicator. This latter encompasses potential de...

  8. European Academy of Neurology/European Association for Palliative Care Taskforce on Neurology Consensus recommendations on palliative care for patients with chronic and progressive neurological disease - acceptability for Belgian neurologists.

    Science.gov (United States)

    Vanopdenbosch, L J; Maes, E; Oliver, D J

    2017-07-01

    A Consensus document on palliative care and neurology has made recommendations on the care of people with chronic and progressive neurological disease. This study aimed to investigate whether these recommendations are understood by, acceptable to and used in practice by neurologists in Belgium. An online survey was undertaken of 100 neurologists in Belgium, asking for their opinion on all of the recommendations in the Consensus document. Sixty-four of the neurologists replied. Overall, they expressed support for the recommendations, in particular open communication with patients, open assessment of patient and family needs, and discussion of dying. There was less understanding of the role of palliative care in the implementation of palliative care early in disease progression and the role of palliative care multidisciplinary teams. The survey shows that many of the recommendations in the European Academy of Neurology/European Association for Palliative Care Taskforce on Neurology Consensus document are understood by neurologists, and several are now seen as part of normal clinical practice. However, there is still a need to develop a more collaborative approach between neurology and palliative care services, for the benefit of patients and families. © 2017 EAN.

  9. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence

    NARCIS (Netherlands)

    Chapple, Christopher R.; Cruz, Francisco; Deffieux, Xavier; Milani, Alfredo L.; Arlandis, Salvador; Artibani, Walter; Bauer, Ricarda M.; Burkhard, Fiona; Cardozo, Linda; Castro-Diaz, David; Cornu, Jean Nicolas; Deprest, Jan; Gunnemann, Alfons; Gyhagen, Maria; Heesakkers, John; Koelbl, Heinz; MacNeil, Sheila; Naumann, Gert; Roovers, Jan-Paul W. R.; Salvatore, Stefano; Sievert, Karl-Dietrich; Tarcan, Tufan; van der Aa, Frank; Montorsi, Francesco; Wirth, Manfred; Abdel-Fattah, Mohamed

    2017-01-01

    Context: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). Objective: A consensus review of existing

  10. Infection control in the management of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease

    DEFF Research Database (Denmark)

    Brouqui, Philippe; Puro, Vincenzo; Fusco, Francesco M

    2009-01-01

    The European Network for Infectious Diseases (EUNID) is a network of clinicians, public health epidemiologists, microbiologists, infection control, and critical-care doctors from the European member states, who are experienced in the management of patients with highly infectious diseases. We aim ...

  11. Translating Guidelines Into Practice: Interpreting the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk.

    Science.gov (United States)

    Waite, Laura H; Phan, Yvonne L; Spinler, Sarah A

    2017-10-01

    In 2016, the American College of Cardiology released a decision pathway, based on expert consensus, to guide use of non-statin agents in the management of atherosclerotic cardiovascular disease risk. The purpose of this article is to assist practitioners, health systems and managed care entities with interpreting this consensus statement in order to simplify implementation of the recommendations into patient care. Major themes from the consensus statement are briefly summarized and explained. Drug therapy recommendations are condensed into a single algorithm, while tables correlate each recommended regimen with the appropriate patient population from both a patient-level and systems-level perspective. Finally, a patient case with evidence-based decision support is explored. These tools allow practitioners to make appropriate patient-specific decisions about the use of non-statin pharmacotherapy and enable health systems and managed care entities to more readily identify guideline-appropriate use of these agents upon review of patient profiles or prescribing patterns. This article provides resources for healthcare providers that facilitate uptake of these recommendations into clinical practice.

  12. Initiation and intensification of antihyperglycemic therapy in type 2 diabetes mellitus: Update of Russian Association of Endocrinologists expert consensus document (2015

    Directory of Open Access Journals (Sweden)

    Ivan Ivanovich Dedov

    2015-03-01

    Full Text Available The current update of the consensus algorithm of initiation and intensification of the antihyperglicemic therapy in treatment of the patients with type 2 diabetes mellitus (2015 is based on the preliminary document issued by the Russian Association of the Endocrinologists in 2011.The update was needed due to new data on the safety of the traditional therapeutic options, availability of the new class of the antidiabetic medications, and necessity to add chapter about initiation and intensification of the insulin therapy.The patient-centered approach remains the absolute priority at any stage of diabetes care as it ensures the efficacy and safety of antihyperglycaemic treatment.

  13. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: A consensus and data-driven methodology involving three international patient cohorts.

    Science.gov (United States)

    Shiboski, Caroline H; Shiboski, Stephen C; Seror, Raphaèle; Criswell, Lindsey A; Labetoulle, Marc; Lietman, Thomas M; Rasmussen, Astrid; Scofield, Hal; Vitali, Claudio; Bowman, Simon J; Mariette, Xavier

    2017-01-01

    To develop and validate an international set of classification criteria for primary Sjögren's syndrome (SS) using guidelines from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). These criteria were developed for use in individuals with signs and/or symptoms suggestive of SS. We assigned preliminary importance weights to a consensus list of candidate criteria items, using multi-criteria decision analysis. We tested and adapted the resulting draft criteria using existing cohort data on primary SS cases and non-SS controls, with case/non-case status derived from expert clinical judgement. We then validated the performance of the classification criteria in a separate cohort of patients. The final classification criteria are based on the weighted sum of five items: anti-SSA/Ro antibody positivity and focal lymphocytic sialadenitis with a focus score of ≥1 foci/4 mm(2), each scoring 3; an abnormal Ocular Staining Score of ≥5 (or van Bijsterveld score of ≥4), a Schirmer's test result of ≤5 mm/5 min and an unstimulated salivary flow rate of ≤0.1 mL/min, each scoring 1. Individuals with signs and/or symptoms suggestive of SS who have a total score of ≥4 for the above items meet the criteria for primary SS. Sensitivity and specificity against clinician-expert-derived case/non-case status in the final validation cohort were high, that is, 96% (95% CI92% to 98%) and 95% (95% CI 92% to 97%), respectively. Using methodology consistent with other recent ACR/EULAR-approved classification criteria, we developed a single set of data-driven consensus classification criteria for primary SS, which performed well in validation analyses and are well suited as criteria for enrolment in clinical trials. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery

    OpenAIRE

    Stoppe, Christian; Goetzenich, Andreas; Whitman, Glenn; Ohkuma, Rika; Brown, Trish; Hatzakorzian, Roupen; Kristof, Arnold; Meybohm, Patrick; Mechanick, Jefferey; Evans, Adam; Yeh, Daniel; McDonald, Bernard; Chourdakis, Michael; Jones, Philip; Barton, Richard

    2017-01-01

    Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group of 25 experts from different clinical specialties from Germany, Canada, Greece, USA and Russia discussed potential approaches to identify patients who may benefit from nutrition support, when best to initiate nut...

  15. Polyanalgesic consensus conference 2007: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel.

    Science.gov (United States)

    Deer, Timothy; Krames, Elliot S; Hassenbusch, Samuel J; Burton, Allen; Caraway, David; Dupen, Stuart; Eisenach, James; Erdek, Michael; Grigsby, Eric; Kim, Phillip; Levy, Robert; McDowell, Gladstone; Mekhail, Nagy; Panchal, Sunil; Prager, Joshua; Rauck, Richard; Saulino, Michael; Sitzman, Todd; Staats, Peter; Stanton-Hicks, Michael; Stearns, Lisa; Willis, K Dean; Witt, William; Follett, Kenneth; Huntoon, Marc; Liem, Leong; Rathmell, James; Wallace, Mark; Buchser, Eric; Cousins, Michael; Ver Donck, Anne

    2007-10-01

    Background.  Expert panels of physicians and nonphysicians in the field of intrathecal therapies convened in 2000 and 2003 to make recommendations for the rational use of intrathecal analgesics based on the preclinical and clinical literature known up to those times. An expert panel of physicians convened in 2007 to update previous recommendations and to form guidelines for the rational use of intrathecal opioid and nonopioid agents. Methods.  A review of preclinical and clinical published relevant studies from 2000 to 2006 was undertaken and disseminated to a convened expert panel of physicians and nonphysicians. Focused discussions were held on the rational use of intrathecal agents and a survey asking questions regarding intrathecal therapies management was given to the panelists. Results.  The panelists, after review of the literature from 2000 to 2006 and discussion, created an updated algorithm for the rational use of intrathecal opioid and nonopioid agents in patients with nonmalignant and end-of-life pain. Of note is that the panelists felt that ziconotide, based on new and relevant literature and experience, should be updated to a line one intrathecal drug.

  16. [The common position of the Czech professional associations on the consensus of the European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine regarding investigation on blood lipids and interpretation of their levels].

    Science.gov (United States)

    Soška, Vladimír; Franeková, Janka; Friedecký, Bedřich; Jabor, Antonín; Kraml, Pavel; Rosolová, Hana; Vrablík, Michal

    The aim of this opinion is to summarize and to comment the consensus of the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine, which covers two main areas: 1) whether it is necessary / required to be fasting or non-fasting before blood sampling for lipids measurement, and what are the changes in the concentration of blood lipids during the day; 2) What decision limits (cut off value) of lipids and lipoproteins should be reported from laboratories and what is the recommended procedure for people with extreme / critical blood lipid values. Following parameters are discused: total cholesterol, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein(a). This opinion should be the object of interest both for professionals in clinical laboratories and for physicians in hospitals and out-patients departments.Key words: apolipoproteins - blood collection - cholesterol - laboratory testing - lipoprotein(a) - cut off limits - triglycerides.

  17. Evaluation of tuberculosis diagnostics in children: 2. Methodological issues for conducting and reporting research evaluations of tuberculosis diagnostics for intrathoracic tuberculosis in children. Consensus from an expert panel.

    Science.gov (United States)

    Cuevas, Luis E; Browning, Renee; Bossuyt, Patrick; Casenghi, Martina; Cotton, Mark F; Cruz, Andrea T; Dodd, Lori E; Drobniewski, Francis; Gale, Marianne; Graham, Stephen M; Grzemska, Malgosia; Heinrich, Norbert; Hesseling, Anneke C; Huebner, Robin; Jean-Philippe, Patrick; Kabra, Sushil Kumar; Kampmann, Beate; Lewinsohn, Deborah; Li, Meijuan; Lienhardt, Christian; Mandalakas, Anna M; Marais, Ben J; Menzies, Heather J; Montepiedra, Grace; Mwansambo, Charles; Oberhelman, Richard; Palumbo, Paul; Russek-Cohen, Estelle; Shapiro, David E; Smith, Betsy; Soto-Castellares, Giselle; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire; Worrell, Carol

    2012-05-15

    Confirming the diagnosis of childhood tuberculosis is a major challenge. However, research on childhood tuberculosis as it relates to better diagnostics is often neglected because of technical difficulties, such as the slow growth in culture, the difficulty of obtaining specimens, and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. Researchers often use individually designed criteria for enrollment, diagnostic classifications, and reference standards, thereby hindering the interpretation and comparability of their findings. The development of standardized research approaches and definitions is therefore needed to strengthen the evaluation of new diagnostics for detection and confirmation of tuberculosis in children. In this article we present consensus statements on methodological issues for conducting research of Tuberculosis diagnostics among children, with a focus on intrathoracic tuberculosis. The statements are complementary to a clinical research case definition presented in an accompanying publication and suggest a phased approach to diagnostics evaluation; entry criteria for enrollment; methods for classification of disease certainty, including the rational use of culture within the case definition; age categories and comorbidities for reporting results; and the need to use standard operating procedures. Special consideration is given to the performance of microbiological culture in children and we also recommend for alternative methodological approaches to report findings in a standardized manner to overcome these limitations are made. This consensus statement is an important step toward ensuring greater rigor and comparability of pediatric tuberculosis diagnostic research, with the aim of realizing the full potential of better tests for children.

  18. The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood : multicenter evaluation and expert consensus

    NARCIS (Netherlands)

    De Luca, Daniele; Piastra, Marco; Chidini, Giovanna; Tissieres, Pierre; Calderini, Edoardo; Essouri, Sandrine; Medina Villanueva, Alberto; Vivanco Allende, Ana; Pons-Odena, Marti; Perez-Baena, Luis; Hermon, Michael; Tridente, Ascanio; Conti, Giorgio; Antonelli, Massimo; Kneyber, Martin

    2013-01-01

    A new acute respiratory distress syndrome (ARDS) definition has been recently issued: the so-called Berlin definition (BD) has some characteristics that could make it suitable for pediatrics. The European Society for Pediatric Neonatal Intensive Care (ESPNIC) Respiratory Section started a project to

  19. Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study.

    NARCIS (Netherlands)

    Devillé, W.; Greacen, T.; Bogic, M.; Dauvrin, M.; Dias, S.; Gaddini, A.; Koitzsch Jensen, N.; Karamanidou, C.; Kluge, U.; Mertaniemi, R.; Puigpinósi Riera, R.; Sarvary, A.; Soares, J.J.F.; Stankunas, M.; Straßmayr, C.; Welbel, M.; Priebe, S.

    2011-01-01

    BACKGROUND: European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and

  20. Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study

    NARCIS (Netherlands)

    Devillé, W.; Greacen, T.; Bogic, M.; Dauvrin, M.; Dias, S.; Gaddini, A.; Koitzsch Jensen, N.; Karamanidou, C.; Kluge, U.; Mertaniemi, R.; Puigpinós i Riera, R.; Sárváry, A.; Soares, J.J.F.; Stankunas, M.; Straßmayr, C.; Welbel, M.; Priebe, S.

    2011-01-01

    Background European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and

  1. Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts

    NARCIS (Netherlands)

    Paap, J.; Vernooij-Dassen, M.J.F.J.; Droes, R.M.; Radbruch, L.; Vissers, K.; Engels, Y.M.

    2014-01-01

    BACKGROUND: Large numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators

  2. Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society….

    Science.gov (United States)

    Parma, Radosław; Zembala, Michał O; Dąbrowski, Maciej; Jagielak, Dariusz; Witkowski, Adam; Suwalski, Piotr; Dudek, Dariusz; Olszówka, Piotr; Wojakowski, Wojciech; Przybylski, Roman; Gil, Robert; Kuśmierczyk, Mariusz; Lesiak, Maciej; Sadowski, Jerzy; Dobrzycki, Sławomir; Ochała, Andrzej; Hoffman, Piotr; Kapelak, Bogusław; Kaźmierczak, Jarosław; Jasiński, Marek; Stępińska, Janina; Szymański, Piotr; Hryniewiecki, Tomasz; Kochman, Janusz; Grygier, Marek; Zembala, Marian; Legutko, Jacek; Różański, Jacek

    2017-01-01

    Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multi-disciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establish-ment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.

  3. Setting an Agenda for Assessment of Health-related Quality of Life Among Men with Prostate Cancer on Active Surveillance: A Consensus Paper from a European School of Oncology Task Force.

    Science.gov (United States)

    Villa, Silvia; Kendel, Friederike; Venderbos, Lionne; Rancati, Tiziana; Bangma, Chris; Carroll, Peter; Denis, Louis; Klotz, Laurence; Korfage, Ida J; Lane, Athene J; Magnani, Tiziana; Mastris, Ken; Rannikko, Antti; Roobol, Monique; Trock, Bruce; Van den Bergh, Roderick; Van Poppel, Hendrik; Valdagni, Riccardo; Bellardita, Lara

    2017-02-01

    Literature on the health-related quality of life (HRQoL) for men with localized prostate cancer (PCa) on active surveillance (AS) shows a need for methodological guidance regarding HRQoL issues and how to address them. The European School of Oncology Task Force (ESO TF) aimed to identify a core set of research questions and related measures to include in AS HRQoL studies. A modified Delphi study was used to reach consensus on AS HRQoL research topics and tools between 2014 and 2015. Data were collected by engaging a multidisciplinary team of 15 experts. An open-ended questionnaire was used to collect information from ESO TF members regarding issues in AS HRQoL research. Then a structured questionnaire was used to collect ratings on the usefulness/importance of different AS HRQoL aspects. Items that ≥80% of ESO TF members rated as useful/important were retained. Items with a 50-80% rating were discussed to reach final agreement. Six main research questions concerning the selection of outcome measures, measurement tools, and comparison groups were identified as relevant. The core set of measures identified were related to individual characteristics, psychological dimensions; decision-making-related issues, and physical functioning. The multidisciplinary expertise of ESO TF members was a significant asset, even if bringing different backgrounds to the discussion table represented a challenge. HRQoL measures have to be sensitive to the specific needs of men on AS. The definition of HRQoL outcomes will enhance a broader understanding of the HRQoL of men on AS and sustain patient-centered medicine. An international panel agreed on a set of health-related quality-of-life aspects to be assessed among men on active surveillance for prostate cancer. Valid relevant questionnaires were identified. The experts' indications lay a foundation for future research and clinical practice. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights

  4. 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways.

    Science.gov (United States)

    Lloyd-Jones, Donald M; Morris, Pamela B; Ballantyne, Christie M; Birtcher, Kim K; Daly, David D; DePalma, Sondra M; Minissian, Margo B; Orringer, Carl E; Smith, Sidney C

    2017-10-03

    In 2016, the American College of Cardiology published the first expert consensus decision pathway (ECDP) on the role of non-statin therapies for low-density lipoprotein (LDL)-cholesterol lowering in the management of atherosclerotic cardiovascular disease (ASCVD) risk. Since the publication of that document, additional evidence and perspectives have emerged from randomized clinical trials and other sources, particularly considering the longer-term efficacy and safety of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in secondary prevention of ASCVD. Most notably, the FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) trial and SPIRE-1 and -2 (Studies of PCSK9 Inhibition and the Reduction of Vascular Events), assessing evolocumab and bococizumab, respectively, have published final results of cardiovascular outcomes trials in patients with clinical ASCVD and in a smaller number of high-risk primary prevention patients. In addition, further evidence on the types of patients most likely to benefit from the use of ezetimibe in addition to statin therapy after acute coronary syndrome has been published. Based on results from these important analyses, the ECDP writing committee judged that it would be desirable to provide a focused update to help guide clinicians more clearly on decision making regarding the use of ezetimibe and PCSK9 inhibitors in patients with clinical ASCVD with or without comorbidities. In the following summary table, changes from the 2016 ECDP to the 2017 ECDP Focused Update are highlighted, and a brief rationale is provided. The content of the full document has been changed accordingly, with more extensive and detailed guidance regarding decision making provided both in the text and in the updated algorithms. Revised recommendations are provided for patients with clinical ASCVD with or without comorbidities on statin therapy for secondary prevention. The ECDP writing committee judged

  5. Clinical commentary --COPD is not a systemic disease. Results from the AIMAR Expert Opinion Consensus/Dissensus Seminar "COPD is/is not a systemic disease?", Venice, Italy, 13-14 November 2008.

    Science.gov (United States)

    Donner, Claudio F; Bjermer, Leif

    2009-09-01

    Although COPD is a major disease worldwide there is a perplexing current uncertainty about the nature of this disease. COPD is characterized at onset and prevalently by the involvement of the lungs and bronchi, but as the disease evolves abnormalities develop in other organs and systems and the question arises: what is the pathogenesis of these respiratory and systemic impairments? Are the alterations that occur outside the respiratory system in the course of COPD a direct consequence of the lung pathology or is the lung simply the local expression of a pathological event whose origin lies in the organism as a whole? To tease out this issue, the Expert Opinion Consensus/Dissensus Seminar "COPD is/is not a systemic disease?" took place in Venice, on 13-14 November 2008. The Seminar was conceived and organized by the Italian Interdisciplinary Association for Research in Lung Disease, AIMAR. Top international opinion leaders in the respiratory field were invited to participate, the aim being to bring together sustainers of the two sides in a format allowing the best opportunity for an in-depth debate. Over the two days, different aspects of the issue 'upstream' (pathophysiology and biology) and 'downstream' (treatment and outcome assessment) were discussed. The general consensus that emerged, based on the still limited evidence available, was that COPD begins as a local inflammation in the lungs and this leads - through differentiated pathways yet to be fully clarified - to systemic consequences.

  6. [Safe prescription recommendations for non steroidal anti-inflammatory drugs: Consensus document ellaborated by nominated experts of three scientific associations (SER-SEC-AEG)].

    Science.gov (United States)

    Lanas, Angel; Benito, Pere; Alonso, Joaquín; Hernández-Cruz, Blanca; Barón-Esquivias, Gonzalo; Perez-Aísa, Angeles; Calvet, Xavier; García-Llorente, José Francisco; Gobbo, Milena; Gonzalez-Juanatey, José R

    2014-03-01

    This article outlines key recommendations for the appropriate prescription of non steroidal anti-inflammatory drugs to patients with different musculoskeletal problems. These recommendations are based on current scientific evidence, and takes into consideration gastrointestinal and cardiovascular safety issues. The recommendations have been agreed on by experts from three scientific societies (Spanish Society of Rheumatology [SER], Spanish Association of Gastroenterology [AEG] and Spanish Society of Cardiology [SEC]), following a two-round Delphi methodology. Areas that have been taken into account encompass: efficiency, cardiovascular risk, gastrointestinal risk, liver risk, renal risk, inflammatory bowel disease, anemia, post-operative pain, and prevention strategies. We propose a patient management algorithm that summarizes the main aspects of the recommendations. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  7. Safe prescription recommendations for non steroidal anti-inflammatory drugs: consensus document ellaborated by nominated experts of three scientific associations (SER-SEC-AEG).

    Science.gov (United States)

    Lanas, Angel; Benito, Pere; Alonso, Joaquín; Hernández-Cruz, Blanca; Barón-Esquivias, Gonzalo; Perez-Aísa, Ángeles; Calvet, Xavier; García-Llorente, José Francisco; Gobbo, Milena; Gonzalez-Juanatey, José R

    2014-01-01

    This article outlines key recommendations for the appropriate prescription of non steroidal anti-inflammatory drugs to patients with different musculoskeletal problems. These recommendations are based on current scientific evidence, and takes into consideration gastrointestinal and cardiovascular safety issues. The recommendations have been agreed on by experts from three scientific societies (Spanish Society of Rheumatology [SER], Spanish Association of Gastroenterology [AEG] and Spanish Society of Cardiology [SEC]), following a two-round Delphi methodology. Areas that have been taken into account encompass: efficiency, cardiovascular risk, gastrointestinal risk, liver risk, renal risk, inflammatory bowel disease, anemia, post-operative pain, and prevention strategies. We propose a patient management algorithm that summarizes the main aspects of the recommendations. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  8. Recommendations for reporting economic evaluations of haemophilia prophylaxis: a nominal groups consensus statement on behalf of the Economics Expert Working Group of The International Prophylaxis Study Group.

    Science.gov (United States)

    Nicholson, A; Berger, K; Bohn, R; Carcao, M; Fischer, K; Gringeri, A; Hoots, K; Mantovani, L; Schramm, W; van Hout, B A; Willan, A R; Feldman, B M

    2008-01-01

    The need for clearly reported studies evaluating the cost of prophylaxis and its overall outcomes has been recommended from previous literature. To establish minimal ''core standards'' that can be followed when conducting and reporting economic evaluations of hemophilia prophylaxis. Ten members of the IPSG Economic Analysis Working Group participated in a consensus process using the Nominal Groups Technique (NGT). The following topics relating to the economic analysis of prophylaxis studies were addressed; Whose perspective should be taken? Which is the best methodological approach? Is micro- or macro-costing the best costing strategy? What information must be presented about costs and outcomes in order to facilitate local and international interpretation? The group suggests studies on the economic impact of prophylaxis should be viewed from a societal perspective and be reported using a Cost Utility Analysis (CUA) (with consideration of also reporting Cost Benefit Analysis [CBA]). All costs that exceed $500 should be used to measure the costs of prophylaxis (macro strategy) including items such as clotting factor costs, hospitalizations, surgical procedures, productivity loss and number of days lost from school or work. Generic and disease specific quality of lífe and utility measures should be used to report the outcomes of the study. The IPSG has suggested minimal core standards to be applied to the reporting of economic evaluations of hemophilia prophylaxis. Standardized reporting will facilitate the comparison of studies and will allow for more rational policy decisions and treatment choices.

  9. A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference.

    Science.gov (United States)

    Kirchhof, Paulus; Breithardt, Günter; Bax, Jeroen; Benninger, Gerlinde; Blomstrom-Lundqvist, Carina; Boriani, Giuseppe; Brandes, Axel; Brown, Helen; Brueckmann, Martina; Calkins, Hugh; Calvert, Melanie; Christoffels, Vincent; Crijns, Harry; Dobrev, Dobromir; Ellinor, Patrick; Fabritz, Larissa; Fetsch, Thomas; Freedman, S Ben; Gerth, Andrea; Goette, Andreas; Guasch, Eduard; Hack, Guido; Haegeli, Laurent; Hatem, Stephane; Haeusler, Karl Georg; Heidbüchel, Hein; Heinrich-Nols, Jutta; Hidden-Lucet, Francoise; Hindricks, Gerd; Juul-Möller, Steen; Kääb, Stefan; Kappenberger, Lukas; Kespohl, Stefanie; Kotecha, Dipak; Lane, Deirdre A; Leute, Angelika; Lewalter, Thorsten; Meyer, Ralf; Mont, Lluis; Münzel, Felix; Nabauer, Michael; Nielsen, Jens C; Oeff, Michael; Oldgren, Jonas; Oto, Ali; Piccini, Jonathan P; Pilmeyer, Art; Potpara, Tatjana; Ravens, Ursula; Reinecke, Holger; Rostock, Thomas; Rustige, Joerg; Savelieva, Irene; Schnabel, Renate; Schotten, Ulrich; Schwichtenberg, Lars; Sinner, Moritz F; Steinbeck, Gerhard; Stoll, Monika; Tavazzi, Luigi; Themistoclakis, Sakis; Tse, Hung Fat; Van Gelder, Isabelle C; Vardas, Panagiotis E; Varpula, Timo; Vincent, Alphons; Werring, David; Willems, Stephan; Ziegler, André; Lip, Gregory Y H; Camm, A John

    2016-01-01

    At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations, remain unacceptably high, even when evidence-based therapies such as anticoagulation and rate control are used. Furthermore, it is still necessary to define how best to prevent AF, largely due to a lack of clinical measures that would allow identification of treatable causes of AF in any given patient. Hence, there are important unmet clinical and research needs in the evaluation and management of AF patients. The ensuing needs and opportunities for improving the quality of AF care were discussed during the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v) personalization of AF management. This report ends with a list of priorities for research in AF patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  10. Comment on: Martelletti et al. Refractory chronic migraine: a consensus statement on clinical definition from the European Headache Federation

    Science.gov (United States)

    2014-01-01

    In this letter, we present the Austrian proposal for diagnostic criteria of refractory chronic migraine and we discuss the consensensus statement of the European Headache Feaderation. We focus in particular on the definition of adequate prophylactic treatment, the management of medication overuse and the requirement for CSF analyses in patients with refractory chronic migraine. In our proposal, the criteria for adequate treatment and recommendations for dealing with medication overuse are more explicit than in the EHF proposal, whereas the requirements for CSF analyses and measurement of CSF pressure are not as strict. PMID:25418797

  11. Continuity and consensus

    DEFF Research Database (Denmark)

    Abrahamson, Peter

    2010-01-01

    maternal leave. These changes can be explained as adjustments to post-industrial conditions within a political culture relying on class compromises and a broad consensus informed by expert advice coming from civil servants and ad hoc policy commissions. The paper concludes that changes in Danish family...

  12. Treatment of non muscle invasive bladder tumor related to the problem of bacillus Calmette-Guerin availability. Consensus of a Spanish expert's panel. Spanish Association of Urology.

    Science.gov (United States)

    Fernández-Gómez, J M; Carballido-Rodríguez, J; Cozar-Olmo, J M; Palou-Redorta, J; Solsona-Narbón, E; Unda-Urzaiz, J M

    2013-01-01

    Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives. To present the work performed by said committee and the resulting recommendations. An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG. In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available. Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  13. Expert consensus workshop report: Guideline for three-dimensional printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy

    Directory of Open Access Journals (Sweden)

    Junjie Wang

    2017-01-01

    Full Text Available Radioactive 125I seeds (RIS interstitial implantation brachytherapy has been a first-line treatment for early-stage cancer of the prostate gland. However, its poor accuracy and homogeneity has limited its indication and hampered its popularization for a long time. Intriguingly, scholars based in China introduced computed tomography (CT-guided technology to improve the accuracy and homogeneity of RIS implantation and broadened the indications. Then, they creatively designed and introduced three-dimensional printing coplanar template (3D-PCT and 3D printing noncoplanar template (3D-PNCT into the practice of RIS implantation. Use of such templates makes RIS implantation more precise and efficacious and aids preoperative planning, real-time dose optimization, and postoperative planning. However, studies on the standard workflow for 3D-PT-assisted CT-guided RIS implantation have not been published. Therefore, the China Northern Radioactive Seeds Brachytherapy Group organized multidisciplinary experts to formulate the guideline for this emerging treatment modality. This guideline aims at standardizing 3D-PT-assisted CT-guided RIS implantation procedures and criteria for selecting treatment candidates and assessing outcomes and for preventing and managing postoperative complications.

  14. Diagnosis and Management of Pemphigus: recommendations by an International Panel of Experts.

    Science.gov (United States)

    Murrell, Dedee F; Peña, Sandra; Joly, Pascal; Marinovic, Branka; Hashimoto, Takashi; Diaz, Luis A; Sinha, Animesh A; Payne, Aimee S; Daneshpazhooh, Maryam; Eming, Rüdiger; Jonkman, Marcel F; Mimouni, Daniel; Borradori, Luca; Kim, Soo-Chan; Yamagami, Jun; Lehman, Julia S; Saleh, Marwah Adly; Culton, Donna A; Czernik, Annette; Zone, John J; Fivenson, David; Ujiie, Hideyuki; Wozniak, Katarzyna; Akman-Karakaş, Ayşe; Bernard, Philippe; Korman, Neil J; Caux, Frédéric; Drenovska, Kossara; Prost-Squarcioni, Catherine; Vassileva, Snejina; Feldman, Ron J; Cardones, Adela Rambi; Bauer, Johann; Ioannides, Dimitrios; Jedlickova, Hana; Palisson, Francis; Patsatsi, Aikaterini; Uzun, Soner; Yayli, Savas; Zillikens, Detlef; Amagai, Masayuki; Hertl, Michael; Schmidt, Enno; Aoki, Valeria; Grando, Sergei A; Shimizu, Hiroshi; Baum, Sharon; Cianchini, Guiseppe; Feliciani, Claudio; Iranzo, Pilar; Mascaró, Jose M; Kowalewski, Cezary; Hall, Russell; Groves, Richard; Harman, Karen E; Marinkovich, M Peter; Maverakis, Emanual; Werth, Victoria P

    2018-02-10

    Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management, OBJECTIVE: We now present results from a subsequent Delphi consensus to broaden the generalizability of recommendations. A preliminary survey, based on the European Dermatology Forum (EDF) and the European Academy of Dermatology and Venereology (EADV) guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology (AAD) conference. A second survey was sent following the meeting to more experts to achieve greater international consensus. The 39 experts participated in the first round of the Delphi-survey while 54 from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II based on Delphi results and meeting discussion. Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first line therapy option for moderate to severe pemphigus. Copyright © 2018. Published by Elsevier Inc.

  15. Self-medication of anaphylactic reactions due to Hymenoptera stings-an EAACI Task Force Consensus Statement

    NARCIS (Netherlands)

    Bilo, M. B.; Cichocka-Jarosz, E.; Pumphrey, R.; Oude-Elberink, J. N.; Lange, J.; Jakob, T.; Bonadonna, P.; Fernandez, J.; Kosnik, M.; Helbling, A.; Mosbech, H.; Gawlik, R.; Niedoszytko, M.; Patella, V.; Pravettoni, V.; Rodrigues-Alves, R.; Sturm, G. J.; Rueff, F.

    An anaphylactic reaction due to a Hymenoptera sting is a clinical emergency, and patients, their caregivers as well as all healthcare professionals should be familiar with its recognition and acute management. This consensus report has been prepared by a European expert panel of the EAACI Interest

  16. Ventilation and health in non-industrial indoor environments: report from a European Multidisciplinary Scientific Consensus Meeting (EUROVEN)

    DEFF Research Database (Denmark)

    Wargocki, Pawel; Sundell, Jan; Bischof, W.

    2002-01-01

    Scientific literature on the effects of ventilation on health, comfort, and productivity in non-industrial indoor environments (offices, schools, homes, etc.) has been reviewed by a multidisciplinary group of European scientists, called EUROVEN, with expertise in medicine, epidemiology, toxicology...... the risk of SBS symptoms, increase short-term sick leave, and decrease productivity among occupants of office buildings; and that ventilation rates above 0.5 air changes per hour (h-1) in homes reduce infestation of house dust mites in Nordic countries. The group concluded additionally that the literature...... leave), and that an association between ventilation and productivity (performance of office work) is indicated. The group also concluded that increasing outdoor air supply rates in non-industrial environments improves perceived air quality; that outdoor air supply rates below 25 l/s per person increase...

  17. When to treat a diabetic patient using an external insulin pump. Expert consensus. Société francophone du diabète (ex ALFEDIAM) 2009.

    Science.gov (United States)

    Lassmann-Vague, V; Clavel, S; Guerci, B; Hanaire, H; Leroy, R; Loeuille, G A; Mantovani, I; Pinget, M; Renard, E; Tubiana-Rufi, N

    2010-02-01

    For years, external insulin pumps have enjoyed proven efficacy as an intensive diabetes treatment to improve glycaemic control and reduce hypoglycaemia. Since the last ALFEDIAM guidelines in 1995, however, basal-bolus treatment using a combination of long- and short-acting insulin analogues have emerged and could challenge, at a lower cost, the efficacy of pumps using rapid-acting insulin analogues, considered the 'gold standard' of insulin treatment. Nevertheless, given its theoretical and practical advantages, some patients will derive more benefit from pump treatment. These cases have been carefully evaluated in the literature by a panel of experts appointed by ALFEDIAM to determine the indications for pump treatment. In patients with type 1 diabetes, persistent elevated HbA(1c) despite multiple daily injections (MDI), and repeated hypoglycaemia and high glycaemic variability, represent the most validated indications. In patients with type 2 diabetes, pump treatment may be indicated in cases of MDI failure to achieve HbA(1c) targets. Absolute contraindications are rare, and comprise severe psychiatric disorders, rapidly progressing ischaemic or proliferative retinopathy before laser treatment and exposure to high magnetic fields. Relative contraindications are mostly related to the patient's lack of compliance or inability to cope with the treatment, and need to be evaluated individually to clearly assess the benefit/risk ratio for the given patient. However, as these conditions are progressive, there should also be annual reassessment of the appropriateness of pump treatment. Specific education on pump treatment initially and throughout the follow-up, delivered by experienced medical and paramedical teams, are the best guarantees of treatment efficacy and safety. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

  18. Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology.

    Science.gov (United States)

    Tonetti, Maurizio S; Jepsen, Søren

    2014-04-01

    The scope of the discussions of this consensus report was to assess the strength of the scientific evidence and make clinical and research recommendations for surgical interventions to cover exposed root surfaces and enhance soft tissues at implants. Discussions were informed by three systematic reviews covering single recessions, multiple recessions and soft-tissue deficiencies at implants. The strength of the evidence was assessed using a modification in GRADE. The group also emphasized the need to report the experience of the surgeon and the performance of the control intervention (CONSORT guidelines for non-pharmacological treatment). A moderate strength of evidence supported the following statements for single (moderately deep, mostly maxillary) recessions without inter-dental attachment loss: (i) The addition of a connective tissue graft (CTG) improved outcomes of coronally advanced flaps (CAF). (ii) The addition of enamel matrix derivative (EMD) improved the outcomes of CAF. For multiple recessions, preliminary data indicate that flaps specifically designed to treat this condition are worthy of additional attention. Emerging data indicate that it is possible to obtain complete root coverage at sites with some inter-dental attachment loss. With regards to soft-tissue deficiencies at implants, several procedures are available, but great heterogeneity among studies does not allow drawing conclusions at this time. The group highlighted that periodontal plastic procedures are complex, technique-sensitive interventions that require advanced skills and expertise. At single recessions, the addition of autologous CTG or EMD under CAF improves complete root coverage and may be considered the procedure of choice at maxillary anterior and premolar teeth. The adjunctive benefit needs to be put in the context of increased morbidity of the donor area or increased cost. Additional research is needed to: (i) assess the role of alternatives to autologous soft-tissue grafting

  19. Rare Cancers Europe (RCE) methodological recommendations for clinical studies in rare cancers: a European consensus position paper.

    Science.gov (United States)

    Casali, P G; Bruzzi, P; Bogaerts, J; Blay, J-Y

    2015-02-01

    . Published by Oxford University Press on behalf of the European Society for Medical Oncology.

  20. Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation.

    Science.gov (United States)

    Gilsdorf, Andreas; Morgan, Dilys; Leitmeyer, Katrin

    2012-11-21

    Travel from countries where viral haemorrhagic fevers (VHF) are endemic has increased significantly over the past decades. In several reported VHF events on airplanes, passenger trace back was initiated but the scale of the trace back differed considerably. The absence of guidance documents to help the decision on necessity and scale of the trace back contributed to this variation.This article outlines the recommendations of an expert panel on Lassa fever, Ebola and Marburg haemorrhagic fever to the wider scientific community in order to advise the relevant stakeholders in the decision and scale of a possible passenger trace back. The evidence was collected through review of published literature and through the views of an expert panel. The guidance was agreed by consensus. Only a few events of VHF cases during air travel are reported in literature, with no documented infection in followed up contacts, so that no evidence of transmission of VHF during air travel exists to date. Based on this and the expert opinion, it was recommended that passenger trace back was undertaken only if: the index case had symptoms during the flight; the flight was within 21 days after detection of the event; and for Lassa fever if exposure of body fluid has been reported. The trace back should only be done after confirmation of the index case. Passengers and crew with direct contact, seat neighbours (+/- 1 seat), crew and cleaning personal of the section of the index case should be included in the trace back. No evidence has been found for the transmission of VHF in airplanes. This information should be taken into account, when a trace back decision has to be taken, because such a measure produces an enormous work load. The procedure suggested by the expert group can guide decisions made in future events, where a patient with suspected VHF infection travelled on a plane. However, the actual decision on start and scale of a trace back always lies in the hands of the responsible people

  1. Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation

    Directory of Open Access Journals (Sweden)

    Gilsdorf Andreas

    2012-11-01

    Full Text Available Abstract Background Travel from countries where viral haemorrhagic fevers (VHF are endemic has increased significantly over the past decades. In several reported VHF events on airplanes, passenger trace back was initiated but the scale of the trace back differed considerably. The absence of guidance documents to help the decision on necessity and scale of the trace back contributed to this variation. This article outlines the recommendations of an expert panel on Lassa fever, Ebola and Marburg haemorrhagic fever to the wider scientific community in order to advise the relevant stakeholders in the decision and scale of a possible passenger trace back. Method The evidence was collected through review of published literature and through the views of an expert panel. The guidance was agreed by consensus. Results Only a few events of VHF cases during air travel are reported in literature, with no documented infection in followed up contacts, so that no evidence of transmission of VHF during air travel exists to date. Based on this and the expert opinion, it was recommended that passenger trace back was undertaken only if: the index case had symptoms during the flight; the flight was within 21 days after detection of the event; and for Lassa fever if exposure of body fluid has been reported. The trace back should only be done after confirmation of the index case. Passengers and crew with direct contact, seat neighbours (+/− 1 seat, crew and cleaning personal of the section of the index case should be included in the trace back. Conclusion No evidence has been found for the transmission of VHF in airplanes. This information should be taken into account, when a trace back decision has to be taken, because such a measure produces an enormous work load. The procedure suggested by the expert group can guide decisions made in future events, where a patient with suspected VHF infection travelled on a plane. However, the actual decision on start and scale

  2. Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).

    Science.gov (United States)

    Lip, Gregory Y H; Collet, Jean Philippe; Caterina, Raffaele de; Fauchier, Laurent; Lane, Deirdre A; Larsen, Torben B; Marin, Francisco; Morais, Joao; Narasimhan, Calambur; Olshansky, Brian; Pierard, Luc; Potpara, Tatjana; Sarrafzadegan, Nizal; Sliwa, Karen; Varela, Gonzalo; Vilahur, Gemma; Weiss, Thomas; Boriani, Giuseppe; Rocca, Bianca

    2017-11-01

    Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA2DS2VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD. To address this topic, a Task Force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Thrombosis, with representation from the ESC Working Group on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to publish a joint consensus document on the management of patients with AF and associated VHD, with up-to-date consensus recommendations for clinical practice for different forms of VHD. This consensus document proposes that the term 'valvular AF' is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional Evaluated Heartvalves, Rheumatic or Artificial (EHRA) categorization in relation to the type of OAC use in patients with AF, as follows: (i) EHRA Type 1 VHD, which refers

  3. Competencies of specialised wound care nurses: a European Delphi study

    NARCIS (Netherlands)

    Eskes, Anne M.; Maaskant, Jolanda M.; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A.; Ubbink, Dirk T.; Vermeulen, Hester

    2014-01-01

    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries

  4. Competencies of specialised wound care nurses : a European Delphi study

    NARCIS (Netherlands)

    Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

    2014-01-01

    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries

  5. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone).

    Science.gov (United States)

    Pergolizzi, Joseph; Böger, Rainer H; Budd, Keith; Dahan, Albert; Erdine, Serdar; Hans, Guy; Kress, Hans-Georg; Langford, Richard; Likar, Rudolf; Raffa, Robert B; Sacerdote, Paola

    2008-01-01

    SUMMARY OF CONSENSUS: 1. The use of opioids in cancer pain: The criteria for selecting analgesics for pain treatment in the elderly include, but are not limited to, overall efficacy, overall side-effect profile, onset of action, drug interactions, abuse potential, and practical issues, such as cost and availability of the drug, as well as the severity and type of pain (nociceptive, acute/chronic, etc.). At any given time, the order of choice in the decision-making process can change. This consensus is based on evidence-based literature (extended data are not included and chronic, extended-release opioids are not covered). There are various driving factors relating to prescribing medication, including availability of the compound and cost, which may, at times, be the main driving factor. The transdermal formulation of buprenorphine is available in most European countries, particularly those with high opioid usage, with the exception of France; however, the availability of the sublingual formulation of buprenorphine in Europe is limited, as it is marketed in only a few countries, including Germany and Belgium. The opioid patch is experimental at present in U.S.A. and the sublingual formulation has dispensing restrictions, therefore, its use is limited. It is evident that the population pyramid is upturned. Globally, there is going to be an older population that needs to be cared for in the future. This older population has expectations in life, in that a retiree is no longer an individual who decreases their lifestyle activities. The "baby-boomers" in their 60s and 70s are "baby zoomers"; they want to have a functional active lifestyle. They are willing to make trade-offs regarding treatment choices and understand that they may experience pain, providing that can have increased quality of life and functionality. Therefore, comorbidities--including cancer and noncancer pain, osteoarthritis, rheumatoid arthritis, and postherpetic neuralgia--and patient functional

  6. Bruxism defined and graded: an international consensus

    NARCIS (Netherlands)

    Lobbezoo, F.; Ahlberg, J.; Glaros, A.G.; Kato, T.; Koyano, K.; Lavigne, G.J.; de Leeuw, R.; Manfredini, D.; Svensson, P.; Winocur, E.

    2013-01-01

    To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined

  7. Consensus on the guidelines for the dietary management of classical galactosemia.

    Science.gov (United States)

    Kerckhove, Kristel Vande; Diels, Marianne; Vanhaesebrouck, Sigrid; Luyten, Karin; Pyck, Nancy; De Meyer, An; Van Driessche, Marleen; Robert, Martine; Corthouts, Karen; Caris, Ariane; Duchateau, Emilie; Dassy, Martine; Bihet, Genevieve

    2015-02-01

    Worldwide there is scientific discussion about the dietary management of galactosemia. The dietary management is very different in several countries among Europe, the US and Canada. The main points of discussion are related to the fact that i) despite a strict diet some patients still have poor outcomes; ii) there is lack of scientific knowledge about the role of endogenous production of galactose on disease evolution, with or without diet. The aim of the current work was the creation of a Belgian consensus on dietary guidelines for the management of galactosemia. A step-wise approach was used to achieve a consensus, including: a workshop, a Delphi round, discussion groups and a round table of different Belgian experts. The consensus is an agreement between strict guidelines (strict limitation of fruits, vegetables and soybean products/French guidelines) and the more liberal guidelines (comparable with a diet free of lactose/guidelines of UK and the Netherlands). The consensus document consists of different modules, including the medical context, the theoretical background of dietary guidelines and the age-specific practical dietary guidelines. A Belgian consensus on the guidelines for the dietary management of classical galactosemia was developed despite the uncertainties of the efficacy and practical application of these guidelines. The final consensus is based on scientific knowledge and practical agreement among experts. In the future, regular revision of the guidelines is recommended and a uniform European guideline is desirable. Copyright © 2014 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  8. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes

    National Research Council Canada - National Science Library

    Nathan, David M; Buse, John B; Davidson, Mayer B; Ferrannini, Ele; Holman, Rury R; Sherwin, Robert; Zinman, Bernard

    2009-01-01

    The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new...

  9. Key priorities in the prevention and control of healthcare-associated infection: a survey of European and other international infection prevention experts.

    Science.gov (United States)

    Dettenkofer, Markus; Humphreys, Hilary; Saenz, Henri; Carlet, Jean; Hanberger, Håkan; Ruef, Christian; Widmer, Andreas; Wolkewitz, Martin; Cookson, Barry

    2016-12-01

    Prevention and control of healthcare-associated infection (HCAI) are important within and beyond Europe. However, it is unclear which areas are considered important by HCAI prevention and control professionals. This study assesses the priorities in the prevention and control of HCAI as judged by experts in the field. A survey was conducted by the European Society of Clinical Microbiology and Infectious Diseases focussing on seven topics using SurveyMonkey(®). Through a newsletter distributed by email, about 5000 individuals were targeted throughout the world in February and March 2013. Participants were asked to rate the importance of particular topics from one (low importance) to ten (extraordinary importance), and there was no restriction on giving equal importance to more than one topic. A total of 589 experts from 86 countries participated including 462 from Europe (response rate: 11.8 %). Physicians accounted for 60 % of participants, and 57 % had ten or more years' experience in this area. Microbial epidemiology/resistance achieved the highest priority scoring with 8.9, followed by surveillance 8.2, and decolonisation/disinfection/antiseptics with 7.9. Under epidemiology/resistance, highly resistant Gram-negative bacilli scored highest (9.0-9.2). The provision of computerised healthcare information systems for the early detection of outbreaks was accorded the top priority under surveillance. The prevention of surgical site and central line infections ranked highest under the category of specific HCAI and HCAI in certain settings. Differences between regions are described. These findings reflect the concerns of experts in HCAI prevention and control. The results from this survey should inform national and international agencies on future action and research priorities.

  10. The role of calcium supplementation in healthy musculoskeletal ageing: an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases ...

    Science.gov (United States)

    The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction ha...

  11. Formal consensus method to evaluate the conformity of prescription of a recently approved chemotherapy treatment in an observatory study.

    Directory of Open Access Journals (Sweden)

    Nadine Houédé

    Full Text Available Cabazitaxel is a second line chemotherapy drug recently approved for the treatment of metastatic castration-resistant prostate cancer. A first panel of French experts and a second independent panel of European experts were convened to assess the conformity of prescription of cabazitaxel with a Delphi consensus method. A two-round modified Delphi consensus process was conducted. This methodology is based on experts' opinion obtained in a systematic manner. The process was divided into five steps: (i elaboration of the questionnaire, (ii rating, (iii analysis, (iv discussion of the points with absence of consensus following rating of the questionnaire, and (v final reporting. Consensus was defined according to RAND method and all analyses were conducted according to the same methodology. At the end of the two rounds of rating and a synthesis meeting, of the 26 items included in the Summary of Product Characteristics (SPC, 11 items were judged appropriate with strong consensus by the two independent panels of experts. These items can therefore be considered of prime importance to evaluate conformity of cabazitaxel prescription in the context of observatory studies as well as in further clinical trials using this new taxane. Our findings further provide important evidence about the value of the Delphi consensus and highlight a requirement for "conformity" standards to assist practitioners in a safe chemotherapy drug prescription.

  12. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

    Science.gov (United States)

    Stroes, Erik S.; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; De Backer, Guy; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; Hegele, Robert A.; Hovingh, G. Kees; Leiter, Lawrence A.; Mach, Francois; März, Winfried; Newman, Connie B.; Wiklund, Olov; Jacobson, Terry A.; Catapano, Alberico L.; Chapman, M. John; Ginsberg, Henry N.; Stroes, Erik; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; März, Winfried; Newman, Connie B.; John Chapman, M.; Ginsberg, Henry N.; John Chapman, M.; Ginsberg, Henry N.; de Backer, Guy; Catapano, Alberico L.; Hegele, Robert A.; Kees Hovingh, G.; Jacobson, Terry A.; Leiter, Lawrence; Mach, Francois; Wiklund, Olov

    2015-01-01

    Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7–29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential. PMID:25694464

  13. Correlation between the Modified Systemic Lupus Erythematosus Disease Activity Index 2000 and the European Consensus Lupus Activity Measurement in juvenile systemic lupus erythematosus.

    Science.gov (United States)

    Sato, J O; Corrente, J E; Saad-Magalhães, C

    2016-11-01

    Objective The objective of this study was to assess Modified Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and European Consensus Lupus Activity Measurement (ECLAM) disease activity correlation in addition to their respective correlation to Pediatric Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (Ped-SDI), in juvenile systemic lupus erythematosus (JSLE). Methods The activity indices were scored retrospectively and summarized by adjusted means during follow-up. The Ped-SDI was scored during the last visit for those with more than six months follow-up. Pearson correlation between the Modified SLEDAI-2K and ECLAM, as well as Spearman correlations between the Modified SLEDAI-2K, ECLAM, and Ped-SDI were calculated. The receiver operating characteristic (ROC) curve was calculated for both activity indices discriminating damage measured by Ped-SDI. Results Thirty-seven patients with mean age at diagnosis 11 ± 2.9 years and mean follow-up time 3.2 ± 2.4 years were studied. The Modified SLEDAI-2K and ECLAM adjusted means were highly correlated ( r = 0.78, p  0.7, p < 0.001), but Modified SLEDAI-2K and ECLAM correlation with Ped-SDI was only moderate. ROC analysis discriminant performance for both activity indices resulted in area under curve (AUC) of 0.74 and 0.73 for Modified SLEDAI-2K and ECLAM, respectively. Conclusion The high correlation found between the Modified SLEDAI-2K and ECLAM adjusted means indicated that both tools can be equally useful for longitudinal estimates of JSLE activity.

  14. Two heads are better than one: Australian tobacco control experts' and mental health change champions' consensus on addressing the problem of high smoking rates among people with mental illness.

    Science.gov (United States)

    Rowley, Della; Lawn, Sharon; Coveney, John

    2016-04-01

    Objective The aims of the present study were to explore the beliefs of Australian experts in tobacco control and change champions working in mental health and tobacco cessation, and to identify measures for addressing the problem of high smoking rates for people with mental illness. Methods Qualitative interviews were undertaken to explore participants' views, and the Delphi technique was used to achieve consensus on ways in which the problem would be best addressed. Results This consensus centred on the need for leadership within the mental health system. The problem was reconceptualised from being solely the responsibility of the mental health sector into an issue that requires the combined resources of a partnership and shared leadership between government and non-government services, public health leaders, policy makers and people with mental illness and their families. Conclusions Collaboration would raise the priority of the issue, reduce the debilitating effect of stigma and discrimination within the mental health sector and would place smoking reduction firmly on the political and public agenda. A recovery-orientated focus would increase the skill base and be inclusive of workers, families and carers of people with mental illness who face smoking issues on a daily basis. Reconceptualising this as an issue that would benefit from cooperation and partnerships would disrupt the notion that the problem is solely the responsibility of the mental health sector. What is known about the topic? Rates of smoking have remained high for people with mental illness despite population-wide public health strategies successfully reducing smoking rates in the general population. For people with mental illness, the benefits of quitting smoking for both their mental and physical health are overshadowed by concerns about the complexity of their needs. There is a lack of knowledge about how smoking cessation support can be improved to increase success rates in smokers with

  15. Percutaneous coronary intervention for the Left Main stem and other bifurcation lesions. The 12(th) consensus document from the European Bifurcation Club

    DEFF Research Database (Denmark)

    Lassen, Jens Flensted; Burzotta, Francesco; Banning, Adrian P

    2018-01-01

    the opinion of interventional cardiologists with the opinion of a large variety of other scientists on bifurcation management. A series of consensus sessions dedicated to specific topics, to strengthen the consensus debates and focus the discussions was introduced in this years meeting. The sessions comprise...

  16. Achieving consensus and controversy around applicability of palliative care to dementia.

    OpenAIRE

    Steen, J.T. van der; Radbruch, L.; Boer, M.E. de; Jünger, S.; Hughes, J.C.; Larkin, P.; Gove, D.; Francke, A.L.; Koopmans, R.T.C.M.; Firth, P.; Volicer, L.; Hertogh, C.M.P.M.

    2016-01-01

    Background: People with dementia may benefit from palliative care which specifically addresses the needs of patients and families affected by this life-limiting disease. On behalf of the European Association for Palliative Care (EAPC), we recently performed a Delphi study to define domains for palliative care in dementia and to provide recommendations for optimal care. An international panel of experts in palliative care, dementia care or both, achieved consensus on almost all domains and rec...

  17. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiología Intervencionista; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    This article provides a brief summary of the relevant recommendations and references related to percutaneous mechanical circulatory support. The goal was to provide the clinician with concise, evidence-based contemporary recommendations, and the supporting documentation to encourage their application. The full text includes disclosure of all relevant relationships with industry for each writing committee member. A fundamental aspect of all expert consensus statements is that these carefully developed, evidence-based documents can neither encompass all clinical circumstances, nor replace the judgment of individual physicians in management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring percutaneous mechanical circulatory support. © 2015 by The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, the Heart Failure Society of America, and The Society for Thoracic Surgery.

  18. Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology.

    Science.gov (United States)

    Hartmann, Karin; Escribano, Luis; Grattan, Clive; Brockow, Knut; Carter, Melody C; Alvarez-Twose, Ivan; Matito, Almudena; Broesby-Olsen, Sigurd; Siebenhaar, Frank; Lange, Magdalena; Niedoszytko, Marek; Castells, Mariana; Oude Elberink, Joanna N G; Bonadonna, Patrizia; Zanotti, Roberta; Hornick, Jason L; Torrelo, Antonio; Grabbe, Jürgen; Rabenhorst, Anja; Nedoszytko, Boguslaw; Butterfield, Joseph H; Gotlib, Jason; Reiter, Andreas; Radia, Deepti; Hermine, Olivier; Sotlar, Karl; George, Tracy I; Kristensen, Thomas K; Kluin-Nelemans, Hanneke C; Yavuz, Selim; Hägglund, Hans; Sperr, Wolfgang R; Schwartz, Lawrence B; Triggiani, Massimo; Maurer, Marcus; Nilsson, Gunnar; Horny, Hans-Peter; Arock, Michel; Orfao, Alberto; Metcalfe, Dean D; Akin, Cem; Valent, Peter

    2016-01-01

    Cutaneous lesions in patients with mastocytosis are highly heterogeneous and encompass localized and disseminated forms. Although a classification and criteria for cutaneous mastocytosis (CM) have been proposed, there remains a need to better define subforms of cutaneous manifestations in patients with mastocytosis. To address this unmet need, an international task force involving experts from different organizations (including the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology) met several times between 2010 and 2014 to discuss the classification and criteria for diagnosis of cutaneous manifestations in patients with mastocytosis. This article provides the major outcomes of these meetings and a proposal for a revised definition and criteria. In particular, we recommend that the typical maculopapular cutaneous lesions (urticaria pigmentosa) should be subdivided into 2 variants, namely a monomorphic variant with small maculopapular lesions, which is typically seen in adult patients, and a polymorphic variant with larger lesions of variable size and shape, which is typically seen in pediatric patients. Clinical observations suggest that the monomorphic variant, if it develops in children, often persists into adulthood, whereas the polymorphic variant may resolve around puberty. This delineation might have important prognostic implications, and its implementation in diagnostic algorithms and future mastocytosis classifications is recommended. Refinements are also suggested for the diagnostic criteria of CM, removal of telangiectasia macularis eruptiva perstans from the current classification of CM, and removal of the adjunct solitary from the term solitary mastocytoma. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  19. Priority target conditions for algorithms for monitoring children's growth: Interdisciplinary consensus.

    Directory of Open Access Journals (Sweden)

    Pauline Scherdel

    Full Text Available Growth monitoring of apparently healthy children aims at early detection of serious conditions through the use of both clinical expertise and algorithms that define abnormal growth. Optimization of growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization.To obtain a consensus about the priority target conditions for algorithms monitoring children's growth.We applied a formal consensus method with a modified version of the RAND/UCLA method, based on three phases (preparatory, literature review, and rating, with the participation of expert advisory groups from the relevant professional medical societies (ranging from primary care providers to hospital subspecialists as well as parent associations. We asked experts in the pilot (n = 11, reading (n = 8 and rating (n = 60 groups to complete the list of diagnostic classification of the European Society for Paediatric Endocrinology and then to select the conditions meeting the four predefined criteria of an ideal type of priority target condition.Strong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma (in decreasing order of agreement.This national consensus can be used to evaluate the algorithms currently suggested for growth monitoring. The method used for this national consensus could be re-used to obtain an international consensus.

  20. Consensus Through Conversation How to Achieve High-Commitment Decisions

    CERN Document Server

    Dressler, Larry

    2006-01-01

    Facilitation expert Larry Dressler's Consensus Through Conversation is a guide for the effective facilitation and practice of one of business's most popular - but most widely misunderstood - decision-making models: consensus.

  1. Patient Access, Unmet Medical Need, Expected Benefits, and Concerns Related to the Utilisation of Biosimilars in Eastern European Countries: A Survey of Experts

    Directory of Open Access Journals (Sweden)

    Andras Inotai

    2018-01-01

    Full Text Available This policy research aims to map patient access barriers to biologic treatments, to explore how increased uptake of biosimilars may lower these hurdles and to identify factors limiting the increased utilisation of biosimilars. A policy survey was developed to review these questions in 10 Central and Eastern European (CEE and Commonwealth of Independent States (CIS countries. Two experts (one public and one private sector representative from each country completed the survey. Questions were related to patient access, purchasing, clinical practice, and real-world data collection on both original biologics and biosimilars. Restrictions on the number of patients that can be treated and related waiting lists were reported as key patient access barriers. According to respondents, for both clinicians and payers the primary benefit of switching patients to biosimilars would be to treat more patients. However, concerns with therapeutic equivalence and fear of immunogenicity may reduce utilisation of biosimilars. Similar limitations in patient access to both original biologics and biosimilars raise concerns about the appropriateness and success of current biosimilar policies in CEE and CIS countries. The conceptual framework for additional real-world data collection exists in all countries which may provide a basis for future risk-management activities including vigorous pharmacovigilance data collection.

  2. The appropriate use of non-steroidal anti-inflammatory drugs in rheumatic disease: opinions of a multidisciplinary European expert panel.

    Science.gov (United States)

    Burmester, Gerd; Lanas, Angel; Biasucci, Luigi; Hermann, Matthias; Lohmander, Stefan; Olivieri, Ignazio; Scarpignato, Carmelo; Smolen, Josef; Hawkey, Chris; Bajkowski, Adam; Berenbaum, Francis; Breedveld, Ferdinand; Dieleman, Peter; Dougados, Maxime; MacDonald, Thomas; Mola, Emilio Martin; Mets, Tony; Van den Noortgate, Nele; Stoevelaar, Herman

    2011-05-01

    Given the safety issues of non-steroidal anti-inflammatory drugs (NSAID) and the robustness of guidelines, making treatment choices in daily clinical practice is increasingly difficult. This study aimed systematically to analyse the opinions of a multidisciplinary European expert panel on the appropriateness of different NSAID, with or without the use of a proton pump inhibitor (PPI), in individual patients with chronic rheumatic disease. /Using the Research and Development/University of California at Los Angeles appropriateness method, the appropriateness of five (non-)selective NSAID with or without a PPI was assessed for 144 hypothetical patient profiles, ie, unique combinations of cardiovascular and gastrointestinal risk factors. Appropriateness statements were calculated for all indications. All options without PPI were considered appropriate in patients with no gastrointestinal/cardiovascular risk factors. Cyclooxygenase-2 selective inhibitors (C2SI) alone and non-selective NSAID plus PPI were preferred for patients with elevated gastrointestinal risk and low cardiovascular risk. Naproxen plus PPI was favoured in patients with high cardiovascular risk. For the combination of high gastrointestinal/high cardiovascular risk the use of any NSAID was discouraged; if needed, naproxen plus PPI or a C2SI plus PPI could be considered. The panel results may support treatment considerations at the level of individual patients, according to their gastrointestinal/cardiovascular risk profile.

  3. Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria.

    NARCIS (Netherlands)

    Segal, B.H.; Herbrecht, R.; Stevens, D.A.; Ostrosky-Zeichner, L.; Sobel, J.; Viscoli, C.; Walsh, T.J.; Maertens, J.; Patterson, T.F.; Perfect, J.R.; Dupont, B.; Wingard, J.R.; Calandra, T.; Kauffman, C.A.; Graybill, J.R.; Baden, L.R.; Pappas, P.G.; Bennett, J.E.; Kontoyiannis, D.P.; Cordonnier, C.; Viviani, M.A.; Bille, J.; Almyroudis, N.G.; Wheat, L.J.; Graninger, W.; Bow, E.J.; Holland, S.M.; Kullberg, B.J.; Dismukes, W.E.; Pauw, B.E. de

    2008-01-01

    Invasive fungal diseases (IFDs) have become major causes of morbidity and mortality among highly immunocompromised patients. Authoritative consensus criteria to diagnose IFD have been useful in establishing eligibility criteria for antifungal trials. There is an important need for generation of

  4. Update of the International Consensus on Palliative Radiotherapy Endpoints for Future Clinical Trials in Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Chow, Edward, E-mail: Edward.Chow@sunnybrook.ca [Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Hoskin, Peter [Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom); Mitera, Gunita; Zeng Liang [Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Lutz, Stephen [Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, OH (United States); Roos, Daniel [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia (Australia); Hahn, Carol [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Linden, Yvette van der [Radiotherapeutic Institute Friesland, Leeuwarden (Netherlands); Hartsell, William [Department of Radiation Oncology, Advocate Good Samaritan Cancer Center, Downers Grove, IL (United States); Kumar, Eshwar [Department of Oncology, Atlantic Health Sciences Cancer Centre, Saint John Regional Hospital, Saint John, NB (Canada)

    2012-04-01

    Purpose: To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. Methods and Materials: A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Results: Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. Conclusion: An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.

  5. Prioridades de investigación en servicios sanitarios en el Sistema Nacional de Salud: Una aproximación por consenso de expertos Setting health services research priorities in the public health system: An approach through expert consensus

    Directory of Open Access Journals (Sweden)

    Enrique Bernal-Delgado

    2006-08-01

    Full Text Available Objetivos: Identificar y priorizar los temas de investigación en los servicios sanitarios, adoptando una perspectiva orientada a satisfacer las necesidades de la población cubierta por el Sistema Nacional de Salud. Material y método: Reunión de 13 expertos estructurada con una técnica grupal mixta, desarrollada en 2 fases consecutivas: grupo nominal y método Delphi. Se identificaron prioridades de investigación en servicios de salud que fueron puntuadas de la siguiente manera: de 7 a 9, muy relevante; de 4 a 6, relevancia intermedia, y de 1 a 3, poco o nada relevante. Los resultados fueron ordenados en función de su puntuación mediana y su dispersión. Resultados: Se identificaron 53 temas de investigación. Se clasificaron como prioritarios los temas relacionados con estrategias para mejorar la efectividad de la atención sanitaria, la información a los pacientes, la calidad y la seguridad de la atención, la equidad y la accesibilidad de los servicios, y la sostenibilidad del sistema sanitario. El consenso entre estos temas fue muy alto: sólo 4 ítems obtuvieron una dispersión reseñable (intervalo intercuartílico (IQ ≥ 2. En un rango de prioridad intermedia se situaron los temas relacionados con las mejoras organizativas del sistema, las mejoras en productividad y eficiencia, y los recursos humanos y equipamientos. El disenso en este caso fue muy alto: el 59% de los ítems obtuvo un IQ ≥ 2. Conclusiones: Aún con diversas limitaciones, se ofrece una referencia de prioridades para los investigadores españoles en servicios de salud y, también, una referencia para los financiadores y los usuarios de esta modalidad de investigación.Objectives: The aim of the present paper was to identify and prioritise health services research issues, from the perspective of Spanish NHS enrollees' health needs. Methods: 13 experts attended to a structured consensual meeting by using a two-phase process, sharing both Nominal Group and Delphi

  6. Spanish Consensus Statement

    Science.gov (United States)

    Rey, Guillermo Álvarez; Cuesta, Jordi Ardevol; Loureda, Rafael Arriaza; España, Fernando Ávila; Matas, Ramón Balius; Pazos, Fernando Baró; de Dios Beas Jiménez, Juan; Rosell, Jorge Candel; Fernandez, César Cobián; Ros, Francisco Esparza; Colmenero, Josefina Espejo; de Prado, Jorge Fernández; Cota, Juan José García; González, Jose Ignacio Garrido; Santander, Manuela González; Munilla, Miguel Ángel Herrador; Ruiz, Francisco Ivorra; Díaz, Fernando Jiménez; Marqueta, Pedro Manonelles; Fernandez, Antonio Maestro; Benito, Juan José Muñoz; Vilás, Ramón Olivé; Teres, Xavier Peirau; Amaro, José Peña; Roque, Juan Pérez San; Parenteu, Christophe Ramírez; Serna, Juan Ribas; Álvarez, Mikel Sánchez; Marchori, Carlos Sanchez; Soto, Miguel del Valle; Alonso, José María Villalón; García, Pedro Guillen; de la Iglesia, Nicolas Hugo; Alcorocho, Juan Manuel Lopez

    2015-01-01

    On the 21st of March, 2015, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of The Spanish Society for Sports Traumatology (SETRADE), The Spanish Federation of Sports Medicine (FEMEDE), The Spanish Association of Medical Services for Football Clubs (AEMEF), and The Spanish Association of Medical Services for Basketball Clubs (AEMB) with the aim of establishing a round table that would allow specialists to consider the most appropriate current general actions to be taken when treating muscle tears in sport, based on proven scientific data described in the medical literature. Each expert received a questionnaire prior to the aforementioned meeting comprising a set of questions concerning therapeutic indications generally applied in the different stages present during muscle repair. The present Consensus Document is the result of the answers to the questionnaire and resulting discussion and consensus over which are the best current indications in the treatment of muscle tears in sport. Avoiding immobilization, not taking nonsteroidal anti-inflammatory drugs (NSAIDs) randomly, fostering early mobilization, increasing vascularization of injured, site and regulating inflammatory mechanisms—without inhibiting these from the early stages of the recovery period—all stood out as main points of the Consensus Document. Additionally, there is controversy concerning cell stimulation techniques and the use of growth factors or cell inhibitors. The decision concerning discharge was unanimous, as was the criteria considered when it came to performing sport techniques without pain. PMID:27213161

  7. European Crohn's and Colitis Organisation Topical Review on environmental factors in IBD

    DEFF Research Database (Denmark)

    Maaser, Christian; Langholz, Ebbe; Gordon, Hannah

    2017-01-01

    This ECCO topical review of the European Crohn's and Colitis Organisation (ECCO) focuses on the role of environmental factors in respect to the development of IBD as well as the influence on the course of established IBD.The objective was to reach expert consensus to provide evidence-based guidance...

  8. European Society of Endodontology position statement: The use of CBCT in Endodontics

    NARCIS (Netherlands)

    Patel, S.; Durack, C.; Abella, F.; Roig, M.; Shemesh, H.; Lambrechts, P.; Lemberg, K.

    2014-01-01

    This Position Statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the use of Cone Beam Computed Tomography (CBCT). The statement is based on the current scientific evidence, and provides the clinician with evidence-based criteria on when

  9. Inhaled treatment of COPD: a Delphi consensus statement

    Directory of Open Access Journals (Sweden)

    Ninane V

    2017-03-01

    Full Text Available Vincent Ninane,1 Jean-Louis Corhay,2 Paul Germonpré,3 Wim Janssens,4 Guy F Joos,5 Giuseppe Liistro,6 Walter Vincken,7 Sandra Gurdain,8 Evelyne Vanvlasselaer,8 An Lehouck8 1Department of Respiratory Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, 2Department of Respiratory Medicine, CHU, Liege, 3Department of Respiratory Medicine, AZ Maria Middelares, Ghent, 4Department of Respiratory Medicine, Katholieke Universiteit, Leuven, 5Department of Respiratory Medicine, Ghent University Hospital, Ghent, 6Department of Respiratory Medicine, University Hospitals Saint-Luc, Brussels, 7Department of Respiratory Medicine, University Hospital Brussels, Brussels, 8Medical Department, Novartis Pharma, Vilvoorde, Belgium Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD global strategy (2015 provides guidance for the treatment of chronic obstructive pulmonary disease (COPD with different first-choice options per GOLD category without specification. Objectives: To evaluate the level of medical experts’ consensus on their preferred first-choice treatment within different COPD categories. Methods: A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31 and European (n=10 COPD experts. Results: Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA was preferred over long-acting ß2-agonist (LABA and LABA/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV1<50%, a very good consensus was reached for LAMA/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA/LAMA/inhaled corticosteroids (ICS as first choice in the Belgian group. According to the European

  10. Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults

    OpenAIRE

    van der Veer, Sabine N; Van Biesen, Wim; Bernaert, Pascale; Bolignano, Davide; Brown, Edwina A.; Covic, Adrian; Farrington, Ken; Jager, Kitty J.; Kooman, Jeroen; Macías-Núñez, Juan F.; Mooney, Andrew; Van Munster, Barbara C; Topinkova, Eva; Van Den Noortgate, Nele J. A.; Wirnsberger, Gerhard

    2016-01-01

    PURPOSE: To identify and prioritize potential topics to be addressed in the development of European multidisciplinary guidelines on the management of chronic kidney disease stage 3b-5 in older patients.METHODS: We composed a list of 47 potential guideline topics by reviewing the literature, consulting online 461 nephrologists and 107 geriatricians, and obtaining expert input. A multidisciplinary panel of twelve experts then prioritized the topics during a face-to-face consensus meeting, follo...

  11. Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options--a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Lip, Gregory Y H; Van Gelder, Isabelle C

    2012-01-01

    the proceedings of the 3rd Atrial Fibrillation NETwork (AFNET)/European Heart Rhythm Association (EHRA) consensus conference that convened over 60 scientists and representatives from industry to jointly discuss emerging therapeutic and diagnostic improvements to achieve better management of AF patients. The paper...... covers four chapters: (i) risk factors and risk markers for AF; (ii) pathophysiological classification of AF; (iii) relevance of monitored AF duration for AF-related outcomes; and (iv) perspectives and needs for implementing better antithrombotic therapy. Relevant published literature for each section...

  12. Consensus conferences

    DEFF Research Database (Denmark)

    Nielsen, Annika Porsborg; Lassen, Jesper

    , the differing perceptions are each in their own way rooted in an argument for democratic legitimacy. We therefore argue that national interpretations of consensus conferences, and of their ability to functions as a tool for public participation, depend to a great extent on the dominant ideals of democratic...

  13. European Crohn's and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn's Disease.

    Science.gov (United States)

    Rieder, Florian; Latella, Giovanni; Magro, Fernando; Yuksel, Elif S; Higgins, Peter D R; Di Sabatino, Antonio; de Bruyn, Jessica R; Rimola, Jordi; Brito, Jorge; Bettenworth, Dominik; van Assche, Gert; Bemelman, Willem; d'Hoore, Andre; Pellino, Gianluca; Dignass, Axel U

    2016-08-01

    This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practice. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  14. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

    Science.gov (United States)

    Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C

    2017-12-01

    Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

  15. Consensus statement on genetic research in dementia

    DEFF Research Database (Denmark)

    Rikkert, M.G. Olde; der, V van; Burns, A.

    2008-01-01

    In this article, the authors describe how the European Dementia Consensus Network developed a consensus on research ethics in dementia, taking into account the questions posed by the era of genetic research and its new research methods. The consensus process started with a Delphi procedure...... procedure fuelled the development of the consensus statement, which is presented in this paper. The consensus statement aims to stimulate ethically acceptable research in the field of dementia and the protection of vulnerable elderly patients with dementia from application of inadequate research methods...

  16. A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people.

    Directory of Open Access Journals (Sweden)

    Derek Stewart

    Full Text Available Inappropriate use of multiple medicines (inappropriate polypharmacy is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU in relation to aspects of the management of polypharmacy in older people.Forty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3.Ninety panel members were recruited (64.3% of target, with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%. During Round 1, consensus was obtained for 27/46 statements (58.7%, with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements; strategic development (7/7; change management (5/7 indicator measures (4/6; legislation (0/3; awareness raising (5/5; polypharmacy reviews (5/7; and EU vision (0/7. Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025.Consensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered

  17. Consensus development for healthcare professionals

    Science.gov (United States)

    Kea, Bory; Sun, Benjamin C.

    2015-01-01

    Consensus development sprang from a desire to synthesize clinician and expert opinions on clinical practice and research agendas in the 1950s. And since the American Institute of Medicine formally defined “guidelines” in 1990, there has been a proliferation of clinical practice guidelines (CPG) both formally and informally. This modern decision making tool used by both physicians and patients, requires extensive planning to meet the challenges of consensus development while reaping its rewards. Consensus allows for a group approach with multiple experts sharing ideas to form consensus on topics ranging from appropriateness of procedures to research agenda development. Disagreements can shed light on areas of controversy and launch further discussions. It has five main components: three inputs (defining the task, participant identification and recruitment, and information synthesis), the approach (consensus development by explicit or implicit means), and the output (dissemination of results). Each aspect requires extensive planning a priori as they influence the entire process, from how information will be interpreted, the interaction of participants, the resulting judgment, to whether there will be uptake of results. Implicit approaches utilize qualitative methods and/or a simple voting structure of majority wins, and are used in informal consensus development methods and consensus development conferences. Explicit approaches aggregate results or judgments using explicit rules set a priori with definitions of “agreement” or consensus. Because the implicit process can be more opaque, unforeseen challenges can emerge such as the undue influence of a minority. And yet, the logistics of explicit approaches may be more time consuming and not appropriate when speed is a priority. In determining which method to use, it is important to understand the pros and cons of the different approaches and how it will affect the overall input, approach, and outcome. PMID

  18. [The good use of home blood pressure monitoring. Consensus document].

    Science.gov (United States)

    Persu, A; Fagard, R; De Cort, P; Legat, P; Van Bortel, L

    2009-06-01

    Self or home blood pressure measurement (HBPM) is increasingly popular. Its prognostic value and clinical interest in the diagnosis and follow-up of hypertension are well established. In addition, experts widely agree on the fact that it improves hypertension management and therapeutic compliance. In particular, HBPM often allows to detect white coat hypertension (to be confirmed by 24-hour ambulatory blood pressure measurement). Unfortunately, a large part of HBPM devices in the European Union have not fulfilled independent validation criteria. Furthermore, many patients buy and use such devices without medical supervision. This consensus document summarizes the advantages and disadvantages of HBPM and the conditions of a proper use, in agreement with the recent European and American guidelines.

  19. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of multifocal motor neuropathy. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society - first revision

    NARCIS (Netherlands)

    van Schaik, Ivo N.; Leger, Jean-Marc; Nobile-Orazio, Eduardo; Cornblath, David R.; Hadden, Robert D. M.; Koski, Carol L.; Pollard, John D.; Sommer, Claudia; Illa, Isabel; van den Bergh, Peter; van Dorrn, Pieter A.

    2010-01-01

    A European Federation of Neurological Societies/Peripheral Nerve Society consensus guideline on the definition, investigation, and treatment of multifocal motor neuropathy (MMN) was published in 2006. The aim is to revise this guideline. Disease experts considered references retrieved from MEDLINE

  20. Role and analysis of monocyte subsets in cardiovascular disease. Joint consensus document of the European Society of Cardiology (ESC) Working Groups "Atherosclerosis & Vascular Biology" and "Thrombosis".

    Science.gov (United States)

    Weber, Christian; Shantsila, Eduard; Hristov, Michael; Caligiuri, Giuseppina; Guzik, Tomasz; Heine, Gunnar H; Hoefer, Imo E; Monaco, Claudia; Peter, Karlheinz; Rainger, Ed; Siegbahn, Agneta; Steffens, Sabine; Wojta, Johann; Lip, Gregory Y H

    2016-09-27

    Monocytes as cells of the innate immunity are prominently involved in the development of atherosclerotic lesions. The heterogeneity of blood monocytes has widely been acknowledged by accumulating experimental and clinical data suggesting a differential, subset-specific contribution of the corresponding subpopulations to the pathology of cardiovascular and other diseases. This document re-evaluates current nomenclature and summarises key findings on monocyte subset biology to propose a consensus statement about phenotype, separation and quantification of the individual subsets.

  1. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report

    NARCIS (Netherlands)

    T. Neogi (Tuhina); D. Aletaha (Daniel); A.J. Silman (Alan); R.L. Naden (Raymond); D. Felson; R. Aggarwal (Rohit); C.O. Bingham (Clifton); N.S. Birnbaum (Neal); G.R. Burmester (Gerd); V.P. Bykerk (Vivian); M.D. Cohen (Marc); B. Combe (Bernard); K.H. Costenbader (Karen); M. Dougados (Maxime); P. Emery (Paul); G. Ferraccioli (Gianfranco); J.M.W. Hazes (Mieke); K. Hobbs (Kathryn); T.W.J. Huizinga (Tom); A. Kavanaugh (Arthur); J. Kay (Jonathan); D. Khanna (Dinesh); T.K. Kvien (Tore); T. Laing (Timothy); K. Liao (Katherine); P. Mease (Philip); H.A. Ménard (Henri); L.W. Moreland (Larry); R. Nair (Raj); T. Pincus (Theodore); S. Ringold (Sarah); J.S. Smolen (Josef); E. Stanislawska-Biernat (Ewa); D. Symmons (Deborah); P.P. Tak (Paul); K.S. Upchurch (Katherine); J. Vencovský (Jiří); F. Wolfe (Frederick); G. Hawker (Gillian)

    2010-01-01

    textabstractObjective. The American College of Rheumatology and the European League Against Rheumatism have developed new classification criteria for rheumatoid arthritis (RA). The aim of Phase 2 of the development process was to achieve expert consensus on the clinical and laboratory variables that

  2. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology.

    Science.gov (United States)

    Corrado, Domenico; Pelliccia, Antonio; Bjørnstad, Hans Halvor; Vanhees, Luc; Biffi, Alessandro; Borjesson, Mats; Panhuyzen-Goedkoop, Nicole; Deligiannis, Asterios; Solberg, Erik; Dugmore, Dorian; Mellwig, Klaus P; Assanelli, Deodato; Delise, Pietro; van-Buuren, Frank; Anastasakis, Aris; Heidbuchel, Hein; Hoffmann, Ellen; Fagard, Robert; Priori, Silvia G; Basso, Cristina; Arbustini, Eloisa; Blomstrom-Lundqvist, Carina; McKenna, William J; Thiene, Gaetano

    2005-03-01

    The 1996 American Heart Association consensus panel recommendations stated that pre-participation cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal, and medical grounds. The present article represents the consensus statement of the Study Group on Sports Cardiology of the Working Group on Cardiac Rehabilitation and Exercise Physiology and the Working Group on Myocardial and Pericardial diseases of the European Society of Cardiology, which comprises cardiovascular specialists and other physicians from different European countries with extensive clinical experience with young competitive athletes, as well as with pathological substrates of sudden death. The document takes note of the 25-year Italian experience on systematic pre-participation screening of competitive athletes and focuses on relevant issues, mostly regarding the relative risk, causes, and prevalence of sudden death in athletes; the efficacy, feasibility, and cost-effectiveness of population-based pre-participation cardiovascular screening; the key role of 12-lead ECG for identification of cardiovascular diseases such as cardiomyopathies and channelopathies at risk of sudden death during sports; and the potential of preventing fatal events. The main purpose of the consensus document is to reinforce the principle of the need for pre-participation medical clearance of all young athletes involved in organized sports programmes, on the basis of (i) the proven efficacy of systematic screening by 12-lead ECG (in addition to history and physical examination) to identify hypertrophic cardiomyopathy-the leading cause of sports-related sudden death-and to prevent athletic field fatalities; (ii) the potential screening ability in detecting other lethal cardiovascular diseases presenting with ECG abnormalities. The consensus document recommends the implementation of a common European screening protocol essentially based on 12-lead ECG.

  3. School Construction Management: Expert Administrators Speak.

    Science.gov (United States)

    Fickes, Michael

    2001-01-01

    Presents expert opinion on school construction management communication concerning educational needs, obtaining consensus among diverse groups, and envisioning what schools must offer in the future. Why furniture issues are also important is highlighted. (GR)

  4. ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents

    Energy Technology Data Exchange (ETDEWEB)

    Neri, E.; Boraschi, P.; Bartolozzi, C. [University of Pisa, Department of Diagnostic and Interventional Radiology, Pisa (Italy); Bali, M.A.; Matos, C. [Hopital Erasme, MRI Clinics, Department of Radiology, Bruxelles (Belgium); Ba-Ssalamah, A. [The General Hospital of the Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Brancatelli, G. [University of Palermo, Department of Radiology, Palermo (Italy); Alves, F.C. [University Hospital of Coimbra, Medical Imaging Department and Faculty of Medicine, Coimbra (Portugal); Grazioli, L. [Spedali Civili di Brescia, Department of Radiology, Brescia (Italy); Helmberger, T. [Academic Teaching Hospital of the Technical University, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Klinikum Bogenhausen, Munich (Germany); Lee, J.M. [Seoul National University College of Medicine, Division of Abdominal Imaging, Department of Radiology, Seoul (Korea, Republic of); Manfredi, R. [University of Verona, Department of Radiology, Verona (Italy); Marti-Bonmati, L. [Hospital Universitario y Politecnico La Fe, Area Clinica de Imagen Medica, Valencia (Spain); Merkle, E.M. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Op De Beeck, B. [Antwerp University Hospital, Department of Radiology, Edegem (Belgium); Schima, W. [KH Goettlicher Heiland, Krankenhaus der Barmherzigen Schwestern and Sankt Josef-Krankenhaus, Department of Diagnostic and Interventional Radiology, Vienna (Austria); Skehan, S. [St Vincent' s University Hospital, Department of Radiology, Dublin (Ireland); Vilgrain, V. [Assistance Publique-Hopitaux de Paris, APHP, Hopital Beaujon, Radiology Department, Clichy, Paris (France); Zech, C. [Universitaetsspital Basel, Abteilungsleiter Interventionelle Radiologie, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland)

    2016-04-15

    To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents. The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach's statistics were used to rate levels of agreement and internal reliability of the consensus. Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases. The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases. (orig.)

  5. Ocular allergy latin american consensus

    Directory of Open Access Journals (Sweden)

    Myrna Serapião dos Santos

    2011-12-01

    Full Text Available PURPOSE: To establish current definition, classification and staging, and to develop diagnosis and treatment recommendations for ocular allergy, by using Delphi approach. METHODS: Ten Latin American experts on ocular allergy participated in a 4-round Delphi panel approach. Four surveys were constructed and answered by panelists. A two-thirds majority was defined as consensus. Definition, classification, staging and diagnosis and treatment recommendations were the main outcomes. RESULTS: "Ocular allergy" was proposed as the general term to describe ocular allergic diseases. Consensus regarding classification was not reached. Signs and symptoms were considered extremely important for the diagnosis. It was consensus that a staging system should be proposed based on the disease severity. Environmental control, avoidance of allergens and the use of artificial tears were recommended as first line treatment. The secondary treatment should include topical anti-histamines, mast cell stabilizers and multi actions drugs. Topical non-steroidal anti-inflammatory and vasoconstrictors were not recommended. Topical corticosteroids were recommended as third line of treatment for the most severe keratoconjunctivitis. Consensus was not reached regarding the use of systemic corticosteroids or immunosuppressant. Surgical approach and unconventional treatments were not recommended as routine. CONCLUSION: The task of creating guidelines for ocular allergies showed to be very complex. Many controversial topics remain unsolved. A larger consensus including experts from different groups around the world may be needed to further improve the current recommendations for several aspects of ocular allergy.

  6. Cologne Consensus Conference, Management of Conflict of Interest, 12 and 13 September 2014, Cologne, Germany

    Directory of Open Access Journals (Sweden)

    Julie Simper

    2015-01-01

    Full Text Available On 12–13 September 2014 the third annual Cologne Consensus Conference (CCC was held in Cologne, Germany. The two-day educational event was organised by the European Cardiology Section Foundation (ECSF and the European Board for Accreditation in Cardiology (EBAC, a specialty CME-CPD accreditation board of the European Union of Medical Specialists (UEMS. The conference was planned in cooperation with an impressive group of international organisations and faculty members representing leading European and North American institutions. Each year, the CCC is organised around a specific topic area. For the conference’s third iteration, the management of conflicts of interest (COI was the focus. The CCC 2014 was an exceptional opportunity for international experts and leadership to gather and learn from one another through both the formal presentations and lively group discussions. This report provides a summary of the presentations and discussions from the educational event.

  7. Expert Witness

    African Journals Online (AJOL)

    Adele

    discipline that permits them to testify to an opinion that will aid a judge or jury in resolving a question that is beyond the understanding or competence of laypersons. An expert witness is an expert who makes his or her knowledge available to a court (a tribunal or any other forum where formal rules of evidence apply) to help ...

  8. Expert System

    DEFF Research Database (Denmark)

    Hildebrandt, Thomas Troels; Cattani, Gian Luca

    2016-01-01

    An expert system is a computer system for inferring knowledge from a knowledge base, typically by using a set of inference rules. When the concept of expert systems was introduced at Stanford University in the early 1970s, the knowledge base was an unstructured set of facts. Today the knowledge...... base of expert systems is often given in terms of an ontology, extracted and built from various data sources by employing natural language-processing and statistics. To emphasize such capabilities, the term “expert” is now often replaced by “cognitive,” “knowledge,” “knowledge-based,” or “intelligent......” system. With very few exceptions, general-purpose expert systems have failed to emerge so far. However, expert systems are applied in specialized domains, particularly in healthcare. The increasing availability of large quantities of data to organizations today provides a valuable opportunity...

  9. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

    Energy Technology Data Exchange (ETDEWEB)

    Bazot, M.; Thomassin-Naggara, I. [Tenon Hospital, Department of Radiology, Paris (France); Bharwani, N. [Imperial College Healthcare NHS Trust, Department of Radiology, St Mary' s Hospital, London (United Kingdom); Huchon, C. [CHI Poissy Saint-Germain en Laye, Versailles University France, Department of Obtetrics and Gynaecology, Poissy (France); Kinkel, K. [Institut de Radiologie, Chene-Bougeries (Switzerland); Cunha, T.M. [Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Servico de Radiologia, Lisboa (Portugal); Guerra, A. [Hospital da Luz, Department of Radiology, Lisbon (Portugal); Manganaro, L. [Sapienza University of Rome, Department of Radiological Sciences, Rome (Italy); Bunesch, L. [Hospital Clinic Barcelona, Department of Radiology (Urogenital Section), Barcelona (Spain); Kido, A.; Togashi, K. [Kyoto University Hospital, Department of Diagnostic Radiology, Kyoto (Japan); Rockall, A.G. [The Royal Marsden Hospital, Department of Radiology, London (United Kingdom)

    2017-07-15

    Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. (orig.)

  10. Explaining the Absence of a Genuine European Social-Democrat Consensus: the Case of 'Une Stratégie pour la Solidarité'

    Directory of Open Access Journals (Sweden)

    Erol Kulahci

    2002-03-01

    Full Text Available Some academic circles have pointed out that the European Union and its Member States suffer from a legitimacy deficit closely linked to the current fiscal policies. In a context which was characterised by the major presence of Labour, Socialist and Social Democrat Parties in the Member States' governments, this article draws attention to Une Stratégie pour la Solidarité of the Party of European Socialists (PES. It argues that this strategy is just a nominal one. Three theoretical assumptions are explored to explain this: the relation between the fiscal policies in the EU and the PES; the emergence of three types of conflicts between the member parties; and the absence of an effective 'pusher' strategy.

  11. Delphi consensus on the current clinical and therapeutic knowledge on Anderson-Fabry disease.

    Science.gov (United States)

    Concolino, Daniela; Degennaro, Emilia; Parini, Rossella

    2014-10-01

    Management of Anderson-Fabry disease (AFD) is contentious, particularly regarding enzyme replacement therapy (ERT). We report results of a Delphi consensus panel on AFD management. A survey to gauge consensus among AFD experts was distributed online and responses were analysed. Statements on: 1) diagnosis; 2) when starting ERT; 3) management of ERT infusion and adverse reactions; and 4) follow-up/monitoring response to therapy and progression of disease were included. Responses without consensus were discussed with an enlarged panel and modified to reach consensus. 15 experts responded to the survey. After plenary discussion among the enlarged panel, consensus was reached on most statements. Key points were the use of a target organ biopsy to show Gb3 deposits in symptomatic women with negative molecular analysis, the need for ERT in symptomatic women and in all patients with persistent signs and symptoms ± organ damage. It was agreed to assess vital signs before ERT administration and use a 0.2 μL filter on infusion to reduce the risk of adverse reactions, that serum should be drawn prior to the first infusion for anti-agalsidase antibody analysis to have a baseline value if a subsequent adverse reaction appears, and that pre-medication is required in those with prior infusion reactions. Holter ECG monitoring, cardiac and brain MRI, renal parameters, and abdominal ultrasound were considered important for the assessment of disease progression and response at ERT. This consensus supplies guidance to healthcare providers on best practice in the management of patients with AFD and indicates a need for more guidance. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. An update on the management of sporadic desmoid-type fibromatosis: a European Consensus Initiative between Sarcoma PAtients EuroNet (SPAEN) and European Organization for Research and Treatment of Cancer (EORTC)/Soft Tissue and Bone Sarcoma Group (STBSG)

    NARCIS (Netherlands)

    Kasper, B.; Baumgarten, C.; Garcia, J.; Bonvalot, S.; Haller, F.; Hohenberger, P.; Penel, N.; Messiou, C.; Graaf, W.T.A. van der; Gronchi, A.

    2017-01-01

    Desmoid-type fibromatosis is a rare and locally aggressive monoclonal, fibroblastic proliferation characterized by a variable and often unpredictable clinical course. Currently, there is no established or evidence-based treatment approach available for this disease. Therefore, in 2015 the European

  13. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista).

    Science.gov (United States)

    Iliescu, Cezar A; Grines, Cindy L; Herrmann, Joerg; Yang, Eric H; Cilingiroglu, Mehmet; Charitakis, Konstantinos; Hakeem, Abdul; Toutouzas, Konstantinos P; Leesar, Massoud A; Marmagkiolis, Konstantinos

    2016-04-01

    In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients. © 2016 Wiley Periodicals, Inc.

  14. International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) & European Competence Network on Mastocytosis (ECNM) consensus response criteria in advanced systemic mastocytosis.

    Science.gov (United States)

    Gotlib, Jason; Pardanani, Animesh; Akin, Cem; Reiter, Andreas; George, Tracy; Hermine, Olivier; Kluin-Nelemans, Hanneke; Hartmann, Karin; Sperr, Wolfgang R; Brockow, Knut; Schwartz, Lawrence B; Orfao, Alberto; Deangelo, Daniel J; Arock, Michel; Sotlar, Karl; Horny, Hans-Peter; Metcalfe, Dean D; Escribano, Luis; Verstovsek, Srdan; Tefferi, Ayalew; Valent, Peter

    2013-03-28

    Systemic mastocytosis (SM) is characterized by accumulation of neoplastic mast cells and is classified into indolent and aggressive forms. The latter include aggressive SM (ASM), mast cell leukemia (MCL), and SM associated with a myeloid neoplasm wherein 1 or both disease compartments exhibit advanced features. These variants, henceforth collectively referred to as advanced SM for the purposes of this report, are typically characterized by organ damage and shortened survival duration. In contrast to indolent SM, in which symptoms are usually managed by noncytotoxic antimediator therapy, cytoreduction is usually necessary for disease control in advanced SM. Unfortunately, current drug treatment of these patients rarely results in complete clinical and histopathologic remissions or improved survival time. Previously defined response criteria were adapted to the heterogeneous presentations of advanced SM and the limited effects of available drugs. However, recent advances in understanding the molecular pathogenesis of SM and the corresponding prospect in targeted therapy make it a priority to modify these criteria. Our current study is the product of an international group of experts and summarizes the challenges in accomplishing this task and forwards a new proposal for response criteria, which builds on prior proposals and should facilitate response evaluation in clinical trials.

  15. Correction to Mathieu D, Marroni A, Kot J: Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32.

    Science.gov (United States)

    Mathieu, Daniel; Marroni, Alessandro; Kot, Jacek

    2017-06-01

    Consistent with the Committee on Publication Ethics guidelines, we the above authors are initiating a partial retraction and correction of our paper: Mathieu D, Marroni A, Kot J: Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. We wish to make the following statement: "Regardless of the strict process of editing and proof-reading of tables included in the above-mentioned publication, we received some comments from readers which showed us that imperfect layout of Table 1 and incorrect layout of Table 2 changed significantly the conclusions which could be drawn from them. Table 1 described the relation between strength of recommendations given by the Jury of the Consensus Conference and the level of evidence based on the GRADE system. There should be a clear and straight relation showing that Level 1 "strong recommendation" should be based on GRADE A "high level of evidence (LOE)", Level 2 "weak recommendation" should be based on GRADE B "moderate LOE", Level 3 "neutral recommendation" should be based on GRADE C "low LOE" and finally no recommendation should be given when only GRADE D "very low LOE" are present. Note that there is no change to the content of the table, but only visual representation of this relationship. Table 2 has been incorrectly printed. In fact, there is no GRADE A LOE. All X marks placed in the column A should be moved to the right, to GRADE B LOE. In the same way, all X marks placed in the column B should be moved to the right, to GRADE C LOE. We voluntarily retract these tables from the above-mentioned publication, expressing our regret for the situation."

  16. Biology of soft tissue wound healing and regeneration--consensus report of Group 1 of the 10th European Workshop on Periodontology.

    Science.gov (United States)

    Hämmerle, Christoph H F; Giannobile, William V

    2014-04-01

    The scope of this consensus was to review the biological processes of soft tissue wound healing in the oral cavity and to histologically evaluate soft tissue healing in clinical and pre-clinical models. To review the current knowledge regarding the biological processes of soft tissue wound healing at teeth, implants and on the edentulous ridge. Furthermore, to review soft tissue wound healing at these sites, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Searches of the literature with respect to recessions at teeth and soft tissue deficiencies at implants, augmentation of the area of keratinized tissue and soft tissue volume were conducted. The available evidence was collected, categorized and summarized. Oral mucosal and skin wound healing follow a similar pattern of the four phases of haemostasis, inflammation, proliferation and maturation/matrix remodelling. The soft connective tissue determines the characteristics of the overlaying oral epithelium. Within 7-14 days, epithelial healing of surgical wounds at teeth is completed. Soft tissue healing following surgery at implants requires 6-8 weeks for maturation. The resulting tissue resembles scar tissue. Well-designed pre-clinical studies providing histological data have been reported describing soft tissue wound healing, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Few controlled clinical studies with low numbers of patients are available for some of the treatments reviewed at teeth. Whereas, histological new attachment has been demonstrated in pre-clinical studies resulting from some of the treatments reviewed, human histological data commonly report a lack of new attachment but rather long junctional epithelial attachment and connective tissue adhesion. Regarding soft tissue healing at implants human data are very scarce. Oral soft tissue healing at teeth, implants and the edentulous ridge follows the same phases

  17. Achieving consensus and controversy around applicability of palliative care to dementia.

    Science.gov (United States)

    van der Steen, Jenny T; Radbruch, Lukas; de Boer, Marike E; Jünger, Saskia; Hughes, Julian C; Larkin, Phil; Gove, Dianne; Francke, Anneke L; Koopmans, Raymond T C M; Firth, Pam; Volicer, Ladislav; Hertogh, Cees M P M

    2016-01-01

    People with dementia may benefit from palliative care which specifically addresses the needs of patients and families affected by this life-limiting disease. On behalf of the European Association for Palliative Care (EAPC), we recently performed a Delphi study to define domains for palliative care in dementia and to provide recommendations for optimal care. An international panel of experts in palliative care, dementia care or both, achieved consensus on almost all domains and recommendations, but the domain concerning the applicability of palliative care to dementia required revision. To examine in detail, the opinions of the international panel of 64 experts around the applicability of palliative care, we explored feedback they provided in the Delphi process. To examine which experts found it less important or less applicable, ordinal regression analyses related characteristics of the panelists to ratings of overall importance of the applicability domain, and to agreement with the domain's four recommendations. Some experts expressed concerns about bringing up end-of-life issues prematurely and about relabeling dementia care as palliative care. Multivariable analyses with the two outcomes of importance and agreement with applicability indicated that younger or less experienced experts and those whose expertise was predominantly in dementia care found palliative care in dementia less important and less applicable. Benefits of palliative care in dementia are acknowledged by experts worldwide, but there is some controversy around its early introduction. Further studies should weigh concerns expressed around care receiving a "palliative" label versus the benefits of applying palliative care early.

  18. Revised response criteria for myelofibrosis: International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) and European LeukemiaNet (ELN) consensus report.

    Science.gov (United States)

    Tefferi, Ayalew; Cervantes, Francisco; Mesa, Ruben; Passamonti, Francesco; Verstovsek, Srdan; Vannucchi, Alessandro M; Gotlib, Jason; Dupriez, Brigitte; Pardanani, Animesh; Harrison, Claire; Hoffman, Ronald; Gisslinger, Heinz; Kröger, Nicolaus; Thiele, Juergen; Barbui, Tiziano; Barosi, Giovanni

    2013-08-22

    The current document is a revision of the International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) criteria for treatment response in myelofibrosis (MF) and represents a collaborative effort by the IWG-MRT and the European LeukemiaNet to objectively assess the value of new drugs in inducing morphologic remission or improvement in MF-associated symptomatic burden (MF-SB). Some of the changes in the current revision include stricter definitions of red cell transfusion dependency and independency and consideration of the Myeloproliferative Neoplasm Symptom Assessment Form as a tool to quantify meaningful changes in disease-related symptoms. Six response categories are listed: complete remission (CR) and partial remission signify treatment effects that are consistent with disease modification, whereas drug-induced improvements in MF-SB were annotated as clinical improvement, anemia response, spleen response, or symptoms response. Additional criteria are provided for progressive disease, stable disease, and relapse. The document also includes recommendations for assessing cytogenetic and molecular remissions, without mandating their inclusion for CR assignment.

  19. Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: Executive Summary of a Joint Consensus Document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, Endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).

    Science.gov (United States)

    Lip, Gregory Y H; Collet, Jean Philippe; de Caterina, Raffaele; Fauchier, Laurent; Lane, Deirdre A; Larsen, Torben B; Marin, Francisco; Morais, Joao; Narasimhan, Calambur; Olshansky, Brian; Pierard, Luc; Potpara, Tatjana; Sarrafzadegan, Nizal; Sliwa, Karen; Varela, Gonzalo; Vilahur, Gemma; Weiss, Thomas; Boriani, Giuseppe; Rocca, Bianca

    2017-12-01

    Management strategies for patients with atrial fibrillation (AF) in association with valvular heart disease (VHD) have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thromboembolic risk also varies according to valve lesion and may also be associated with CHA2DS2-VASc score risk factor components, rather than only the valve disease being causal. Given the need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD, a task force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group (WG) on Thrombosis, with representation from the ESC WG on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to produce a consensus document on the management of patients with AF and associated VHD, with up-to-date consensus statements for clinical practice for different forms of VHD, based on the principles of evidence-based medicine. This is an executive summary of a consensus document which proposes that the term ‘valvular AF’ is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional EHRA (Evaluated Heartvalves, Rheumatic or Artificial) categorization in relation to the type of OAC use in patients with AF, as follows: (1) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 1 VHD, which refers to AF patients with ‘VHD needing therapy with a vitamin K antagonist (VKA)’ and (2) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 2 VHD, which refers to AF patients with ‘VHD needing therapy with a VKA or a non-VKA oral anticoagulant also taking

  20. ExpertFOAF recommends experts

    DEFF Research Database (Denmark)

    Iofcu, Tereza; Diederich, Joerg; Dolog, Peter

    2007-01-01

    the GrowBag approach [1]. The main assumption is that such user profiles can provide good hints about users' expertise. Such extended FOAF files (called ExpertFOAF) can be published on a user's home page, on web pages of institutions or conferences to characterize them. They can be crawled by distributed...

  1. Clinical end points for drug treatment trials in BCR-ABL1-negative classic myeloproliferative neoplasms: consensus statements from European LeukemiaNET (ELN) and Internation Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT).

    Science.gov (United States)

    Barosi, G; Tefferi, A; Besses, C; Birgegard, G; Cervantes, F; Finazzi, G; Gisslinger, H; Griesshammer, M; Harrison, C; Hehlmann, R; Hermouet, S; Kiladjian, J-J; Kröger, N; Mesa, R; Mc Mullin, M F; Pardanani, A; Passamonti, F; Samuelsson, J; Vannucchi, A M; Reiter, A; Silver, R T; Verstovsek, S; Tognoni, G; Barbui, T

    2015-01-01

    The discovery of somatic mutations, primarily JAK2V617F and CALR, in classic BCR-ABL1-negative myeloproliferative neoplasms (MPNs) has generated interest in the development of molecularly targeted therapies, whose accurate assessment requires a standardized framework. A working group, comprised of members from European LeukemiaNet (ELN) and International Working Group for MPN Research and Treatment (IWG-MRT), prepared consensus-based recommendations regarding trial design, patient selection and definition of relevant end points. Accordingly, a response able to capture the long-term effect of the drug should be selected as the end point of phase II trials aimed at developing new drugs for MPNs. A time-to-event, such as overall survival, or progression-free survival or both, as co-primary end points, should measure efficacy in phase III studies. New drugs should be tested for preventing disease progression in myelofibrosis patients with early disease in randomized studies, and a time to event, such as progression-free or event-free survival should be the primary end point. Phase III trials aimed at preventing vascular events in polycythemia vera and essential thrombocythemia should be based on a selection of the target population based on new prognostic factors, including JAK2 mutation. In conclusion, we recommended a format for clinical trials in MPNs that facilitates communication between academic investigators, regulatory agencies and drug companies.

  2. Taiwanese Dermatological Association consensus statement on management of psoriasis

    Directory of Open Access Journals (Sweden)

    Tsen-Fang Tsai

    2017-06-01

    Conclusion: The Expert Panel, comprising distinguished Taiwanese dermatologists, succeeded in developing a consensus about the management of psoriasis in Taiwanese patients. Unavailability of data in certain areas may suggest a possibility of new directions in research.

  3. NIH Blood and Marrow Transplant Late Effects Consensus Conference

    Science.gov (United States)

    This day and a half symposium will bring together experts in blood and marrow transplantation, late effects, and health care delivery to discuss current evidence and knowledge gaps, develop consensus guidelines, and inform future research in the BMT survivor population.

  4. [Consensus on objectives and action guidelines on low density lipoproteins-cholesterol control in very high risk cardiovascular patients].

    Science.gov (United States)

    Galve, Enrique; Guijarro-Herraiz, Carlos; Masana-Marin, Luis; Cordero-Fort, Alberto

    2016-01-01

    Cardiovascular disease is the leading cause of death in developed countries. Among cardiovascular disease risk factors one of the most relevant is low-density lipoprotein-associated cholesterol (LDL-c), but there is controversy about the methods used to control it. The aim was to obtain an expert opinion to clarify the most relevant issues regarding the control of dyslipidemia in very high cardiovascular risk patients. A survey with 55 items, stratified into 4 blocks: LDL-c as a therapeutic target, therapeutic goals, causes of the failure to achieve LDL-c goals, and recommendations to optimize their achievement, was addressed to 41 specialists (Cardiology and Internal Medicine) using the Delphi method to achieve professional consensus criteria. A high consensus was reached among all items, in line with the European recommendations. The panelists considered that the goal of 70mg/dl for LDL-c for high cardiovascular disease risk (mainly vascular disease, diabetes mellitus, and renal failure), using combined treatment when necessary. Lack of adherence and therapeutic inertia were considered the main reasons for treatment failure. The Spanish experts show an elevated consensus with the European recommendations, confirming the LDL-c control target of <70mg/dl. The simplification of the guidelines and the combined treatment may favor an improvement the achievement of lipid target goals. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  5. Statistical Development and Application of Cultural Consensus Theory

    Science.gov (United States)

    2012-03-31

    experts) to estimate their consensus knowledge, unknown apriori to the researcher. During the period of the grant, the PI made progress in all five...model at about the same level of precision as would be had in case one had the consensus answers apriori . For this reason it has become of paramount

  6. Democracy-based consensus in medicine.

    Science.gov (United States)

    Greco, Massimiliano; Zangrillo, Alberto; Mucchetti, Marta; Nobile, Leda; Landoni, Paolo; Bellomo, Rinaldo; Landoni, Giovanni

    2015-04-01

    High-quality evidence and derived guidelines, as typically published in major academic journals, are a major process that shapes physician decision-making worldwide. However, for many aspects of medical practice, there is a lack of High-quality evidence or an overload of somewhat contradictory low-quality information, which makes decision-making a difficult, uncertain, and unpredictable process. When the issues in question are important and evidence limited or controversial, the medical community seeks to establish common ground for "best practice" through consensus conferences and consensus statements or guidelines. Such consensus statements are seen as a useful tool to establish expert agreement, define the boundaries of acceptable practice, provide priorities for the research agenda, and obtain opinions from different countries and healthcare systems. This standard approach, however, can be criticized for being elitist, noninclusive, and poorly representative of the community of clinicians who will have to make decisions about the implementation of such recommendations. Accordingly, the authors propose a new model based on a combination of a local core meeting (detailed review and expert input) followed by a worldwide web-based network assessment (democracy-based consensus). The authors already have applied this approach to develop consensus on all nonsurgical interventions that increase or reduce perioperative mortality in critically ill patients and in those with acute kidney injury. The methodology was based on 5 sequential local and web-based steps. Both a panel of experts and a large number of professionals from all over the world were involved, giving birth to a new type of "democracy-based consensus." This new type of "democracy-based consensus" has the potential to increase grass-root clinician involvement, expand the reach to less-developed countries, provide a more global perspective on proposed interventions, and perhaps more importantly, increase

  7. Bruxism defined and graded: an international consensus.

    Science.gov (United States)

    Lobbezoo, F; Ahlberg, J; Glaros, A G; Kato, T; Koyano, K; Lavigne, G J; de Leeuw, R; Manfredini, D; Svensson, P; Winocur, E

    2013-01-01

    To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of 'possible', 'probable' and 'definite' sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains. © 2012 Blackwell Publishing Ltd.

  8. What are the communication challenges for politicians, experts and stakeholders in order to enhance transparency in nuclear waste management decisions? Report from a Team Syntegrity Meeting. The European Project RISCOM-II. Work Package 3

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Kjell [Karinta-Konsult, Taeby (Sweden); Espejo, Raul [Syncho Ltd., Birmingham (United Kingdom); Wene, Clas-Otto [Wenergy, Lund (Sweden)

    2003-09-01

    ; Resourcing; Facts and values; and Siting. In this summary the discussions and conclusion of these groups are brought together under eight themes or conclusions: 1) Consultation and mutual learning, 2) Trust, 3) The expert role, facts and values, 4) Transparency and consensus, 5) Institutional structures, 6) Resourcing, 7) Sustainable development, and 8) Nuclear debate. The main conclusions that can be summarised from the group discussions are as follows: For consultation and learning a stepwise process is important. People need to know where you are in the process and where you are going, how and when they can be involved and how their views will be used. Dialogue and public involvement must be given time enough so that each step in the process in well grounded. For good communication, trust between the actors is necessary. There is a mutual relationship between transparency and trust. Starting the transparency process requires some initial trust and when the process is successful, it deepens and widens this trust. Transparency is the outcome of a process and trust describes relations between actors. Trust so created is a social good needed for a participative decision process, and one benefit is that you free resources from all involved to deal with other issues One should strive for clarification about the factual versus the value-laden domain of an issue. This will increase transparency and set limits of the experts professional area e.g. by revealing hidden values in expert investigations. In distinguishing between facts and values you are able to reduce the power differences between experts and other stakeholders and empower the lay people in a decision-making process. Transparency is more important than consensus. A transparent and democratic decision-making process may not always lead to the acceptance of a proposed project. However, it should still be possible to present a coherent view on the impacts of the planned project. There is a need for strong institutional

  9. How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology.

    Science.gov (United States)

    Leonardi, Maria Cristina; Maisonneuve, Patrick; Mastropasqua, Mauro Giuseppe; Morra, Anna; Lazzari, Roberta; Rotmensz, Nicole; Sangalli, Claudia; Luini, Alberto; Veronesi, Umberto; Orecchia, Roberto

    2012-07-01

    To verify how the classification according to the American Society for Therapeutic Radiation Oncology (ASTRO) consensus statement (CS) for the application of accelerated partial breast irradiation (APBI) fits patients treated with intraoperative radiotherapy with electrons (ELIOT) at a single institution. The study included 1,822 patients treated with ELIOT as the sole radiation modality outside of a clinical trial at the European Institute of Oncology after breast-conserving surgery for invasive breast cancer, who were classified into CS groups of suitable, cautionary, and unsuitable. The outcome in terms of ipsilateral breast recurrence, regional node relapse, distant metastases, progression free-survival, cause-specific survival, and overall survival were assessed. All the 1,822 cases except for 25 could be classified according to ASTRO CS: 294 patients met the criteria for inclusion into the suitable group, 691 patients into the cautionary group, and 812 patients into the unsuitable group. The 5-year rate of ipsilateral breast recurrence for suitable, cautionary, and unsuitable groups were 1.5%, 4.4%, and 8.8%, respectively (p = 0.0003). Whereas the regional node relapse showed no difference, the rate of distant metastases was significantly different in the unsuitable group compared with the suitable and cautionary groups, having a significant impact on survival. In the context of patients treated with ELIOT, the ASTRO guidelines identify well the groups for whom APBI might be considered as an effective alternative to whole breast radiotherapy and also identify groups for whom APBI is not indicated. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. How Do the ASTRO Consensus Statement Guidelines for the Application of Accelerated Partial Breast Irradiation Fit Intraoperative Radiotherapy? A Retrospective Analysis of Patients Treated at the European Institute of Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Leonardi, Maria Cristina, E-mail: cristina.leonardi@ieo.it [Division of Radiation Oncology, European Institute of Oncology, Milan (Italy); Maisonneuve, Patrick [Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan (Italy); Mastropasqua, Mauro Giuseppe [Division of Pathology, European Institute of Oncology, Milan (Italy); Morra, Anna; Lazzari, Roberta [Division of Radiation Oncology, European Institute of Oncology, Milan (Italy); Rotmensz, Nicole [Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan (Italy); Sangalli, Claudia; Luini, Alberto [Division of Breast Surgery, European Institute of Oncology, Milan (Italy); Veronesi, Umberto [Scientific Directorate, European Institute of Oncology, Milan (Italy); Orecchia, Roberto [Division of Radiation Oncology, European Institute of Oncology, Milan (Italy); University of Milan (Italy)

    2012-07-01

    Purpose: To verify how the classification according to the American Society for Therapeutic Radiation Oncology (ASTRO) consensus statement (CS) for the application of accelerated partial breast irradiation (APBI) fits patients treated with intraoperative radiotherapy with electrons (ELIOT) at a single institution. Methods and Materials: The study included 1,822 patients treated with ELIOT as the sole radiation modality outside of a clinical trial at the European Institute of Oncology after breast-conserving surgery for invasive breast cancer, who were classified into CS groups of suitable, cautionary, and unsuitable. The outcome in terms of ipsilateral breast recurrence, regional node relapse, distant metastases, progression free-survival, cause-specific survival, and overall survival were assessed. Results: All the 1,822 cases except for 25 could be classified according to ASTRO CS: 294 patients met the criteria for inclusion into the suitable group, 691 patients into the cautionary group, and 812 patients into the unsuitable group. The 5-year rate of ipsilateral breast recurrence for suitable, cautionary, and unsuitable groups were 1.5%, 4.4%, and 8.8%, respectively (p = 0.0003). Whereas the regional node relapse showed no difference, the rate of distant metastases was significantly different in the unsuitable group compared with the suitable and cautionary groups, having a significant impact on survival. Conclusion: In the context of patients treated with ELIOT, the ASTRO guidelines identify well the groups for whom APBI might be considered as an effective alternative to whole breast radiotherapy and also identify groups for whom APBI is not indicated.

  11. International multispecialty consensus on how to evaluate ultrasound competence: a Delphi consensus survey.

    Directory of Open Access Journals (Sweden)

    Martin G Tolsgaard

    Full Text Available OBJECTIVES: To achieve international consensus across multiple specialties on a generic ultrasound rating scale using a Delphi technique. METHODS: Ultrasound experts from Obstetrics-Gynaecology, Surgery, Urology, Radiology, Rheumatology, Emergency Medicine, and Gastro-Enterology representing North America, Australia, and Europe were identified. A multi-round survey was conducted to obtain consensus between these experts. Of 60 invited experts, 44 experts agreed to participate in the first Delphi round, 41 remained in the second round, and 37 completed the third Delphi round. Seven key elements of the ultrasound examination were identified from existing literature and recommendations from international ultrasound societies. All experts rated the importance of these seven elements on a five-point Likert scale in the first round and suggested potential new elements for the assessment of ultrasound skills. In the second round, the experts re-rated all elements and a third round was conducted to allow final comments. Agreement on which elements to include in the final rating scale was pre-defined as more than 80% of the experts rating an element four or five, on importance to the ultrasound examination. RESULTS: Two additional elements were suggested by more than 10% of the experts in the first Delphi round. Consensus was obtained to include these two new elements along with five of the original elements in the final assessment instrument: 1 Indication for the examination 2 Applied knowledge of ultrasound equipment 3 Image optimization 4 Systematic examination 5 Interpretation of images 6 Documentation of examination and 7 Medical decision making. CONCLUSION: International multispecialty consensus was achieved on the content of a generic ultrasound rating scale. This is the first step to ensure valid assessment of clinicians in different medical specialties using ultrasound.

  12. Response to the European Commission's consultation on the future of European company law

    NARCIS (Netherlands)

    Böckli, P.; Davies, P.; Ferran, E.; Ferrarini, G.; Garrido, J.; Hopt, K.; Pietrancosta, A.; Pistor, K.; Skog, R.; Soltysinski, S.; Winter, J.; Wymeersch, E.

    2012-01-01

    This paper contains the views of the European Company Law Experts (ECLE) on the future of European company law. The paper accompanies the responses of the European Company Law Experts to the European Commission’s Consultation on the future of European Company Law of spring 2012. In the first part of

  13. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

    Science.gov (United States)

    Hansen, Dominique; Dendale, Paul; Coninx, Karin; Vanhees, Luc; Piepoli, Massimo F; Niebauer, Josef; Cornelissen, Veronique; Pedretti, Roberto; Geurts, Eva; Ruiz, Gustavo R; Corrà, Ugo; Schmid, Jean-Paul; Greco, Eugenio; Davos, Constantinos H; Edelmann, Frank; Abreu, Ana; Rauch, Bernhard; Ambrosetti, Marco; Braga, Simona S; Barna, Olga; Beckers, Paul; Bussotti, Maurizio; Fagard, Robert; Faggiano, Pompilio; Garcia-Porrero, Esteban; Kouidi, Evangelia; Lamotte, Michel; Neunhäuserer, Daniel; Reibis, Rona; Spruit, Martijn A; Stettler, Christoph; Takken, Tim; Tonoli, Cajsa; Vigorito, Carlo; Völler, Heinz; Doherty, Patrick

    2017-07-01

    Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in

  14. Combating sexual orientation discrimination in employment: legislation in fifteen EU members states (France) : Report of the European Group of Experts on Combating sexual orientation discrimination about the implementation up to April 2004 of Directive 2000/78/EC establishing a general framework for equal treatement in employment and occupation

    OpenAIRE

    Borrillo, Daniel

    2004-01-01

    Report of the European Group of Experts on Combating sexual orientation discrimination about the implementation up to April 2004 of Directive 2000/78/EC establishing a general framework for equal treatement in employment and occupation; France was the first country in the world to discriminalize sodomy.....

  15. Standard operating procedures for ESPEN guidelines and consensus papers.

    Science.gov (United States)

    Bischoff, Stephan C; Singer, Pierre; Koller, Michael; Barazzoni, Rocco; Cederholm, Tommy; van Gossum, André

    2015-12-01

    The ESPEN Guideline standard operating procedures (SOP) is based on the methodology provided by the Association of Scientific Medical Societies of Germany (AWMF), the Scottish Intercollegiate Guidelines Network (SIGN), and the Centre for Evidence-based Medicine at the University of Oxford. The SOP is valid and obligatory for all future ESPEN-sponsored guideline projects aiming to generate high-quality guidelines on a regular basis. The SOP aims to facilitate the preparation of guideline projects, to streamline the consensus process, to ensure quality and transparency, and to facilitate the dissemination and publication of ESPEN guidelines. To achieve this goal, the ESPEN Guidelines Editorial board (GEB) has been established headed by two chairmen. The GEB will support and supervise the guideline processes and is responsible for the strategic planning of ESPEN guideline activities. Key elements of the SOP are the generation of well-built clinical questions according to the PICO system, a systemic literature search, a classification of the selected literature according to the SIGN evidence levels providing an evidence table, and a clear and straight-forward consensus procedure consisting of online voting's and a consensus conference. Only experts who meet the obligation to disclosure any potential conflict of interests and who are not employed by the Industry can participate in the guideline process. All recommendations will be graded according to the SIGN grading and novel outcome models besides biomedical endpoints. This approach will further extent the leadership of ESPEN in creating up-to-date and suitable for implementation guidelines and in sharing knowledge on malnutrition and clinical nutrition. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  16. Consensus over peri-implantaire infecties

    NARCIS (Netherlands)

    van Winkelhoff, A J

    2010-01-01

    In 2008, in a workshop of the European Federation on Periodontology, a consensus was reached concerning oral peri-implant infections on the basis of the state of the art in the relevant sciences. Important conclusions were that peri-implant mucositis occurs in 80% of subjects with oral implants, and

  17. Multimodality Imaging in Restrictive Cardiomyopathies : An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography

    NARCIS (Netherlands)

    Habib, Gilbert; Bucciarelli-Ducci, Chiara; Caforio, Alida L. P.; Cardim, Nuno; Charron, Philippe; Cosyns, Bernard; Dehaene, Aure ' Lie; Derumeaux, Genevieve; Donal, Erwan; Dweck, Marc R.; Edvardsen, Thor; Erba, Paola Anna; Ernande, Laura; Gaemperli, Oliver; Galderisi, Maurizio; Grapsa, Julia; Jacquier, Alexis; Klingel, Karin; Lancellotti, Patrizio; Neglia, Danilo; Pepe, Alessia; Perrone-Filardi, Pasquale; Petersen, Steffen E.; Plein, Sven; Popescu, Bogdan A.; Reant, Patricia; Sade, L. Elif; Salaun, Erwan; Slart, Riemer H. J. A.; Tribouilloy, Christophe; Zamorano, Jose

    2017-01-01

    Restrictive cardiomyopathies (RCMs) are a diverse group of myocardial diseases with a wide range of aetiologies, including familial, genetic and acquired diseases and ranging from very rare to relatively frequent cardiac disorders. In all these diseases, imaging techniques play a central role.

  18. Buprenorphine dosing choices in specific populations: review of expert opinion.

    Science.gov (United States)

    Maremmani, Icro; Rolland, Benjamin; Somaini, Lorenzo; Roncero, Carlos; Reimer, Jens; Wright, Nat; Littlewood, Richard; Krajci, Peter; Alho, Hannu; D'Agnone, Oscar; Simon, Nicolas

    2016-09-01

    Treatment of opioid dependence with buprenorphine improves outcomes. Typical dosing ranges for all patients from clinical evidence and as defined in the product information are wide. For specific groups with complex clinical scenarios, there is no clear consensus on dosing choices to achieve best possible outcomes. The doses of buprenorphine used in 6 European countries was reviewed. A review of published evidence supported rapid induction with buprenorphine and the benefits of higher doses but did not identify clearly useful guidance on dosing choices for groups with complex clinical scenarios. An expert group of physicians with experience in addiction care participated in a discussion meeting to share clinical practice experience and develop a consensus on dosing choices. There was general agreement that treatment outcomes can be improved by optimising buprenorphine doses in specific subgroups. Specific groups in whom buprenorphine doses may be too low and who could have better outcomes with optimised dosing were identified on the basis of clinical practice experience. These groups include people with severe addiction, high tolerance to opioids, and psychiatric comorbidities. In these groups it is recommended to review dosing choices to ensure buprenorphine dosing is sufficient.

  19. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).

    Science.gov (United States)

    Sarafidis, Pantelis A; Persu, Alexandre; Agarwal, Rajiv; Burnier, Michel; de Leeuw, Peter; Ferro, Charles J; Halimi, Jean-Michel; Heine, Gunnar H; Jadoul, Michel; Jarraya, Faical; Kanbay, Mehmet; Mallamaci, Francesca; Mark, Patrick B; Ortiz, Alberto; Parati, Gianfranco; Pontremoli, Roberto; Rossignol, Patrick; Ruilope, Luis; Van der Niepen, Patricia; Vanholder, Raymond; Verhaar, Marianne C; Wiecek, Andrzej; Wuerzner, Gregoire; London, Gérard M; Zoccali, Carmine

    2017-04-01

    In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnoea and the use of erythropoietin-stimulating agents may also be involved. Non-pharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium and volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  20. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).

    Science.gov (United States)

    Sarafidis, Pantelis A; Persu, Alexandre; Agarwal, Rajiv; Burnier, Michel; de Leeuw, Peter; Ferro, Charles; Halimi, Jean-Michel; Heine, Gunnar; Jadoul, Michel; Jarraya, Faical; Kanbay, Mehmet; Mallamaci, Francesca; Mark, Patrick B; Ortiz, Alberto; Parati, Gianfranco; Pontremoli, Roberto; Rossignol, Patrick; Ruilope, Luis; Van der Niepen, Patricia; Vanholder, Raymond; Verharr, Marianne C; Wiecek, Andrzej; Wuerzner, Gregoire; London, Gérard M; Zoccali, Carmine

    2017-04-01

    In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

  1. Diagnosis and Management of Chronic Pruritus: An Expert Consensus Review

    OpenAIRE

    Murlidhar Rajagopalan; Abir Saraswat; Kiran Godse; D S Krupa Shankar; Sanjiv Kandhari; Shrutakirthi D Shenoi; Sushil Tahiliani; V Vijay Zawar

    2017-01-01

    The aim of this study is to formulate the best clinical practice in the diagnosis and management of chronic pruritus (CP). We searched PubMed, EMBASE, Scopus, Web of Science, and the WHO's regional databases, for studies on “Diagnosis and management of chronic pruritus” from January 1, 2014, to July 31, 2015. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data. We screened 87 of 95 stud...

  2. Diagnosis and management of chronic pruritus: An expert consensus review

    Directory of Open Access Journals (Sweden)

    Murlidhar Rajagopalan

    2017-01-01

    Full Text Available The aim of this study is to formulate the best clinical practice in the diagnosis and management of chronic pruritus (CP. We searched PubMed, EMBASE, Scopus, Web of Science, and the WHO's regional databases, for studies on “Diagnosis and management of chronic pruritus” from January 1, 2014, to July 31, 2015. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data. We screened 87 of 95 studies that contained qualitative data. Avoid: Dry climate, heat, alcohol compress, ice packs, frequent bathing and washing, intake of very hot and spicy food, intake of alcohol, contact with irritant substances, excitement, strain and stress, and allergens. Using: Mild nonalkaline soaps, moisturizers, bathing oils, lukewarm water while bathing, soft cotton clothing and night creams/lotions, relaxation therapy, autogenic training, psychosocial education, educating patients to cope with itching and scratching, and educational programs. Especially use of moisturizers is considered important. In addition, symptomatic treatment options include systemic H1 antihistamines and topical corticosteroids. Symptomatic therapy directed toward the cause (hepatic, renal, atopic, polycythemia, etc.. If refractory or cause is unknown, consider capsaicin, calcineurin inhibitors for localized pruritus and naltrexone, pregabalin, ultraviolet therapy, Cyclosporine for generalized itching. CP is quite frequent finding associated with skin and systemic diseases in the overall population. It is known to significantly affect quality life score of an individual and also adds burden on the health-care cost. A specific recommendation for treatment of CP is difficult as a result of varied and diverse possibility of underlying diseases associated with CP.

  3. Expert consensus on an in vitro approach to assess ...

    Science.gov (United States)

    Report from an international workshop with the goal of reviewing the state-of-the-science and determine the technical needs to develop an in vitro system that will reduce and eventually replace the use of animals for evaluating the potential inhalation toxicity of nanomaterials (NMs) in a regulatory setting. Workshop was co-organized in February 2015 by the PETA International Science Consortium Ltd. with the National Toxicology Program Interagency Center for the Evaluation of Alternative Toxicological Methods an international workshop that was attended by representatives from industry, government, academia, and non-governmental organizations with expertise in in vivo and in vitro lung systems, respiratory toxicology, inhalation particle dosimetry, nanotoxicology, and hazard and human health risk analysis. This report provides an overview of the presentations, discussions, and recommendations of the participants on the design of an in vitro system for the prediction of pulmonary fibrosis. The workshop participants identified multi-walled carbon nanotubes (MWCNTs), which have been shown to induce fibrosis in animal experiments and represent an important commercial nanomaterial class, as representative pro-fibrogenic NMs to use for the development of an in vitro test system. Recommendations were made for designing a system using lung relevant cells co-cultured at the air-liquid interface to assess the pro-fibrogenic potential of aerosolized MWCNTs, while consider

  4. Quality assurance in conservative treatment of early breast cancer. Report on a consensus meeting of the EORTC Radiotherapy and Breast Cancer Cooperative Groups and the EUSOMA (European Society of Mastology)

    NARCIS (Netherlands)

    Bartelink, H.; Garavaglia, G.; Johansson, K. A.; Mijnheer, B. J.; van den Bogaert, W.; van Tienhoven, G.; Yarnold, J.

    1991-01-01

    A consensus on a quality assurance programme of the treatment of early breast cancer was reached in a multidisciplinary meeting of surgeons, pathologists, radiotherapists, physicists and radiographers. Guidelines for treatment preparation and execution have been set up, including careful location

  5. Operational expert system applications in Europe

    CERN Document Server

    Zarri, Gian Piero

    1992-01-01

    Operational Expert System Applications in Europe describes the representative case studies of the operational expert systems (ESs) that are used in Europe.This compilation provides examples of operational ES that are realized in 10 different European countries, including countries not usually examined in the standard reviews of the field.This book discusses the decision support system using several artificial intelligence tools; expert systems for fault diagnosis on computerized numerical control (CNC) machines; and expert consultation system for personal portfolio management. The failure prob

  6. International consensus on allergy immunotherapy.

    Science.gov (United States)

    Jutel, Marek; Agache, Ioana; Bonini, Sergio; Burks, A Wesley; Calderon, Moises; Canonica, Walter; Cox, Linda; Demoly, Pascal; Frew, Antony J; O'Hehir, Robin; Kleine-Tebbe, Jörg; Muraro, Antonella; Lack, Gideon; Larenas, Désirée; Levin, Michael; Nelson, Harald; Pawankar, Ruby; Pfaar, Oliver; van Ree, Ronald; Sampson, Hugh; Santos, Alexandra F; Du Toit, George; Werfel, Thomas; Gerth van Wijk, Roy; Zhang, Luo; Akdis, Cezmi A

    2015-09-01

    Allergen immunotherapy (AIT) has been used to treat allergic disease since the early 1900s. Despite numerous clinical trials and meta-analyses proving AIT efficacious, it remains underused and is estimated to be used in less than 10% of patients with allergic rhinitis or asthma worldwide. In addition, there are large differences between regions, which are not only due to socioeconomic status. There is practically no controversy about the use of AIT in the treatment of allergic rhinitis and allergic asthma, but for atopic dermatitis or food allergy, the indications for AIT are not well defined. The elaboration of a wider consensus is of utmost importance because AIT is the only treatment that can change the course of allergic disease by preventing the development of asthma and new allergen sensitizations and by inducing allergen-specific immune tolerance. Safer and more effective AIT strategies are being continuously developed both through elaboration of new allergen preparations and adjuvants and alternate routes of administration. A number of guidelines, consensus documents, or both are available on both the international and national levels. The international community of allergy specialists recognizes the need to develop a comprehensive consensus report to harmonize, disseminate, and implement the best AIT practice. Consequently, the International Collaboration in Asthma, Allergy and Immunology, formed by the European Academy of Allergy and Clinical Immunology; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma & Immunology; and the World Allergy Organization, has decided to issue an international consensus on AIT. Copyright © 2015. Published by Elsevier Inc.

  7. [SECOT consensus on medial femorotibial osteoarthritis].

    Science.gov (United States)

    Moreno, A; Silvestre, A; Carpintero, P

    2013-01-01

    A consensus, prepared by SECOT, is presented on the management of medial knee compartment osteoarthritis, in order to establish clinical criteria and recommendations directed at unifying the criteria in its management, dealing with the factors involved in the pathogenesis of medial femorotibial knee osteoarthritis, the usefulness of diagnostic imaging techniques, and the usefulness of arthroscopy. Conservative and surgical treatments are also analysed. The experts consulted showed a consensus (agreed or disagreed) in 65.8% of the items considered, leaving 14items where no consensus was found, which included the aetiopathogenesis of the osteoarthritis, the value of NMR in degenerative disease, the usefulness of COX-2 and the chondroprotective drugs, as well as on the ideal valgus tibial osteotomy technique. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  8. Key attributes of expert NRL referees.

    Science.gov (United States)

    Morris, Gavin; O'Connor, Donna

    2017-05-01

    Experiential knowledge of elite National Rugby League (NRL) referees was investigated to determine the key attributes contributing to expert officiating performance. Fourteen current first-grade NRL referees were asked to identify the key attributes they believed contributed to their expert refereeing performance. The modified Delphi method involved a 3-round process of an initial semi-structured interview followed by 2 questionnaires to reach consensus of opinion. The data revealed 25 attributes that were rated as most important that underpin expert NRL refereeing performance. Results illustrate the significance of the cognitive category, with the top 6 ranked attributes all cognitive skills. Of these, the referees ranked decision-making accuracy as the most important attribute, followed by reading the game, communication, game understanding, game management and knowledge of the rules. Player rapport, positioning and teamwork were the top ranked game skill attributes underpinning performance excellence. Expert referees also highlighted a number of psychological attributes (e.g., concentration, composure and mental toughness) that were significant to performance. There were only 2 physiological attributes (fitness, aerobic endurance) that were identified as significant to elite officiating performance. In summary, expert consensus was attained which successfully provided a hierarchy of the most significant attributes of expert NRL refereeing performance.

  9. Hypertension and cardiac arrhythmias: a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).

    Science.gov (United States)

    Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas; Boriani, Giuseppe; Manolis, Antonis S; Olsen, Michael Hecht; Oto, Ali; Potpara, Tatjana S; Steffel, Jan; Marín, Francisco; de Oliveira Figueiredo, Márcio Jansen; de Simone, Giovanni; Tzou, Wendy S; Chiang, Chern-En; Williams, Bryan; Dan, Gheorghe-Andrei; Gorenek, Bulent; Fauchier, Laurent; Savelieva, Irina; Hatala, Robert; van Gelder, Isabelle; Brguljan-Hitij, Jana; Erdine, Serap; Lovic, Dragan; Kim, Young-Hoon; Salinas-Arce, Jorge; Field, Michael

    2017-06-01

    Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit to comprehensively review the available evidence to publish a joint consensus document on hypertension and cardiac arrhythmias, and to provide up-to-date consensus recommendations for use in clinical practice. The ultimate judgment regarding care of a particular patient must be made by the healthcare provider and the patient in light of all of the circumstances presented by that patient. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  10. Expert witness perceptions of bias in experts.

    Science.gov (United States)

    Commons, Michael Lamport; Miller, Patrice Marie; Gutheil, Thomas G

    2004-01-01

    A pilot study of perceptions of different sources of expert bias, as well as of personal investment in case outcomes, was performed among attendees at a workshop at an annual meeting of the American Academy of Psychiatry and the Law. Participants were asked to rate hypothetical responses by experts to various case outcomes and the biasing potential of different kinds of situations for opposing or other experts. A factor analysis produced two factors. Factor 1 included questions about situations that were obviously biasing (such as working only for the defense). Factor 2 included questions assessing the potential of certain situations to cause bias in experts, or how likely experts thought other experts were to be biased. In general, experts identified only four areas to be overtly biasing. All occurred within situations in which experts worked only for one or the other side of civil or criminal cases. Experts otherwise thought other experts were reasonably bias free and well able to compensate for any bias when it occurred. The data suggest that experts may deal with bias by turning down cases that may cause them personal discomfort.

  11. The Limits of Consensus.

    Science.gov (United States)

    Poster, John B.

    Dynamics in the education policy arena suggest that, despite two generations of researchers extolling democratic leadership styles and consensus building over autocratic techniques, wide participation in policymaking and the broadest possible consensus are not always productive: American society has not yet agreed on what schools should…

  12. International Consensus Statement on the Clinical and Therapeutic Management of Leber Hereditary Optic Neuropathy.

    Science.gov (United States)

    Carelli, Valerio; Carbonelli, Michele; de Coo, Irenaeus F; Kawasaki, Aki; Klopstock, Thomas; Lagrèze, Wolf A; La Morgia, Chiara; Newman, Nancy J; Orssaud, Christophe; Pott, Jan Willem R; Sadun, Alfredo A; van Everdingen, Judith; Vignal-Clermont, Catherine; Votruba, Marcela; Yu-Wai-Man, Patrick; Barboni, Piero

    2017-12-01

    Leber hereditary optic neuropathy (LHON) is currently estimated as the most frequent mitochondrial disease (1 in 27,000-45,000). Its molecular pathogenesis and natural history is now fairly well understood. LHON also is the first mitochondrial disease for which a treatment has been approved (idebenone-Raxone, Santhera Pharmaceuticals) by the European Medicine Agency, under exceptional circumstances because of the rarity and severity of the disease. However, what remains unclear includes the optimal target population, timing, dose, and frequency of administration of idebenone in LHON due to lack of accepted definitions, criteria, and general guidelines for the clinical management of LHON. To address these issues, a consensus conference with a panel of experts from Europe and North America was held in Milan, Italy, in 2016. The intent was to provide expert consensus statements for the clinical and therapeutic management of LHON based on the currently available evidence. We report the conclusions of this conference, providing the guidelines for clinical and therapeutic management of LHON.

  13. A hematology consensus agreement on antifungal strategies for neutropenic patients with hematological malignancies and stem cell transplant recipients. Gruppo Italiano Malattie Ematologiche dell'Adulto, Gruppo Italiano Trapianto di Midollo Osseo, Associazione Italiana Ematologia ed Oncologia Pediatrica, Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer and Sorveglianza Epidemiologica delle Infezioni Fungine nelle Emopatie Maligne.

    Science.gov (United States)

    Girmenia, Corrado; Aversa, Franco; Busca, Alessandro; Candoni, Anna; Cesaro, Simone; Luppi, Mario; Pagano, Livio; Rossi, Giuseppe; Venditti, Adriano; Nosari, Anna Maria

    2013-09-01

    In the attempt to establish key therapy definitions and provide shared approaches to invasive fungal diseases in neutropenic patients, trials of empiric, preeemptive and targeted antifungal therapy (EAT, PAT and TAT) were reviewed, and a Consensus Development Conference Project was convened. The Expert-Panel concurred that all antifungal treatments, including EAT, should always follow an adequate diagnostic strategy and that the standard definition of PAT may be misleading: being PAT guided by the results of a diagnostic work-up, it should better be termed diagnostic-driven antifungal therapy (DDAT). The Expert-Panel agreed that radiological findings alone are insufficient for the choice of a TAT and that the identification of the etiologic pathogen is needed. The Consensus Agreement proceeded identifying which clinical and microbiological findings were sufficient to start a DDAT and which were not. Finally, an algorithm to rationalize the choice of antifungal drugs on the basis of clinical manifestations, antifungal prophylaxis, instrumental and laboratory findings was drawn up. Copyright © 2012 John Wiley & Sons, Ltd.

  14. Recurrence of Dupuytren's contracture: A consensus-based definition.

    Directory of Open Access Journals (Sweden)

    Hester J Kan

    Full Text Available One of the major determinants of Dupyutren disease (DD treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence.To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren's research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic.Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as "more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment". In addition, "recurrence should be reported individually for every treated joint" and afterwards measurements should be repeated and reported yearly.This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives.

  15. Added value of electromyography in the diagnosis of myopathy: A consensus exercise.

    Science.gov (United States)

    Pugdahl, K; Johnsen, B; Tankisi, H; Camdessanché, J P; de Carvalho, M; Fawcett, P R W; Labarre-Vila, A; Liguori, R; Nix, W; Schofield, I; Fuglsang-Frederiksen, A

    2017-05-01

    Currently, neurologists may primarily rely on blood biomarkers, muscle biopsy, MRI, and genetics in the diagnostic work-up of suspected myopathy. Using expert consensus as diagnostic reference standard, this study addressed the added value of electrodiagnostic medicine (EDX) in diagnosis of myopathies. One hundred ninety-four EDX evaluations of patients with a peer-review consensus diagnosis of myopathy were collected by seven European centres. Each patient was given three different consensus diagnoses: (1) the EDX diagnosis solely based on EDX results, (2) the pure clinical diagnosis based on all available information except EDX results, and (3) the final diagnosis including EDX and all additional information. The myopathies were grouped as muscular dystrophy (45), inflammatory myopathy (46), other aetiology (36) or unknown aetiology (67). Higher diagnostic probabilities for myopathy were seen in the final diagnosis compared to the pure clinical diagnosis (p<0.001). Adding EDX information increased the diagnostic probability of myopathy in 67 patients (34.4%). The greatest increase was seen for myopathies of unknown aetiology. EDX has a major impact in the diagnosis of myopathies of unknown aetiology. In genetically or biopsy proven myopathies, EDX generally supports the diagnosis. EDX is still a useful tool in the diagnostic work-up of most patients with suspected myopathy. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  16. The European general practice research network presents the translations of its comprehensive definition of multimorbidity in family medicine in ten European languages.

    Science.gov (United States)

    Le Reste, Jean Yves; Nabbe, Patrice; Rivet, Charles; Lygidakis, Charilaos; Doerr, Christa; Czachowski, Slawomir; Lingner, Heidrun; Argyriadou, Stella; Lazic, Djurdjica; Assenova, Radost; Hasaganic, Melida; Munoz, Miquel Angel; Thulesius, Hans; Le Floch, Bernard; Derriennic, Jeremy; Sowinska, Agnieska; Van Marwijk, Harm; Lietard, Claire; Van Royen, Paul

    2015-01-01

    Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review. To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research. Forward translation of the EGPRN's definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached. 229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved. A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care.

  17. The European General Practice Research Network Presents the Translations of Its Comprehensive Definition of Multimorbidity in Family Medicine in Ten European Languages

    Science.gov (United States)

    Le Reste, Jean Yves; Nabbe, Patrice; Rivet, Charles; Lygidakis, Charilaos; Doerr, Christa; Czachowski, Slawomir; Lingner, Heidrun; Argyriadou, Stella; Lazic, Djurdjica; Assenova, Radost; Hasaganic, Melida; Munoz, Miquel Angel; Thulesius, Hans; Le Floch, Bernard; Derriennic, Jeremy; Sowinska, Agnieska; Van Marwijk, Harm; Lietard, Claire; Van Royen, Paul

    2015-01-01

    Background Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review. Objective To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research. Method Forward translation of the EGPRN’s definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached Results 229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved. Conclusion A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care. PMID:25607642

  18. Diagnosis and management of testicular cancer the European point of view

    CERN Document Server

    Krege, Susanne

    2015-01-01

    This book presents the views of leading European experts on the diagnosis and management of testicular cancer, with coverage of current hot topics in the field. It opens by providing an overview of the recommendations in the most recent consensus paper from the European Germ Cell Cancer Consensus Group, which is based on interdisciplinary cooperation among urologists, medical oncologists, radio-oncologists, pathologists, and basic scientists. The remainder of the book focuses on areas of controversy in the diagnosis, treatment, and follow-up of testicular cancer. In each case the evidence base is discussed and results from the most recent studies are reviewed, drawing attention to new findings that might alter treatment recommendations. The treatment-related chapters cover a broad range of issues, including the best approach in patients with poor-prognosis and recurrent disease and those with long-term toxicities. Relevant aspects of survivorship care are also addressed. The book will help clinicians and prac...

  19. Elicitation of expert prior opinion: application to the MYPAN trial in childhood polyarteritis nodosa.

    Directory of Open Access Journals (Sweden)

    Lisa V Hampson

    Full Text Available Definitive sample sizes for clinical trials in rare diseases are usually infeasible. Bayesian methodology can be used to maximise what is learnt from clinical trials in these circumstances. We elicited expert prior opinion for a future Bayesian randomised controlled trial for a rare inflammatory paediatric disease, polyarteritis nodosa (MYPAN, Mycophenolate mofetil for polyarteritis nodosa.A Bayesian prior elicitation meeting was convened. Opinion was sought on the probability that a patient in the MYPAN trial treated with cyclophosphamide would achieve disease remission within 6-months, and on the relative efficacies of mycophenolate mofetil and cyclophosphamide. Expert opinion was combined with previously unseen data from a recently completed randomised controlled trial in ANCA associated vasculitis.A pan-European group of fifteen experts participated in the elicitation meeting. Consensus expert prior opinion was that the most likely rates of disease remission within 6 months on cyclophosphamide or mycophenolate mofetil were 74% and 71%, respectively. This prior opinion will now be taken forward and will be modified to formulate a Bayesian posterior opinion once the MYPAN trial data from 40 patients randomised 1:1 to either CYC or MMF become available.We suggest that the methodological template we propose could be applied to trial design for other rare diseases.

  20. Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group

    Science.gov (United States)

    Gronchi, A.; Fossati, P.; Akiyama, T.; Alapetite, C.; Baumann, M.; Blay, J. Y.; Bolle, S.; Boriani, S.; Bruzzi, P.; Capanna, R.; Caraceni, A.; Casadei, R.; Colia, V.; Debus, J.; Delaney, T.; Desai, A.; Dileo, P.; Dijkstra, S.; Doglietto, F.; Flanagan, A.; Froelich, S.; Gardner, P. A.; Gelderblom, H.; Gokaslan, Z. L.; Haas, R.; Heery, C.; Hindi, N.; Hohenberger, P.; Hornicek, F.; Imai, R.; Jeys, L.; Jones, R. L.; Kasper, B.; Kawai, A.; Krengli, M.; Leithner, A.; Logowska, I.; Martin Broto, J.; Mazzatenta, D.; Morosi, C.; Nicolai, P.; Norum, O. J.; Patel, S.; Penel, N.; Picci, P.; Pilotti, S.; Radaelli, S.; Ricchini, F.; Rutkowski, P.; Scheipl, S.; Sen, C.; Tamborini, E.; Thornton, K. A.; Timmermann, B.; Torri, V.; Tunn, P. U.; Uhl, M.; Yamada, Y.; Weber, D. C.; Vanel, D.; Varga, P. P.; Vleggeert-Lankamp, C. L. A.; Casali, P. G.; Sommer, J.

    2017-01-01

    Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper. PMID:28184416

  1. World Endometriosis Society consensus on the classification of endometriosis.

    Science.gov (United States)

    Johnson, Neil P; Hummelshoj, Lone; Adamson, G David; Keckstein, Jörg; Taylor, Hugh S; Abrao, Mauricio S; Bush, Deborah; Kiesel, Ludwig; Tamimi, Rulla; Sharpe-Timms, Kathy L; Rombauts, Luk; Giudice, Linda C

    2017-02-01

    Enzian and Endometriosis Fertility Index staging systems), that may be used by all surgeons in each case of surgery undertaken for women with endometriosis. We also propose wider use of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project surgical and clinical data collection tools for research to improve classification of endometriosis in the future, of particular relevance when surgery is not undertaken. This consensus process differed from that of formal guideline development, although based on the same available evidence. A different group of international experts from those participating in this process may have yielded subtly different consensus statements. This is the first time that a large, global, consortium-representing 29 major stake-holding organizations, from 19 countries - has convened to systematically evaluate the best available evidence on the classification of endometriosis and reach consensus. In addition to 21 international medical organizations and companies, representatives from eight national endometriosis organizations were involved, including lay support groups, thus generating and including input from women who suffer from endometriosis in an endeavour to keep uppermost the goal of optimizing quality of life for women with endometriosis. The World Endometriosis Society convened and hosted the consensus meeting. Financial support for participants to attend the meeting was provided by the organizations that they represented. There was no other specific funding for this consensus process. Mauricio Abrao is an advisor to Bayer Pharma, and a consultant to AbbVie and AstraZeneca; G David Adamson is the Owner of Advanced Reproductive Care Inc and Ziva and a consultant to Bayer Pharma, Ferring, and AbbVie; Deborah Bush has received travel grants from Fisher & Paykel Healthcare and Bayer Pharmaceuticals; Linda Giudice is a consultant to AbbVie, Juniper Pharmaceutical, and NextGen Jane, holds research

  2. [Spanish consensus on infantile haemangioma].

    Science.gov (United States)

    Baselga Torres, Eulalia; Bernabéu Wittel, José; van Esso Arbolave, Diego L; Febrer Bosch, María Isabel; Carrasco Sanz, Ángel; de Lucas Laguna, Raúl; Del Pozo Losada, Jesús; Hernández Martín, Ángela; Jiménez Montañés, Lorenzo; López Gutiérrez, Juan Carlos; Martín-Santiago, Ana; Redondo Bellón, Pedro; Ruíz-Canela Cáceres, Juan; Torrelo Fernández, Antonio; Vera Casaño, Ángel; Vicente Villa, María Asunción

    2016-11-01

    Infantile haemangiomas are benign tumours produced by the proliferation of endothelial cells of blood vessels, with a high incidence in children under the age of one year (4-10%). It is estimated that 12% of them require treatment. This treatment must be administered according to clinical practice guidelines, expert experience, patient characteristics and parent preferences. The consensus process was performed by using scientific evidence on the diagnosis and treatment of infantile haemangiomas, culled from a systematic review of the literature, together with specialist expert opinions. The recommendations issued were validated by the specialists, who also provided their level of agreement. This document contains recommendations on the classification, associations, complications, diagnosis, treatment, and follow-up of patients with infantile haemangioma. It also includes action algorithms, and addresses multidisciplinary management and referral criteria between the different specialities involved in the clinical management of this type of patient. The recommendations and the diagnostic and therapeutic algorithms of infantile haemangiomas contained in this document are a useful tool for the proper management of these patients. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View.

    Science.gov (United States)

    Collins, Justin W; Patel, Hiten; Adding, Christofer; Annerstedt, Magnus; Dasgupta, Prokar; Khan, Shamim M; Artibani, Walter; Gaston, Richard; Piechaud, Thierry; Catto, James W; Koupparis, Anthony; Rowe, Edward; Perry, Matthew; Issa, Rami; McGrath, John; Kelly, John; Schumacher, Martin; Wijburg, Carl; Canda, Abdullah E; Balbay, Meviana D; Decaestecker, Karel; Schwentner, Christian; Stenzl, Arnulf; Edeling, Sebastian; Pokupić, Sasa; Stockle, Michael; Siemer, Stefan; Sanchez-Salas, Rafael; Cathelineau, Xavier; Weston, Robin; Johnson, Mark; D'Hondt, Fredrik; Mottrie, Alexander; Hosseini, Abolfazl; Wiklund, Peter N

    2016-10-01

    Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials. To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients. The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee. Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation. This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs. There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We

  4. Medical Expert Systems Survey

    OpenAIRE

    Abu-Nasser, Bassem S.

    2017-01-01

    International audience; There is an increase interest in the area of Artificial Intelligence in general and expert systems in particular. Expert systems are rapidly growing technology. Expert system is a branch of Artificial Intelligence which is having a great impact on many fields of human life. Expert systems use human expert knowledge to solve complex problems in many fields such as Health, science, engineering, business, and weather forecasting. Organizations employing the technology of ...

  5. Explosion probability of unexploded ordnance: expert beliefs.

    Science.gov (United States)

    MacDonald, Jacqueline Anne; Small, Mitchell J; Morgan, M G

    2008-08-01

    This article reports on a study to quantify expert beliefs about the explosion probability of unexploded ordnance (UXO). Some 1,976 sites at closed military bases in the United States are contaminated with UXO and are slated for cleanup, at an estimated cost of $15-140 billion. Because no available technology can guarantee 100% removal of UXO, information about explosion probability is needed to assess the residual risks of civilian reuse of closed military bases and to make decisions about how much to invest in cleanup. This study elicited probability distributions for the chance of UXO explosion from 25 experts in explosive ordnance disposal, all of whom have had field experience in UXO identification and deactivation. The study considered six different scenarios: three different types of UXO handled in two different ways (one involving children and the other involving construction workers). We also asked the experts to rank by sensitivity to explosion 20 different kinds of UXO found at a case study site at Fort Ord, California. We found that the experts do not agree about the probability of UXO explosion, with significant differences among experts in their mean estimates of explosion probabilities and in the amount of uncertainty that they express in their estimates. In three of the six scenarios, the divergence was so great that the average of all the expert probability distributions was statistically indistinguishable from a uniform (0, 1) distribution-suggesting that the sum of expert opinion provides no information at all about the explosion risk. The experts' opinions on the relative sensitivity to explosion of the 20 UXO items also diverged. The average correlation between rankings of any pair of experts was 0.41, which, statistically, is barely significant (p= 0.049) at the 95% confidence level. Thus, one expert's rankings provide little predictive information about another's rankings. The lack of consensus among experts suggests that empirical studies

  6. Practical problems in aggregating expert opinions

    Energy Technology Data Exchange (ETDEWEB)

    Booker, J.M.; Picard, R.R.; Meyer, M.A.

    1993-11-01

    Expert opinion is data given by a qualified person in response to a technical question. In these analyses, expert opinion provides information where other data are either sparse or non-existent. Improvements in forecasting result from the advantageous addition of expert opinion to observed data in many areas, such as meteorology and econometrics. More generally, analyses of large, complex systems often involve experts on various components of the system supplying input to a decision process; applications include such wide-ranging areas as nuclear reactor safety, management science, and seismology. For large or complex applications, no single expert may be knowledgeable enough about the entire application. In other problems, decision makers may find it comforting that a consensus or aggregation of opinions is usually better than a single opinion. Many risk and reliability studies require a single estimate for modeling, analysis, reporting, and decision making purposes. For problems with large uncertainties, the strategy of combining as diverse a set of experts as possible hedges against underestimation of that uncertainty. Decision makers are frequently faced with the task of selecting the experts and combining their opinions. However, the aggregation is often the responsibility of an analyst. Whether the decision maker or the analyst does the aggregation, the input for it, such as providing weights for experts or estimating other parameters, is imperfect owing to a lack of omniscience. Aggregation methods for expert opinions have existed for over thirty years; yet many of the difficulties with their use remain unresolved. The bulk of these problem areas are summarized in the sections that follow: sensitivities of results to assumptions, weights for experts, correlation of experts, and handling uncertainties. The purpose of this paper is to discuss the sources of these problems and describe their effects on aggregation.

  7. In search for a public health leadership competency framework to support leadership curriculum-a consensus study.

    Science.gov (United States)

    Czabanowska, Katarzyna; Smith, Tony; Könings, Karen D; Sumskas, Linas; Otok, Robert; Bjegovic-Mikanovic, Vesna; Brand, Helmut

    2014-10-01

    Competency-based education is increasingly popular, especially in the area of continuing professional development. Many competency frameworks have been developed; however, few address leadership competencies for European public health professionals. The aim of this study was to develop a public health leadership competency framework to inform a leadership curriculum for public health professionals. The framework was developed as part of the Leaders for European Public Health project-supported by the EU Lifelong Learning Programme. The study was carried out in three phases: a literature review, consensus development panel and Delphi survey. The public health leadership competency framework was initially developed from a literature review. A preliminary list of competencies was submitted to a panel of experts. Two consensus development panels were held to evaluate and make changes to the initial draft competency framework. Then two rounds of a Delphi survey were carried out in an effort to reach consensus. Both surveys were presented through Survey Monkey to members of the Association of the Schools of Public Health in the European Region Working Group on Innovation in Public Health Teaching and Education. The framework was developed consisting of 52 competencies organized into eight domains: Systems Thinking; Political Leadership; Collaborative Leadership: Building and Leading Interdisciplinary Teams; Leadership and Communication; Leading Change; Emotional Intelligence and Leadership in Team-based Organizations; Leadership, Organizational Learning and Development and Ethics and Professionalism. The framework can serve as a useful tool in identifying gaps in knowledge and skills, and shaping competency-based continuing professional development leadership curricula for public health professionals in Europe. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  8. Management and follow-up of gallbladder polyps : Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE).

    Science.gov (United States)

    Wiles, Rebecca; Thoeni, Ruedi F; Barbu, Sorin Traian; Vashist, Yogesh K; Rafaelsen, Søren Rafael; Dewhurst, Catherine; Arvanitakis, Marianna; Lahaye, Max; Soltes, Marek; Perinel, Julie; Roberts, Stuart Ashley

    2017-09-01

    The management of incidentally detected gallbladder polyps on radiological examinations is contentious. The incidental radiological finding of a gallbladder polyp can therefore be problematic for the radiologist and the clinician who referred the patient for the radiological examination. To address this a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). A targeted literature search was performed and consensus guidelines were created using a series of Delphi questionnaires and a seven-point Likert scale. A total of three Delphi rounds were performed. Consensus regarding which patients should have cholecystectomy, which patients should have ultrasound follow-up and the nature and duration of that follow-up was established. The full recommendations as well as a summary algorithm are provided. These expert consensus recommendations can be used as guidance when a gallbladder polyp is encountered in clinical practice. • Management of gallbladder polyps is contentious • Cholecystectomy is recommended for gallbladder polyps >10 mm • Management of polyps polyp characteristics • Further research is required to determine optimal management of gallbladder polyps.

  9. Consensus on the competencies required for public health nutrition workforce development in Europe - the JobNut project.

    Science.gov (United States)

    Jonsdottir, Svandis; Hughes, Roger; Thorsdottir, Inga; Yngve, Agneta

    2011-08-01

    To assess and develop consensus among a European panel of public health nutrition stakeholders regarding the competencies required for effective public health nutrition practice and the level of proficiency required in different practice contexts. A modified Delphi study involving three rounds of questionnaires. European Union. Public health nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries. A total of fifty-two expert panellists (84 % of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a public health nutritionist to effectively practice (Essential competencies). Twenty-nine of the fifty-seven competency units (51 %) met the consensus criteria (≥66·7 % agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within the Nutrition science, Professional, Analytical and Public health services competency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a public health nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study. Competencies identified as essential can be used to review current public health nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.

  10. Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT): Endorsed by the Society of Pediatric Radiology (SPR) and the North American Society of Cardiac Imaging (NASCI).

    Science.gov (United States)

    Han, B Kelly; Rigsby, Cynthia K; Hlavacek, Anthony; Leipsic, Jonathon; Nicol, Edward D; Siegel, Marilyn J; Bardo, Dianna; Abbara, Suhny; Ghoshhajra, Brian; Lesser, John R; Raman, Subha; Crean, Andrew M

    2015-01-01

    This is an expert consensus document created to provide information about the current use of cardiovascular computed tomography (CT) in patients of all ages with proven or suspected congenital heart disease (CHD). The discussion and recommendations are based on available literature and the judgment of a diverse group of subspecialists with extensive experience in the use of CT imaging in CHD. The field of CHD CT imaging is evolving rapidly with the availability of new scanner technology. In addition, the prevalence of palliated CHD has increased with marked improvements in patient survival. We believe it is important to review the clinical indications, strengths, limitations, and risks of cardiovascular CT in this patient population. This is the first of two complementary documents. It will concentrate on the disease entities and circumstances in which CT may be used. The second document will focus on recommendations for the technical performance of cardiovascular CT in patients with CHD. Successful cardiovascular CT imaging of CHD requires an in depth understanding of the core teaching elements of both cardiology and radiology. The ability to perform and interpret high quality congenital cardiovascular CT in a clinical context requires focused time and effort regardless of the previous background of the cardiac imager. This is reflected by a writing committee that consists of pediatric and adult radiologists and cardiologists, all whom have extensive experience in performing CT in this patient population. Cardiovascular CT is complementary to other imaging modalities and its optimal use will be in centers where all diagnostic modalities are available. The choice of modality for an individual patient should be determined by age, diagnosis, clinical condition, clinical question and patient preference.(1-4) Use of CT in CHD should be reserved for situations in which it is expected to provide unique diagnostic information for the individual patient or clinical

  11. Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017.

    Science.gov (United States)

    Gillessen, Silke; Attard, Gerhardt; Beer, Tomasz M; Beltran, Himisha; Bossi, Alberto; Bristow, Rob; Carver, Brett; Castellano, Daniel; Chung, Byung Ha; Clarke, Noel; Daugaard, Gedske; Davis, Ian D; de Bono, Johann; Dos Reis, Rodolfo Borges; Drake, Charles G; Eeles, Ros; Efstathiou, Eleni; Evans, Christopher P; Fanti, Stefano; Feng, Felix; Fizazi, Karim; Frydenberg, Mark; Gleave, Martin; Halabi, Susan; Heidenreich, Axel; Higano, Celestia S; James, Nicolas; Kantoff, Philip; Kellokumpu-Lehtinen, Pirkko-Liisa; Khauli, Raja B; Kramer, Gero; Logothetis, Chris; Maluf, Fernando; Morgans, Alicia K; Morris, Michael J; Mottet, Nicolas; Murthy, Vedang; Oh, William; Ost, Piet; Padhani, Anwar R; Parker, Chris; Pritchard, Colin C; Roach, Mack; Rubin, Mark A; Ryan, Charles; Saad, Fred; Sartor, Oliver; Scher, Howard; Sella, Avishay; Shore, Neal; Smith, Matthew; Soule, Howard; Sternberg, Cora N; Suzuki, Hiroyoshi; Sweeney, Christopher; Sydes, Matthew R; Tannock, Ian; Tombal, Bertrand; Valdagni, Riccardo; Wiegel, Thomas; Omlin, Aurelius

    2017-06-24

    Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  12. Contrast-media-induced nephrotoxicity: a consensus report

    Energy Technology Data Exchange (ETDEWEB)

    Morcos, S.K.; Thomsen, H.S.; Webb, J.A.W. [Department of Diagnostic Imaging, Northern General Hospital NHS Trust, Sheffield (United Kingdom)

    1999-10-01

    The purpose of this study was, using consensus methodology, to document current understanding of contrast media nephrotoxicity (CMN) and to identify areas where there is disagreement or confusion. To draw up guidelines for avoiding CMN based on the current understanding of the condition established by the survey. One hundred sixty-four statements were mailed to 148 members of the European Society of Urogenital Radiology (ESUR) and to 48 experts in the field of CMN. They were asked about the definition, clinical features, predisposing factors and pathophysiology of CMN and about prophylactic measures. The importance of the statements was rated on a scale from 1 to 10 (1 least important, 10 most important). Fifty-three members (38 %) and 23 experts (48 %) responded. Both groups considered that an increase in serum creatinine that peaks within 3-4 days and a decrease in creatinine clearance are the most important (rating > 7) features of CMN. Enzymuria was not considered important (rating < 6). Pre-existing renal insufficiency, diabetic nephropathy, dehydration, congestive heart failure, concurrent administration of nephrotoxic drugs and the dose and type of contrast media were considered to be risk factors. Reduction in renal perfusion and damage to tubular cells were considered the main factors in the pathophysiology of CMN (rating > 6). Hydration and the use of low osmolar contrast media were thought to minimize the incidence of CMN (rating > 6). The majority of the responders (84.6 % of members and 95.5 % of experts) believe that the incidence of CMN in patients with normal renal function is less than 5 %. Of the members, 62.5 %, and 35.3 % of experts, believe that the incidence of CMN is 20-30 % in the presence of risk factors. There was disagreement about the definition of CMN, the threshold dose of contrast media above which renal complications may develop, the safe period between repeat injections, the relevance of contrast media renal retention shown on CT

  13. Consensus on domains, formation objectives and contents in cariology for undergraduate dental students in Colombia.

    Science.gov (United States)

    Martignon, S; Marín, L M; Pitts, N; Jácome-Liévano, S

    2014-11-01

    To achieve a consensus for an undergraduate cariology teaching curriculum between Colombian dental schools in line with the 2015 Global Alliance for a Cavity-Free Future goal: '90% of dental schools adopting the current caries paradigm'. First phase: Four-regional 2-day workshops were conducted with 4 representative teachers (cariology, clinics, basic-science, public health and specialisations) from each of the 24-ACFO schools (Colombian Dental Schools Association) as follows: Presentations: -Main Colombian cariology teaching barriers, -Caries and public health current paradigms; -Schools' cariology teaching descriptions; -European Cariology Curriculum. Five main-domain subgroup discussions: (i) the knowledge base; (ii) risk assessment, diagnosis and synthesis; (iii) decision-making, preventive non-surgical therapy; (iv) decision-making, surgical therapy; and (v) evidence-based cariology in clinical and public health practice, to adapt domains, objectives and contents to Colombian curriculum, public health and national health system needs. These 4-regional plus 24-school consensuses sent 1 month afterwards were adapted into a preliminary document. 2nd-phase: 10 peer review by national faculty in cariology, and 10 curriculum, basic sciences, research, clinical management and public health experts. School participants and deans reviewed the draft document and suggestions were discussed and adapted into a final consensus document officially presented to the academic community at the ACFO National-Research-Meeting (September, 2012). 24 schools and 92 teachers participated. The Colombian Cariology Curriculum was agreed by 23 schools. It positioned public health into one domain. A general focus on social determination was included, and more relevance was given to fluorosis than erosion. A consensus on cariology teaching for undergraduate dental students was achieved in Colombia and work to promote its adoption has commenced. © 2014 John Wiley & Sons A/S. Published by

  14. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care.

    Science.gov (United States)

    Radbruch, Lukas; Leget, Carlo; Bahr, Patrick; Müller-Busch, Christof; Ellershaw, John; de Conno, Franco; Vanden Berghe, Paul

    2016-02-01

    In recognition of the ongoing discussion on euthanasia and physician-assisted suicide, the Board of Directors of the European Association for Palliative Care commissioned this white paper from the palliative care perspective. This white paper aims to provide an ethical framework for palliative care professionals on euthanasia and physician-assisted suicide. It also aims to provide an overview on the available evidence as well as a discourse of ethical principles related to these issues. Starting from a 2003 European Association for Palliative Care position paper, 21 statements were drafted and submitted to a five-round Delphi process A panel with 17 experts commented on the paper in round 1. Board members of national palliative care or hospice associations that are collective members of European Association for Palliative Care were invited to an online survey in rounds 2 and 3. The expert panel and the European Association for Palliative Care board members participated in rounds 4 and 5. This final version was adopted as an official position paper of the European Association for Palliative Care in April 2015. Main topics of the white paper are concepts and definitions of palliative care, its values and philosophy, euthanasia and physician-assisted suicide, key issues on the patient and the organizational level. The consensus process confirmed the 2003 European Association for Palliative Care white paper and its position on the relationship between palliative care and euthanasia and physician-assisted suicide. The European Association for Palliative Care feels that it is important to contribute to informed public debates on these issues. Complete consensus seems to be unachievable due to incompatible normative frameworks that clash. © The Author(s) 2015.

  15. Hypertension and cardiac arrhythmias: executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).

    Science.gov (United States)

    Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas; Boriani, Giuseppe; Manolis, Antonis S; Olsen, Michael Hecht; Oto, Ali; Potpara, Tatjana S; Steffel, Jan; Marín, Francisco; de Oliveira Figueiredo, Márcio Jansen; de Simone, Giovanni; Tzou, Wendy S; En Chiang, Chern; Williams, Bryan

    2017-10-01

    Hypertension (HTN) is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease (CAD), stroke, peripheral artery disease and chronic renal failure. Hypertensive heart disease can manifest as many types of cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both supraventricular and ventricular arrhythmias may occur in HTN patients, especially in those with left ventricular hypertrophy (LVH), CAD, or HF. In addition, high doses of thiazide diuretics commonly used to treat HTN, may result in electrolyte abnormalities (e.g. hypokalaemia, hypomagnesaemia), contributing further to arrhythmias, while effective blood pressure control may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between HTN and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit of comprehensively reviewing the available evidence and publishing a joint consensus document on HTN and cardiac arrhythmias, and providing up-to-date consensus recommendations for use in clinical practice. The ultimate judgment on the care of a specific patient must be made by the healthcare provider and the patient in light of all individual factors presented. This is an executive summary of the full document co-published by EHRA in EP-Europace. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

  16. Expert auditors’ services classification

    OpenAIRE

    Jolanta Wisniewska

    2013-01-01

    The profession of an expert auditor is a public trust occupation with a distinctive feature of taking responsibility for actions in the public interest. The main responsibility of expert auditors is performing financial auditing; however, expert auditors are prepared to carry out different tasks which encompass a wide plethora of financial and auditing services for different kinds of institutions and companies. The aim of the article is first of all the description of expert auditors’ service...

  17. Reporting Guidelines for the Use of Expert Judgement in Model-Based Economic Evaluations.

    Science.gov (United States)

    Iglesias, Cynthia P; Thompson, Alexander; Rogowski, Wolf H; Payne, Katherine

    2016-11-01

    Expert judgement has a role in model-based economic evaluations (EEs) of healthcare interventions. This study aimed to produce reporting criteria for two types of study design to use expert judgement in model-based EE: (i) an expert elicitation (quantitative) study; and (ii) a Delphi study to collate (qualitative) expert opinion. A two-round online Delphi process identified the degree of consensus for four core definitions (expert; expert parameter values; expert elicitation study; expert opinion) and two sets of reporting criteria in a purposive sample of experts. The initial set of reporting criteria comprised 17 statements for reporting a study to elicit parameter values and/or distributions and 11 statements for reporting a Delphi survey to obtain expert opinion. Fifty experts were invited to become members of the Delphi process panel by e-mail. Data analysis summarised the extent of agreement (using a pre-defined 75 % 'consensus' threshold) on the definitions and suggested reporting criteria. Free-text comments were analysed using thematic analysis. The final panel comprised 12 experts. Consensus was achieved for the definitions of expert (88 %); expert parameter values (83 %); and expert elicitation study (83 %). The panel recommended criteria to use when reporting an expert elicitation study (16 criteria) and a Delphi study to collate expert opinion (11 criteria). This study has produced guidelines for reporting two types of study design to use expert judgement in model-based EE: (i) an expert elicitation study requiring 16 reporting criteria; and (ii) a Delphi study to collate expert opinion requiring 11 reporting criteria.

  18. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications

    NARCIS (Netherlands)

    Basson, R.; Berman, J.; Burnett, A.; Derogatis, L.; Ferguson, D.; Fourcroy, J.; Goldstein, I.; Graziottin, A.; Heiman, J.; Laan, E.; Leiblum, S.; Padma-Nathan, H.; Rosen, R.; Segraves, K.; Segraves, R. T.; Shabsigh, R.; Sipski, M.; Wagner, G.; Whipple, B.

    2000-01-01

    PURPOSE: Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. MATERIALS AND METHODS: An interdisciplinary consensus conference panel consisting of 19 experts in female sexual

  19. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus : recommendations and future directions

    NARCIS (Netherlands)

    Sharif, A.; Hecking, M.; de Vries, A. P. J.; Porrini, E.; Hornum, M.; Rasoul-Rockenschaub, S.; Berlakovich, G.; Krebs, M.; Kautzky-Willer, A.; Schernthaner, G.; Marchetti, P.; Pacini, G.; Ojo, A.; Takahara, S.; Larsen, J. L.; Budde, K.; Eller, K.; Pascual, J.; Jardine, A.; Bakker, S. J. L.; Valderhaug, T. G.; Jenssen, T. G.; Cohney, S.; Saeemann, M. D.

    A consensus meeting was held in Vienna on September 8-9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientists,

  20. International Pediatric Otolaryngology Group (IPOG) consensus recommendations : Hearing loss in the pediatric patient

    NARCIS (Netherlands)

    Liming, Bryan J; Carter, John; Cheng, Alan; Choo, Daniel; Curotta, John; Carvalho, Daniela; Germiller, John A; Hone, Stephen; Kenna, Margaret A; Loundon, Natalie; Preciado, Diego; Schilder, Anne; Reilly, Brian J; Roman, Stephane; Strychowsky, Julie; Triglia, Jean-Michel; Young, Nancy; Smith, Richard J H

    2016-01-01

    OBJECTIVE: To provide recommendations for the workup of hearing loss in the pediatric patient. METHODS: Expert opinion by the members of the International Pediatric Otolaryngology Group. RESULTS: Consensus recommendations include initial screening and diagnosis as well as the workup of

  1. Consensus Moderation System

    Directory of Open Access Journals (Sweden)

    Andrei TOMA

    2011-01-01

    Full Text Available The present paper formulates a consensus moderation system based on the negotiation of the actors involved. There are a series of steps in the moderation process, the first of which is constructing a front of Pareto optimal solutions. Since this in itself will likely not lead to consensus in a real life scenario, Kaldor-Hicks compromises are then detected. Compromises are recommended at every iteration of the negotiation process which can lead to a lengthy negotiation time, which is addressed by using a recommendation engine based on the previous behavior of the actor.

  2. [Brazilian Consensus on Chagas Disease, 2015].

    Science.gov (United States)

    Dias, João Carlos Pinto; Ramos, Alberto Novaes; Gontijo, Eliane Dias; Luquetti, Alejandro; Shikanai-Yasuda, Maria Aparecida; Coura, José Rodrigues; Torres, Rosália Morais; Melo, José Renan da Cunha; Almeida, Eros Antonio de; Oliveira, Wilson de; Silveira, Antônio Carlos; Rezende, Joffre Marcondes de; Pinto, Fabiane Scalabrini; Ferreira, Antonio Walter; Rassi, Anis; Fragata, Abílio Augusto; Sousa, Andréa Silvestre de; Correia, Dalmo; Jansen, Ana Maria; Andrade, Glaucia Manzan Queiroz; Britto, Constança Felícia De Paoli de Carvalho; Pinto, Ana Yecê das Neves; Rassi, Anis; Campos, Dayse Elisabeth; Abad-Franch, Fernando; Santos, Silvana Eloi; Chiari, Egler; Hasslocher-Moreno, Alejandro Marcel; Moreira, Eliane Furtado; Marques, Divina Seila de Oliveira; Silva, Eliane Lages; Marin-Neto, José Antonio; Galvão, Lúcia Maria da Cunha; Xavier, Sergio Salles; Valente, Sebastião Aldo da Silva; Carvalho, Noêmia Barbosa; Cardoso, Alessandra Viana; Silva, Rafaella Albuquerque E; Costa, Veruska Maia da; Vivaldini, Simone Monzani; Oliveira, Suelene Mamede; Valente, Vera da Costa; Lima, Mayara Maia; Alves, Renato Vieira

    2016-06-01

    Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

  3. ESMO Consensus Conference on malignant lymphoma

    DEFF Research Database (Denmark)

    Buske, C; Hutchings, M; Ladetto, M

    2018-01-01

    into three working groups; each group focused on one of these areas in order to address clinically-relevant questions relating to that topic. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, each working group developed...... of the three key areas identified. This manuscript presents the consensus recommendations regarding the clinical management of elderly patients diagnosed with malignant lymphoma. Four clinically-relevant topics identified by the panel were: 1) how to define patient fitness, 2) assessing quality of life, 3......) diagnostic work-up and 4) clinical management of elderly patients with lymphoma. Each of these key topics is addressed in the context of five different lymphoma entities, namely: CLL, follicular lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma and diffuse large B-cell lymphoma. Results, including...

  4. Differential diagnosis of suspected multiple sclerosis: a consensus approach

    NARCIS (Netherlands)

    Miller, D. H.; Weinshenker, B.G.; Filippi, M.; Banwell, B.L.; Cohen, J.A.; Freedman, M.S.; Galetta, S.L.; Hutchinson, M.; Johnson, R.T.; Kappos, L.; Kira, J.; Lublin, F.D.; McFarland, H.F.; Montalban, X.; Panitch, H.; Richert, J.R.; Reingold, S.C.; Polman, C.H.

    2008-01-01

    Background and objectives: Diagnosis of multiple sclerosis (MS) requires exclusion of diseases that could better explain the clinical and paraclinical findings. A systematic process for exclusion of alternative diagnoses has not been defined. An International Panel of MS experts developed consensus

  5. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology

    National Research Council Canada - National Science Library

    Corrado, Domenico; Pelliccia, Antonio; Bjørnstad, Hans Halvor; Vanhees, Luc; Biffi, Alessandro; Borjesson, Mats; Panhuyzen-Goedkoop, Nicole; Deligiannis, Asterios; Solberg, Erik; Dugmore, Dorian; Mellwig, Klaus P; Assanelli, Deodato; Delise, Pietro; van-Buuren, Frank; Anastasakis, Aris; Heidbuchel, Hein; Hoffmann, Ellen; Fagard, Robert; Priori, Silvia G; Basso, Cristina; Arbustini, Eloisa; Blomstrom-Lundqvist, Carina; McKenna, William J; Thiene, Gaetano

    ..., legal, and medical grounds. The present article represents the consensus statement of the Study Group on Sports Cardiology of the Working Group on Cardiac Rehabilitation and Exercise Physiology and the Working Group...

  6. Expert status and performance.

    Directory of Open Access Journals (Sweden)

    Mark A Burgman

    Full Text Available Expert judgements are essential when time and resources are stretched or we face novel dilemmas requiring fast solutions. Good advice can save lives and large sums of money. Typically, experts are defined by their qualifications, track record and experience. The social expectation hypothesis argues that more highly regarded and more experienced experts will give better advice. We asked experts to predict how they will perform, and how their peers will perform, on sets of questions. The results indicate that the way experts regard each other is consistent, but unfortunately, ranks are a poor guide to actual performance. Expert advice will be more accurate if technical decisions routinely use broadly-defined expert groups, structured question protocols and feedback.

  7. The Consensus: Another View.

    Science.gov (United States)

    Brown, H. Douglas

    1984-01-01

    Comments on the seven points of consensus presented in "A Theoretical Basis for Teaching the Receptive Skills" by Stephen Krashen, et al., particularly on the terminology that is derived from Krashen's other writings. Offers eight statements which reflect in more general terms an interpretation of Krashen's theories for language teachers…

  8. International veterinary epilepsy task force consensus proposal

    DEFF Research Database (Denmark)

    Potschka, Heidrun; Fischer, Andrea; Löscher, Wolfgang

    2015-01-01

    Common criteria for the diagnosis of drug resistance and the assessment of outcome are needed urgently as a prerequisite for standardized evaluation and reporting of individual therapeutic responses in canine epilepsy. Thus, we provide a proposal for the definition of drug resistance and partial...... therapeutic success in canine patients with epilepsy. This consensus statement also suggests a list of factors and aspects of outcome, which should be considered in addition to the impact on seizures. Moreover, these expert recommendations discuss criteria which determine the validity and informative value...

  9. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report

    DEFF Research Database (Denmark)

    Malfertheiner, Peter; Megraud, Francis; O'Morain, Colm A

    2012-01-01

    Management of Helicobacter pylori infection is evolving and in this 4th edition of the Maastricht consensus report aspects related to the clinical role of H pylori were looked at again in 2010. In the 4th Maastricht/Florence Consensus Conference 44 experts from 24 countries took active part...

  10. International Pediatric Otolaryngology Group (IPOG) consensus recommendations : Routine peri-operative pediatric tracheotomy care

    NARCIS (Netherlands)

    Strychowsky, Julie E; Albert, David; Chan, Kenny; Cheng, Alan; Daniel, Sam J; De Alarcon, Alessandro; Garabedian, Noel; Hart, Catherine; Hartnick, Christopher; Inglis, Andy; Jacobs, Ian; Kleinman, Monica E; Mehta, Nilesh M; Nicollas, Richard; Nuss, Roger; Pransky, Seth; Russell, John; Rutter, Mike; Schilder, Anne; Thompson, Dana; Triglia, Jean-Michel; Volk, Mark; Ward, Bob; Watters, Karen; Wyatt, Michelle; Zalzal, George; Zur, Karen; Rahbar, Reza

    OBJECTIVES: To develop consensus recommendations for peri-operative tracheotomy care in pediatric patients. METHODS: Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the

  11. Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine

    NARCIS (Netherlands)

    Laan, Ellen; Rellini, Alessandra H.; Barnes, Tricia

    2013-01-01

    As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment

  12. European Society of Endodontology position statement: the use of CBCT in endodontics.

    Science.gov (United States)

    Patel, S; Durack, C; Abella, F; Roig, M; Shemesh, H; Lambrechts, P; Lemberg, K

    2014-06-01

    This Position Statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the use of Cone Beam Computed Tomography (CBCT). The statement is based on the current scientific evidence, and provides the clinician with evidence-based criteria on when to use CBCT in Endodontics. Given the dynamic and changing nature of research, development of new devices and clinical practice relating to CBCT, this Position Statement will be updated within 3 years, or before that time should new evidence become available. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  13. Forensic experts' perceptions of expert bias.

    Science.gov (United States)

    Commons, Michael Lamport; Miller, Patrice Marie; Li, Eva Yujia; Gutheil, Thomas Gordon

    2012-01-01

    How do expert witnesses perceive the possible biases of their fellow expert witnesses? Participants, who were attendees at a workshop at the American Academy of Psychiatry and Law were asked to rate for their biasing potential a number of situations that might affect the behavior of an opposing expert. A Rasch analysis produced a linear scale as to the perceived biasing potential of these different kinds of situations from the most biasing to the least biasing. Working for only one side in both civil and criminal cases had large scaled values and also were the first factor. In interesting contrast, a) an opposing expert also serving as the litigant's treater and b) an opposing expert being viewed as a "hired gun" (supplying an opinion only for money) were two situations viewed as not very biasing. Order of Hierarchical Complexity also accounted for items from the 1st, 2nd and 3rd factors. The result suggests that the difficulty in understanding the conceptual basis of bias underlies the perception of how biased a behavior or a situation is. The more difficult to understand the questionnaire item, the less biasing its behavior or situation is perceived by participants. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. International Consensus on drug allergy.

    Science.gov (United States)

    Demoly, P; Adkinson, N F; Brockow, K; Castells, M; Chiriac, A M; Greenberger, P A; Khan, D A; Lang, D M; Park, H-S; Pichler, W; Sanchez-Borges, M; Shiohara, T; Thong, B Y- H

    2014-04-01

    When drug reactions resembling allergy occur, they are called drug hypersensitivity reactions (DHRs) before showing the evidence of either drug-specific antibodies or T cells. DHRs may be allergic or nonallergic in nature, with drug allergies being immunologically mediated DHRs. These reactions are typically unpredictable. They can be life-threatening, may require or prolong hospitalization, and may necessitate changes in subsequent therapy. Both underdiagnosis (due to under-reporting) and overdiagnosis (due to an overuse of the term ‘allergy’) are common. A definitive diagnosis of such reactions is required in order to institute adequate treatment options and proper preventive measures. Misclassification based solely on the DHR history without further testing may affect treatment options, result in adverse consequences, and lead to the use of more-expensive or less-effective drugs, in contrast to patients who had undergone a complete drug allergy workup. Several guidelines and/or consensus documents on general or specific drug class-induced DHRs are available to support the medical decision process. The use of standardized systematic approaches for the diagnosis and management of DHRs carries the potential to improve outcomes and should thus be disseminated and implemented. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the World Allergy Organization (WAO), has decided to issue an International CONsensus (ICON) on drug allergy. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences and deficiencies of evidence, thus providing a comprehensive reference document for the diagnosis and management of

  15. Consensus Paper: Cerebellum and Emotion.

    Science.gov (United States)

    Adamaszek, M; D'Agata, F; Ferrucci, R; Habas, C; Keulen, S; Kirkby, K C; Leggio, M; Mariën, P; Molinari, M; Moulton, E; Orsi, L; Van Overwalle, F; Papadelis, C; Priori, A; Sacchetti, B; Schutter, D J; Styliadis, C; Verhoeven, J

    2017-04-01

    Over the past three decades, insights into the role of the cerebellum in emotional processing have substantially increased. Indeed, methodological refinements in cerebellar lesion studies and major technological advancements in the field of neuroscience are in particular responsible to an exponential growth of knowledge on the topic. It is timely to review the available data and to critically evaluate the current status of the role of the cerebellum in emotion and related domains. The main aim of this article is to present an overview of current facts and ongoing debates relating to clinical, neuroimaging, and neurophysiological findings on the role of the cerebellum in key aspects of emotion. Experts in the field of cerebellar research discuss the range of cerebellar contributions to emotion in nine topics. Topics include the role of the cerebellum in perception and recognition, forwarding and encoding of emotional information, and the experience and regulation of emotional states in relation to motor, cognitive, and social behaviors. In addition, perspectives including cerebellar involvement in emotional learning, pain, emotional aspects of speech, and neuropsychiatric aspects of the cerebellum in mood disorders are briefly discussed. Results of this consensus paper illustrate how theory and empirical research have converged to produce a composite picture of brain topography, physiology, and function that establishes the role of the cerebellum in many aspects of emotional processing.

  16. Introduction to expert systems

    Energy Technology Data Exchange (ETDEWEB)

    Jackson, P.

    1986-01-01

    Expert systems have become one of the most exciting applications within the domain of artificial intelligence. Further interest has been provoked by Japan's Fifth Generation Project, which identifies expert or knowledge-based systems as a key element in the computer systems of the future. This book presents an introduction to expert systems at a level suited to the undergraduate student and the interested layman. It surveys the three main techniques for knowledge representation - rules, frames and logic. and describes in detail the expert systems which employ them. Contents: Expert systems and artificial intelligence; Formalisms for knowledge representation; MYCIN; Medical diagnosis using rules. MYCIN derivatives; TEIRESIAS, EMYCIN, and GUIDON; RI: recognition as a problem-solving strategy; CENTAUR: a combination of frames metalevel inference and commonsense reasoning in MECHO; Tools for building expert systems; Summary and conclusions; Exercises.

  17. QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC Working Group on Cardiac Cellular Electrophysiology

    Science.gov (United States)

    Baumert, Mathias; Porta, Alberto; Vos, Marc A.; Malik, Marek; Couderc, Jean-Philippe; Laguna, Pablo; Piccirillo, Gianfranco; Smith, Godfrey L.; Tereshchenko, Larisa G.; Volders, Paul G.A.

    2016-01-01

    This consensus guideline discusses the electrocardiographic phenomenon of beat-to-beat QT interval variability (QTV) on surface electrocardiograms. The text covers measurement principles, physiological basis, and clinical value of QTV. Technical considerations include QT interval measurement and the relation between QTV and heart rate variability. Research frontiers of QTV include understanding of QTV physiology, systematic evaluation of the link between QTV and direct measures of neural activity, modelling of the QTV dependence on the variability of other physiological variables, distinction between QTV and general T wave shape variability, and assessing of the QTV utility for guiding therapy. Increased QTV appears to be a risk marker of arrhythmic and cardiovascular death. It remains to be established whether it can guide therapy alone or in combination with other risk factors. QT interval variability has a possible role in non-invasive assessment of tonic sympathetic activity. PMID:26823389

  18. Consensus on precision medicine for metastatic cancers: a report from the MAP conference.

    Science.gov (United States)

    Swanton, C; Soria, J-C; Bardelli, A; Biankin, A; Caldas, C; Chandarlapaty, S; de Koning, L; Dive, C; Feunteun, J; Leung, S-Y; Marais, R; Mardis, E R; McGranahan, N; Middleton, G; Quezada, S A; Rodón, J; Rosenfeld, N; Sotiriou, C; André, F

    2016-08-01

    Recent advances in biotechnologies have led to the development of multiplex genomic and proteomic analyses for clinical use. Nevertheless, guidelines are currently lacking to determine which molecular assays should be implemented in metastatic cancers. The first MAP conference was dedicated to exploring the use of genomics to better select therapies in the treatment of metastatic cancers. Sixteen consensus items were covered. There was a consensus that new technologies like next-generation sequencing of tumors and ddPCR on circulating free DNA have convincing analytical validity. Further work needs to be undertaken to establish the clinical utility of liquid biopsies and the added clinical value of expanding from individual gene tests into large gene panels. Experts agreed that standardized bioinformatics methods for biological interpretation of genomic data are needed and that precision medicine trials should be stratified based on the level of evidence available for the genomic alterations identified. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  19. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference

    Science.gov (United States)

    Ezzedine, K.; Lim, H. W.; Suzuki, T.; Katayama, I.; Hamzavi, I.; Lan, C. C. E.; Goh, B. K.; Anbar, T.; de Castro, C. Silva; Lee, A. Y.; Parsad, D.; van Geel, N.; Le Poole, I. C.; Oiso, N.; Benzekri, L.; Spritz, R.; Gauthier, Y.; Hann, S. K.; Picardo, M.; Taieb, A.

    2012-01-01

    Summary During the 2011 International Pigment Cell Conference (IPCC), the Vitiligo European Taskforce (VETF) convened a consensus conference on issues of global importance for vitiligo clinical research. As suggested by an international panel of experts, the conference focused on four topics: classification and nomenclature; definition of stable disease; definition of Koebner’s phenomenon (KP); and ‘autoimmune vitiligo’. These topics were discussed in seven working groups representing different geographical regions. A consensus emerged that segmental vitiligo be classified separately from all other forms of vitiligo and that the term ‘vitiligo’ be used as an umbrella term for all non-segmental forms of vitiligo, including ‘mixed vitiligo’ in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo. Further, the conference recommends that disease stability be best assessed based on the stability of individual lesions rather than the overall stability of the disease as the latter is difficult to define precisely and reliably. The conference also endorsed the classification of KP for vitiligo as proposed by the VETF (history based, clinical observation based, or experimentally induced). Lastly, the conference agreed that ‘autoimmune vitiligo’ should not be used as a separate classification as published evidence indicates that the pathophysiology of all forms of vitiligo likely involves autoimmune or inflammatory mechanisms. PMID:22417114

  20. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3).

    Science.gov (United States)

    Paluch-Shimon, Shani; Pagani, Olivia; Partridge, Ann H; Abulkhair, Omalkhair; Cardoso, Maria-João; Dent, Rebecca Alexandra; Gelmon, Karen; Gentilini, Oreste; Harbeck, Nadia; Margulies, Anita; Meirow, Dror; Pruneri, Giancarlo; Senkus, Elzbieta; Spanic, Tanja; Sutliff, Medha; Travado, Luzia; Peccatori, Fedro; Cardoso, Fatima

    2017-10-01

    The 3rd International Consensus Conference for Breast Cancer in Young Women (BCY3) took place in November 2016, in Lugano, Switzerland organized by the European School of Oncology (ESO) and the European Society of Medical Oncologists (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY2 with incorporation of new evidence to inform the guidelines, and areas of research priorities were identified. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA). Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Achieving diagnosis by consensus

    LENUS (Irish Health Repository)

    Kane, Bridget

    2009-08-01

    This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.

  2. Explaining the Absence of a Genuine European Social-Democrat Consensus: the Case of 'Une Stratégie pour la Solidarité'

    Directory of Open Access Journals (Sweden)

    Erol Kulahci

    2002-03-01

    Full Text Available Some academic circles have pointed out that the European Union and its Member States suffer from a legitimacy deficit closely linked to the current fiscal policies. In a context which was characterised by the major presence of Labour, Socialist and Social Democrat Parties in the Member States' governments, this article draws attention to Une Stratégie pour la Solidarité of the Party of European Socialists (PES. It argues that this strategy is just a nominal one. Three theoretical assumptions are explored to explain this: the relation between the fiscal policies in the EU and the PES; the emergence of three types of conflicts between the member parties; and the absence of an effective 'pusher' strategy.

  3. Overlapping Consensus in Malaysia

    OpenAIRE

    Monsen, Mats

    2007-01-01

    An empirical study of how Malaysian pluralism is understood through Islam Hadhari, Article 11 and the Inter-faith Commission against the backdrop of current Malaysian political and social history, coupled with a theoretical analysis through John Rawls' Political Liberalism, with particular emphasis on the idea of Overlapping Consensus. The thesis is an attempt at applying Rawls' theory on the practical case of Malaysia, as a plural society, while at the same time using the practical case of M...

  4. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer.

    Science.gov (United States)

    Cardoso, Fatima; Loibl, Sibylle; Pagani, Olivia; Graziottin, Alessandra; Panizza, Pietro; Martincich, Laura; Gentilini, Oreste; Peccatori, Fedro; Fourquet, Alain; Delaloge, Suzette; Marotti, Lorenza; Penault-Llorca, Frédérique; Kotti-Kitromilidou, Anna Maria; Rodger, Alan; Harbeck, Nadia

    2012-12-01

    EUSOMA (The European Society of Breast Cancer Specialists) is committed to writing recommendations on different topics of breast cancer care which can be easily adopted and used by health professionals dedicated to the care of patients with breast cancer in their daily practice. In 2011, EUSOMA identified the management of young women with breast cancer as one of the hot topics for which a consensus among European experts was needed. Therefore, the society recently organised a workshop to define such recommendations. Thirteen experts from the different disciplines met for two days to discuss the topic. This international and multidisciplinary panel thoroughly reviewed the literature in order to prepare evidence-based recommendations. During the meeting, two working groups were set up to discuss in detail diagnosis and loco-regional and systemic treatments, including both group aspects of psychology and sexuality. The conclusions reached by the working groups were then discussed in a plenary session to reach panel consensus. Whenever possible, a measure of the level of evidence (LoE) from 1 (the highest) to 4 (the lowest) degree, based on the methodology proposed by the US Agency for Healthcare Research and Quality (AHRQ), was assigned to each recommendation. The present manuscript presents the recommendations of this consensus group for the management of young women with breast cancer in daily clinical practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Clinical Consensus Strategies for Interpersonal Problems between Young Adults and Their Parents

    Science.gov (United States)

    Eubanks-Carter, Catherine; Burckell, Lisa A.; Goldfried, Marvin R.

    2010-01-01

    Objective: Research that identifies areas of agreement among expert therapists can complement findings from clinical trials by highlighting common practices as well as innovations. The present study accessed consensus among expert therapists on the effectiveness of clinical strategies for treating young adults experiencing interpersonal problems…

  6. Dietary management practices in phenylketonuria across European centres

    DEFF Research Database (Denmark)

    Ahring, Kirsten; Bélanger-Quintana, Amaya; Dokoupil, Katharina

    2009-01-01

    BACKGROUND: Dietary phenylalanine restriction is the cornerstone of phenylketonuria (PKU) management. However, there are no European consensus guidelines for its optimal dietary care. METHODS: Detailed information on the routine dietary management of PKU was obtained from 10 European centres usin...

  7. [SECOT consensus on painful knee replacement].

    Science.gov (United States)

    Vaquero, J; Macule, F; Bello, S; Chana, F; Forriol, F

    2013-01-01

    The opinions of 21 experts in knee surgery were evaluated in this study, using a DELPHI questionnaire method in two successive rounds, on 64 controversial scenarios that covered both the diagnosis and possible treatment of painful knee replacements. The level of consensus was significantly unanimous in 42 items and of the design in 5, with no agreement in 17 of the questions presented. light of the published scientific evidence, the surgeons who took part showed to have a notable level of information on the most effective diagnostic tests, although, it should be pointed out that there was a lack of confidence in the possibility of ruling out an infection when the erythrocyte sedimentation rate and the C-reactive protein were within normal values, which have been demonstrated in the literature to have a high negative predictive value As regards the treatments to employ in the different situations, the responses of the expert panel were mainly in agreement with the data in the literature. The conclusions of this consensus may help other surgeons when they are faced with a painful knee prosthesis. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  8. How Expert Designers Design

    NARCIS (Netherlands)

    Dr. Peter Sloep; J. van Merrienboer; C. Carr; P. Kirschner

    2003-01-01

    This paper discusses two studies - the one in a business context, the other in a university context - carried out with expert educational designers. The studies aimed to determine the priorities experts claim to employ when designing competence-based learning environments. Designers in both contexts

  9. Expert Systems in Education.

    Science.gov (United States)

    Hartschuh, Wayne

    This paper argues that the concepts and techniques used in the development of expert systems should be expanded and applied to the field of education, particularly in the area of intelligent tutoring systems. It is noted that expert systems are a well known area of artificial intelligence and have been proven effective in well-defined topic areas.…

  10. Expert Opinions on Nutrition Issues in Clinical Dentistry.

    Science.gov (United States)

    Palmer, Carole A.; And Others

    1990-01-01

    A survey of 79 experts in dental nutrition sought consensus on the appropriate scope of nutrition in clinical dentistry. Results support the need for greater attention to nutrition issues in dental schools and better models for nutrition interventions in dental practice. (Author/MSE)

  11. Achieving consensus in environmental programs

    Energy Technology Data Exchange (ETDEWEB)

    Kurstedt, Jr., H. A.; Jones, R. M.; Walker, J. A.; Middleman, L. I.

    1989-01-01

    In this paper, we describe a new research effort on consensus tied to the Environmental Restoration Program (ERP) within the US Department of Energy's Office of Defense Waste and Transportation Management (DWTM). We define consensus and explain why consensus decisions are not merely desirable but necessary in furthering ERP activities. As examples of our planned applied research, we first discuss Nominal Group Technique as a representative consensus-generating tool, and we conclude by describing the consensus-related mission of the Waste Management Review Group, established at Virginia Tech to conduct independent, third-party review of DWTM/ERP plans and activities. 10 refs.

  12. Consensus statement on the use of gonadotropin-releasing hormone analogs in children.

    Science.gov (United States)

    Carel, Jean-Claude; Eugster, Erica A; Rogol, Alan; Ghizzoni, Lucia; Palmert, Mark R; Antoniazzi, Franco; Berenbaum, Sheri; Bourguignon, Jean-Pierre; Chrousos, George P; Coste, Joël; Deal, Sheri; de Vries, Liat; Foster, Carol; Heger, Sabine; Holland, Jack; Jahnukainen, Kirsi; Juul, Anders; Kaplowitz, Paul; Lahlou, Najiba; Lee, Mary M; Lee, Peter; Merke, Deborah P; Neely, E Kirk; Oostdijk, Wilma; Phillip, Moshe; Rosenfield, Robert L; Shulman, Dorothy; Styne, Dennis; Tauber, Maïthé; Wit, Jan M

    2009-04-01

    Gonadotropin-releasing hormone analogs revolutionized the treatment of central precocious puberty. However, questions remain regarding their optimal use in central precocious puberty and other conditions. The Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology convened a consensus conference to review the clinical use of gonadotropin-releasing hormone analogs in children and adolescents. When selecting the 30 participants, consideration was given to equal representation from North America (United States and Canada) and Europe, an equal male/female ratio, and a balanced spectrum of professional seniority and expertise. Preference was given to articles written in English with long-term outcome data. The US Public Health grading system was used to grade evidence and rate the strength of conclusions. When evidence was insufficient, conclusions were based on expert opinion. Participants were put into working groups with assigned topics and specific questions. Written materials were prepared and distributed before the conference, revised on the basis of input during the meeting, and presented to the full assembly for final review. If consensus could not be reached, conclusions were based on majority vote. All participants approved the final statement. The efficacy of gonadotropin-releasing hormone analogs in increasing adult height is undisputed only in early-onset (girls <6 years old) central precocious puberty. Other key areas, such as the psychosocial effects of central precocious puberty and their alteration by gonadotropin-releasing hormone analogs, need additional study. Few controlled prospective studies have been performed with gonadotropin-releasing hormone analogs in children, and many conclusions rely in part on collective expert opinion. The conference did not endorse commonly voiced concerns regarding the use of gonadotropin-releasing hormone analogs, such as promotion of weight gain or long-term diminution of bone

  13. Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Leeuwenburgh, Marjolein M.N., E-mail: m.m.leeuwenburgh@amc.uva.nl [Department of Surgery, Academic Medical Center, University of Amsterdam (Netherlands); Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands); Wiarda, Bart M. [Department of Radiology, Alkmaar Medical Center, Alkmaar (Netherlands); Jensch, Sebastiaan [Department of Radiology, Sint Lucas Andreas Hospital, Amsterdam (Netherlands); Wouter van Es, H. [Department of Radiology, Sint Antonius Hospital, Nieuwegein (Netherlands); Stockmann, Hein B.A.C. [Department of Surgery, Kennemer Gasthuis, Haarlem (Netherlands); Gratama, Jan Willem C. [Department of Radiology, Gelre Hospitals, Apeldoorn (Netherlands); Cobben, Lodewijk P.J. [Department of Radiology, Haaglanden Medical Center, Leidschendam (Netherlands); Bossuyt, Patrick M.M. [Department of Clinical Epidemiology, Academic Medical Center, University of Amsterdam (Netherlands); Boermeester, Marja A. [Department of Surgery, Academic Medical Center, University of Amsterdam (Netherlands); Stoker, Jaap [Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands)

    2014-01-15

    Objective: To compare accuracy and interobserver agreement between radiologists with limited experience in the evaluation of abdominal MRI (non-experts), and radiologists with longer MR reading experience (experts), in reading MRI in patients with suspected appendicitis. Methods: MR imaging was performed in 223 adult patients with suspected appendicitis and read independently by two members of a team of eight MR-inexperienced radiologists, who were trained with 100 MR examinations previous to this study (non-expert reading). Expert reading was performed by two radiologists with a larger abdominal MR experience (>500 examinations) in consensus. A final diagnosis was assigned after three months based on all available information, except MRI findings. We estimated MRI sensitivity and specificity for appendicitis and for all urgent diagnoses separately. Interobserver agreement was evaluated using kappa statistics. Results: Urgent diagnoses were assigned to 147 of 223 patients; 117 had appendicitis. Sensitivity for appendicitis was 0.89 by MR-non-expert radiologists and 0.97 in MR-expert reading (p = 0.01). Specificity was 0.83 for MR-non-experts versus 0.93 for MR-expert reading (p = 0.002). MR-experts and MR-non-experts agreed on appendicitis in 89% of cases (kappa 0.78). Accuracy in detecting urgent diagnoses was significantly lower in MR-non-experts compared to MR-expert reading: sensitivity 0.84 versus 0.95 (p < 0.001) and specificity 0.71 versus 0.82 (p = 0.03), respectively. Agreement on urgent diagnoses was 83% (kappa 0.63). Conclusion: MR-non-experts have sufficient sensitivity in reading MRI in patients with suspected appendicitis, with good agreement with MR-expert reading, but accuracy of MR-expert reading was higher.

  14. Recommendations for Promoting Physical Activity for Children and Adolescents in Germany. A Consensus Statement

    Directory of Open Access Journals (Sweden)

    Christine Graf

    2014-05-01

    Full Text Available Increasing physical activity and reduction of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases in children and adolescents. However, the question of how much physical activity is useful for which target group is still a matter of debate. International guidelines (World Health Organization; European Association for the Study of Obesity, which are mainly based on expert opinions, recommend 60 min of physical activity every day. Age- and sex-specific features and regional differences are not taken into account. Therefore, expert consensus recommendations for promoting physical activity of children and adolescents in Germany were developed with special respect to national data, but also with respect to aspects of specific target groups, e.g., children with a lower socio-economic status (SES or with migration background. They propose 90 min/day of physical activity, or at least 12,000 steps daily. Additionally, lifestyle factors, especially restriction of media consumption, were integrated. The recommendations provide orientation for parents and caregivers, for institutions such as schools and kindergartens as well as for communities and stakeholders.

  15. Recommendations for Promoting Physical Activity for Children and Adolescents in Germany. A Consensus Statement

    Science.gov (United States)

    Graf, Christine; Beneke, Ralph; Bloch, Wilhelm; Bucksch, Jens; Dordel, Sigrid; Eiser, Stefanie; Ferrari, Nina; Koch, Benjamin; Krug, Susanne; Lawrenz, Wolfgang; Manz, Kristin; Naul, Roland; Oberhoffer, Renate; Quilling, Eike; Schulz, Henry; Stemper, Theo; Stibbe, Günter; Tokarski, Walter; Völker, Klaus; Woll, Alexander

    2014-01-01

    Increasing physical activity and reduction of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases in children and adolescents. However, the question of how much physical activity is useful for which target group is still a matter of debate. International guidelines (World Health Organization; European Association for the Study of Obesity), which are mainly based on expert opinions, recommend 60 min of physical activity every day. Age- and sex-specific features and regional differences are not taken into account. Therefore, expert consensus recommendations for promoting physical activity of children and adolescents in Germany were developed with special respect to national data, but also with respect to aspects of specific target groups, e.g., children with a lower socio-economic status (SES) or with migration background. They propose 90 min/day of physical activity, or at least 12,000 steps daily. Additionally, lifestyle factors, especially restriction of media consumption, were integrated. The recommendations provide orientation for parents and caregivers, for institutions such as schools and kindergartens as well as for communities and stakeholders. PMID:24821136

  16. Endothelial factors in the pathogenesis and treatment of chronic kidney disease Part II: Role in disease conditions: a joint consensus statement from the European Society of Hypertension Working Group on Endothelin and Endothelial Factors and the Japanese Society of Hypertension.

    Science.gov (United States)

    Rossi, Gian Paolo; Seccia, Teresa M; Barton, Matthias; Danser, A H Jan; de Leeuw, Peter W; Dhaun, Neeraj; Rizzoni, Damiano; Rossignol, Patrick; Ruilope, Luis-Miguel; van den Meiracker, Anton H; Ito, Sadayoshi;