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PubMed2005

Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

The objective of this report was to develop a case definition of distal symmetric polyneuropathy to standardize and facilitate clinical research and epidemiologic studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetric polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiologic studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach to defining distal symmetric polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiologic research studies will ensure greater consistency of case selection.

Clinical Protocols↗
PubMed2004

Improving health care globally: a critical review of the necessity of family medicine research and recommendations to build research capacity.

An invitational conference led by the World Organization of Family Doctors (Wonca) involving selected delegates from 34 countries was held in Kingston, Ontario, Canada, March 8 to 12, 2003. The conference theme was "Improving Health Globally: The Necessity of Family Medicine Research." Guiding conference discussions was the value that to improve health care worldwide, strong, evidence-based primary care is indispensable. Eight papers reviewed before the meeting formed the basic material from which the conference developed 9 recommendations. Wonca, as an international body of family medicine, was regarded as particularly suited to pursue these conference recommendations: 1. Research achievements in family medicine should be displayed to policy makers, health (insurance) authorities, and academic leaders in a systematic way. 2. In all countries, sentinel practice systems should be developed to provide surveillance reports on illness and diseases that have the greatest impact on the population's health and wellness in the community. 3. A clearinghouse should be organized to provide a central repository of knowledge about family medicine research expertise, training, and mentoring.4. National research institutes and university departments of family medicine with a research mission should be developed. 5. Practice-based research networks should be developed around the world.6. Family medicine research journals, conferences, and Web sites should be strengthened to disseminate research findings internationally, and their use coordinated. Improved representation of family medicine research journals in databases, such as Index Medicus, should be pursued.7. Funding of international collaborative research in family medicine should be facilitated.8. International ethical guidelines, with an international ethical review process, should be developed in particular for participatory (action) research, where researchers work in partnership with communities. 9. When implementing these recommendations, the specific needs and implications for developing countries should be addressed.The Wonca executive committee has reviewed these recommendations and the supporting rationale for each. They plan to follow the recommendations, but to do so will require the support and cooperation of many individuals, organizations, and national governments around the world.

Biomedical Research↗
PubMed2004

Nomenclature and decimal places in bone densitometry.

There are inconsistencies in densitometry nomenclature and in the use of decimal places in reporting bone density results. These issues were discussed at the 2003 Position Development Conference (PDC) of the International Society for Clinical Densitometry (ISCD). Regarding nomenclature, there was agreement that DXA is the preferred designation for dual-energy X-ray absorptiometry. T-score (not T score, t score, or tscore) is the preferred designation for the standard deviation variance of bone mineral density (BMD) from the mean BMD of the young adult reference population. Z-score terminology should be consistent with that for T-score. For the reporting of bone densitometry results, BMD should be expressed to three decimal places, bone mineral content and area to two decimal places, T-scores and Z-scores to one decimal place, and percentages (percentage of reference population mean BMD) as integers.

Absorptiometry, Photon↗
PubMed2002

Hemoglobin A1c: need to standardize the term.

PURPOSE: To discuss studies that investigate the understanding of patients with diabetes and the information provided by physicians regarding the terminology and meaning of tests for glycated hemoglobin. FINDINGS: Patients with diabetes seldom know or remember the terminology for glycated hemoglobin assay techniques, even when they are participating in self-monitoring of blood glucose. Physicians use a variety of terms for the glycated hemoglobin test and are not consistent in their terminology. CONCLUSION: One term for glycated hemoglobin assay should be used and promoted by all health-care professionals and patients. Because it is most readily remembered, "A1C" is the preferred lay term.

Diabetes Mellitus↗
PubMed1999

Drawing up clinical guidelines.

This report describes the processes involved in compiling a set of guidelines, locally developed by informal consensus, for the management of common paediatric medical problems in a teaching hospital.

Decision Making↗
PubMed1999

[Ambulatory management of chronic obstructive pulmonary disease (COPD): a consensus report].

Based on the Consensus of the Chilean Respiratory Society, this article summarizes the main topics of the ambulatory management of patients with COPD. The Consensus proposes operative definitions in order to prevent the most frequent conceptual errors, specially those related to the confusion between patients with chronic bronchitis without chronic obstruction and those with COPD. Among the diagnostic criteria, the consensus emphasizes the importance of demonstrating irreversible airway obstruction through spirometry, as well as strategies to the differential diagnosis between COPD and asthma. The Consensus summarizes the therapeutic interventions used in the ambulatory setting, including smoking cessation, bronchodilators, corticosteroids, antibiotics, vaccination, oxygen therapy, respiratory rehabilitation and environmental management. The Consensus emphasizes the importance of patient education in order to involve them in their own management. Some criteria for referral of patients are given and the role of exceptional therapeutical interventions, such as non invasive mechanical ventilation and lung reduction surgery are mentioned. The Consensus states that a significative improvement of the quality of life can be achieved with a proper combination of therapeutic interventions.

Ambulatory Care↗
PubMed1999

Evaluating chronic pelvic pain. A consensus recommendation. Pelvic Pain Expert Working Group.

OBJECTIVE: To identify a comprehensive approach to evaluating women with chronic pelvic pain based on findings in the literature. STUDY DESIGN: A working group of gynecologist pelvic pain specialists was convened to consider principles on which consensus could be reached and to identify areas in which consensus is not yet possible. RESULTS: Chronic pelvic pain affects 15% of American women. The diagnostic and therapeutic approach to the complaint may be influenced inordinately by the specialty of the practitioner to whom the woman presents. A comprehensive approach to the complaint requires recognition of the multiple organ systems that may be involved. Evaluation of the woman with chronic pelvic pain begins with a comprehensive history and physical examination, followed by selected laboratory and imaging studies. For those women in whom the evaluation does not yield a likely cause of the complaint, the empiric use of nonsteroidal antiinflammatory agents, oral contraceptives, and perhaps antibiotics or antispasmodics is indicated. Women who fail to respond to empiric therapy should be considered highly likely to have endometriosis or adenomyosis. Further diagnostic (laparoscopy) or therapeutic (gonadotropin-releasing hormone agonist) interventions should be directed toward the high likelihood of endometriosis or adenomyosis. CONCLUSION: A comprehensive approach to chronic pelvic pain includes consideration of multiple organ systems, with empiric therapy appropriate after a thorough history and physical examination, to further delineate the pain problem.

Diagnosis, Differential↗
PubMed1999

Impact of the consensus conference on polycythemia vera. An opportunity to change or a sign of change?

OBJECTIVE: To assess the impact of guidelines on drug use issued by a consensus conference on polycythemia vera held in Paris in June 1993. 32Phosphorus (32P) was recommended for patients over 70 and/or at risk, whereas pipobroman and hydroxyurea were recommended for patients under 70. METHODS: A questionnaire was sent to all 119 departments of nuclear medicine in France 1 year after the conference to find out whether and how often they measured plasma volume and red cell mass (the recommended diagnostic tests for polycythemia vera). Time-series analyses were performed on sales of 32P, pipobroman (both virtually exclusively prescribed for polycythemia), and hydroxyurea over a 4-year span (January 1992-December 1995). RESULTS: The average number of plasma volume determinations per year did not change significantly after the conference (22 +/- 26 before vs 21 +/- 25 after). 32P and pipobroman sales were stable until July 1993, when 32P sales decreased while pipobroman sales rose steadily. Hydroxyurea sales increased over the whole period with no change in trend after the guidelines were published. CONCLUSIONS: The guidelines apparently influenced clinical practice since sales of drugs that are specifically used to treat polycythemia vera showed clear changes in trend after publication of the guidelines. This type of study seems to be an effective way of assessing the impact of consensus conferences.

Drug Utilization Review↗