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PubMed1989

Primary and community health services in Newcastle upon Tyne--a joint statement of intent.

In the absence of a single primary health care authority (except in Scotland) district health authorities and family practitioner committees must cooperate in planning health services for the community. Equally, in the field, the potential for teamwork between salaried district health authority nursing staff and the independent general practitioners remains largely unrealized. Yet the government has restated its commitment to the development of primary health care teams as the best means of delivering health care in the community. In Newcastle upon Tyne the local medical committee and the community health services management team have set out their shared aspirations for future development in a joint 'Statement of intent'. This statement, since endorsed by the district health authority and family practitioner committee, includes a number of key principles as a basis for future joint working. These principles emanate from an understanding of the complementary nature of general practice and district health authority community services, and firmly support the primary health care team approach. This statement of intent could serve as a useful model for collaboration and planning of services elsewhere in the country.

Community Health Services↗

PubMed1989

Developing a preservation policy and procedure statement for a health sciences library.

The preconditions for creating a preservation policy document in a health sciences library are an existing preservation policy for the institution of which it is a part and administrative support for preservation. The assumption underlying preservation activity, from the formulation of general guidelines to the detail of operating procedure, is that collection development and preservation are complementary functions. Documentation of operational procedures in some detail should be a part of the statement. Since preservation activity cuts across functional library structures, all management staff should be involved in the planning process and be made aware of their responsibilities. The creation of a preservation policy statement will highlight unaddressed issues, procedural inadequacies, and differences in staff perceptions of priorities, but a written statement provides a framework for setting priorities and making decisions.

Corrosion↗

PubMed1988

The case for modifying adolescents' cognitive self-statements.

The purpose of this study was to develop, implement, and evaluate a cognitive-behavior modification program designed to change adolescents' self-statements and increase their levels of self-esteem. Subjects were 27 ninth graders, 18 in the experimental group and 9 in the no-contact control group. Students in the experimental group were given 14 hours of training designed to modify their self-statements to be more positive. Results indicated a significant increase in positive self-statements for the experimental group as compared with the control group immediately after training and three months following training. There were no significant changes in self-esteem. Discussion focused on the relative merits of the program and on the implications of the findings for future research.

Adolescent↗

PubMed1979

Standardization of electrocardiographic interpretive statements: a menu for word processing.

Standardization of electrocardiographic interpretive statements is a goal of various coding systems, but word processing has not usually been considered. A simple, easily memorized system for clinical electrocardiography has been developed and used for approximately 60 000 interpretations. It takes the form of a "menu", in which boxes stand for various interpretive statements; the boxes are identified by mnemonics and marked by the interpreter when appropriate. The results provide better standardization, significant decreases in the numbers of descriptive statements and words per interpretation and considerable saving in typing time. Acceptance by the interpreters has been good. Features of the system allow for word processing as part of a polarcardiography computing system.

Computers↗

PubMed1994

Joint position statement: essential provisions for critical care in health system reform. Society of Critical Care Medicine. American Association of Critical Care Nurses.

OBJECTIVE: Production of a statement defining the essential provisions of health system reform as determined by the Society of Critical Care Medicine (SCCM) and the American Association of Critical-Care Nurses (AACN). This document is the only nurse-physician joint statement to result from the 1994 health system reform debate. DATA SOURCES: A joint SCCM-AACN working group developed the document. Working group members referenced position papers previously developed by SCCM and AACN. DATA SYNTHESIS: Working group members refined drafts of the statement until a consensus was reached. Final versions of the paper were reviewed and endorsed by the SCCM Council and the AACN Board of Directors. CONCLUSIONS: SCCM and AACN agreed that health system reform should ultimately achieve universal coverage, access, control cost, and should improve the quality of care. SCCM and AACN endorsed improved access to and coverage for preventive care services. Recognizing that critical illness and injury cannot be prevented entirely, SCCM and AACN agreed that a reformed system must foster improved care of the critically ill and injured as described below.

Cost Control↗

PubMed1996

[Expert statement and assessment of medical impairment in work-related pulmonary disease].

The Norwegian Societies of Thoracic Medicine and Occupational Medicine established a working group to standardise diagnostic procedures and evaluation of work-related respiratory disorders. In cases of suspected work-related diseases the physician may be asked by the National Insurance Administration or an insurance company to make a statement which will be one of the documents used to decide the patient's right to compensation benefit. We discuss the role of the physician as an independent expert. This is different from his role as clinician. The statement should include a balanced presentation of information from different sources, including health and occupational history, and the employer's information about the work environment (quantitative and qualitative exposure data). The statement must also include the results of a clinical examination and an assessment of functional status based on objective tests. The paper contains recommendations for evaluation of permanent impairment in light of the present Norwegian laws and regulations.

Air Pollutants, Occupational↗

PubMed2003

Addendum to the International Consensus Statement on testing and reporting of antineutrophil cytoplasmic antibodies. Quality control guidelines, comments, and recommendations for testing in other autoimmune diseases.

Antineutrophil cytoplasmic antibody (ANCA) tests are used to diagnose and monitor inflammatory activity in Wegener granulomatosis, microscopic polyangiitis and its renal-limited variant (pauci-immune crescentic glomerulonephritis), and Churg-Strauss syndrome. The International Consensus Statement on testing and reporting of ANCA states that ANCA are demonstrated most readily in these conditions by using a combination of indirect immunofluorescence (IIF) of normal peripheral blood neutrophils and enzyme-linked immunosorbent assays (ELISAs) that detect ANCA specific for proteinase 3 or myeloperoxidase. The group that produced the International Consensus Statement has developed guidelines for the corresponding quality control activities, examples of comments for various IIF patterns and ELISA results, and recommendations for ANCA testing when inflammatory bowel disease and other nonvasculitic ANCA-associated autoimmune diseases are suspected.

Antibodies, Antineutrophil Cytoplasmic↗

PubMed1997

Psychiatry of the elderly: a consensus statement.

This consensus statement, published by The Division of Mental Health and Prevention of Substance Abuse of the World Health Organisation, was co-sponsored by WHO and the Geriatric Section of the World Psychiatric Association, under the Section presidency of Professor J. Wertheimer. The final statement was prepared by an inter-disciplinary group representing the principal international association, at a meeting in Lausanne, 5-7 February 1996, chaired by Professor H. Hafner. Professor Cornelius Katona and Dr. Nori Graham were co-rapporteurs. A full list of participants is available from Professor Wertheimer.

Aged↗

PubMed1997

National Institutes of Health Consensus Development Conference Panel statement: management of hepatitis C.

The objective of this article is to provide health care providers, patients, and the general public with a responsible assessment of current available methods to diagnose, treat, and manage hepatitis C. A non-Federal, non-advocate, 12-member panel representing the fields of general internal medicine, hepatology, gastroenterology, infectious diseases, medical ethics, transfusion medicine, epidemiology, biostatistics, and the public participated. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 1,600. The literature was searched through Medline, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after conference. Hepatitis C is a common infection with variable course that can lead to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. The course of illness may be adversely affected by various factors, especially alcohol consumption. Therefore, more than one drink per day is strongly discouraged in patients with hepatitis C, and abstinence from alcohol is recommended. Initial therapy with interferon alfa (or equivalent) should be 3 million units three times per week for 12 months. Patients not responding to therapy after 3 months should not receive further treatment with interferon alone, but should be considered for combination therapy of interferon and ribavirin or for enrollment in investigational studies. Individuals infected with the hepatitis C virus (HCV) should not donate blood, organs, tissues, or semen. Safe sexual practices, including the use of latex condoms, is strongly encouraged for individuals with multiple sexual partners. Expansion of needle exchange programs should be considered in an effort to reduce the rate of transmission of hepatitis C among injection drug users.

Forecasting↗

PubMed1998

Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee.

This is a proposal of the Movement Disorder Society for a clinical classification of tremors. The classification is based on the distinction between rest, postural, simple kinetic, and intention tremor (tremor during target-directed movements). Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes defined in this statement: enhanced physiologic tremor, classical essential tremor (ET), primary orthostatic tremor, task- and position-specific tremors, dystonic tremor, tremor in Parkinson's disease (PD), cerebellar tremor, Holmes' tremor, palatal tremor, drug-induced and toxic tremor, tremor in peripheral neuropathies, or psychogenic tremor. Conditions such as asterixis, epilepsia partialis continua, clonus, and rhythmic myoclonus can be misinterpreted as tremor. The features distinguishing these conditions from tremor are described. Controversial issues are outlined in a comment section for each item and thus reflect the open questions that at present cannot be answered on a scientific basis. We hope that this statement provides a basis for better communication among clinicians working in the field and stimulates tremor research.

Adult↗

PubMed1997

National Institutes of Health Consensus Development Conference statement on cervical cancer. April 1-3, 1996.

OBJECTIVE: To provide physicians and the general public with a responsible assessment of current screening, prevention, and treatment approaches to cervical cancer. PARTICIPANTS: The participants were a non-Federal, nonadvocate, 13-member panel representing the fields of obstetrics and gynecology, gynecologic oncology, radiation oncology, and epidemiology. In addition, 28 experts in obstetrics and gynecology, gynecologic oncology, radiation oncology, gynecologic surgery, and psychology presented data to the panel and a conference audience of 500. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Carcinoma of the cervix is causally related to infection with the human papillomavirus (HPV). Reducing the rate of HPV infection by changes in sexual behaviors in young people and/or through the development of an effective HPV vaccine would reduce the incidence of this disease. Pap smear screening remains the best available method of reducing the incidence and mortality of invasive cervical cancer. Persons with stage IA1 disease have a high cure rate with either simple hysterectomy or, where fertility preservation is an issue, by cone biopsy with clear margins. For patients with stage I and stage IIA disease, radical surgery and radiation are equally effective treatments. These patients should be carefully selected to receive one treatment or the other, but not both, as their combined use substantially increases the cost and morbidity of treatment. Women with more advanced, nonmetastatic disease should be treated with radiation. Recurrent cervical cancer confined to the pelvis should be treated with the modality not previously received. Radiation is recommended to palliate symptoms in patients with metastatic disease.

Combined Modality Therapy↗

PubMed1989

Statement on guidelines for total parenteral nutrition. The Patient Care Committee of the American Gastroenterological Association.

This is one of a series of clinical guidelines. They represent a consensus statement dealing with optimum patient care in significant clinical areas. The statement has been prepared by the Patient Care Committee, with the advice of other experts and with peer review. As with all such guidelines, they should be interpreted in a nondogmatic manner, so as not to exclude other therapies or opinions in any particular situation. Based on present knowledge, limited at times, future modifications or other changes in these guidelines may be necessary.

Gastroenterology↗

PubMed2004

Optimal management of the morbidly obese patient. SAGES appropriateness conference statement.

BACKGROUND: Obesity is a growing health problem that contributes to numerous life-threatening or disabling disorders, including coronary artery disease, hypertension, type 2 diabetes mellitus, hyperlipidemia, degenerative joint disease, and obstructive sleep apnea. Significant weight reduction in the morbidly obese improves or reverses associated illness and benefits well-being. The purpose of the SAGES Appropriateness Conference was to summarize the state of the art for open and laparoscopic operations for the morbidly obese. METHODS: The English literature comparing bariatric procedures was reviewed and grouped by level of evidence by three surgeons (BS, LV, and CC). From more than 1,500 articles, all conference participants were provided with reprints and table summaries of no less than 50 selected manuscripts. Ten experts were requested to present reviews and make evidence-based arguments for and against the open and laparoscopic approaches in written format. An expert panel of six surgeons, including an ethicist and patient, commented on implications of data presented. The finalized statement was e-mailed to all participants for approval and comment. RESULTS: Consensus statements were achieved on various aspects of morbid obesity, including indications for surgery, resolution of comorbid illnesses with significant weight loss, and the importance of committed bariatric program. Our panel of experts agreed, in general, to the advantages of laparoscopic approaches compared to open operations in skilled hands. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass (RYGB) affords improved short-term recovery compared to open gastric bypass. Laparoscopic adjustable banding can be performed with lower average mortality than either RYGB or any of the malabsorptive operations, and it produces variable degrees of short-term weight loss. Prospective randomized trials are needed to compare gastric bypass, malabsorptive, and restrictive procedures.

Aftercare↗

PubMed2006

Background to Eusoma guidelines and statements.

The European Society of Mastology (Eusoma) is committed in writing and diffusing guidelines on Breast Cancer, aiming at harmonising the quality of Breast Cancer care throughout Europe. To achieve this Eusoma organises scientific meetings, "workshops" or "Consensus meeting", inviting European experts from the different disciplines involved in the multidisciplinary management of Breast Cancer patients, to give their contribution in drafting "guidelines" or "consensus statements". In this regard Eusoma Executive Committee members found it appropriate to define the rules to organise its scientific meetings and to write the documents resulting from these meetings, i.e guidelines or statements. This will guarantee an homogeneity in the meeting organisations and in drawing up the scientific documents.

Breast Neoplasms↗

PubMed2004

The use of "as-needed" range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American Pain Society.

The use of "as needed" or "PRN" range orders for opioid analgesics in the management of acute pain is a common clinical practice. This approach provides flexibility in dosing to meet individual patients' unique analgesic requirements. Range orders enable necessary and safe dose adjustments based on an individual's response to treatment. The purpose of this paper is to present the consensus statement of the American Society for Pain Management Nursing and the American Pain Society on the use of "as-needed" range orders for opioid analgesics in the management of acute pain. The implementation of this statement should promote quality pain management through safe medication practices and the appropriate use of range orders for opioid analgesics in acute pain management.

Acute Disease↗

PubMed1999

Orbital vascular malformations: a consensus statement on terminology and its clinical implications. Orbital Society.

PURPOSE: Orbital venous anomalies and lymphangiomas have been generally classified on morphologic grounds. However, conflicting concepts of these lesions have hampered scientific dialogue and confused clinicians, with occasionally serious consequences for patients. As a step toward uniform nomenclature and better communication, a consensus on the terminology of orbital vascular malformations was sought among the members of the Orbital Society. METHODS: A classification of orbital vascular malformations based on their hemodynamic relationships, as revealed by clinical and imaging features, was presented, discussed, and adopted at the 1998 Annual Meeting of the Orbital Society. A consensus statement was drafted and distributed to all members. The statement was then modified in accordance with members' responses, which included minor stylistic recommendations but no substantive dissent. RESULTS: Orbital vascular malformations may be classified according to their hemodynamic relationships as no flow, venous flow, and arterial flow lesions. Assignment to each group is based on pertinent clinical and imaging criteria. Mixed forms with both venous and no flow components are grouped within the venous flow category to emphasize the clinical importance of that relationship. CONCLUSIONS: A hemodynamic classification of orbital vascular malformations emphasizes features most germane to their management. It should reduce the clinical confusion resulting from purely morphologic differentiation. Widely accepted definitions may allow a better comparison of therapeutic protocols for these troublesome lesions.

Arteries↗

PubMed1999

Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses.

BACKGROUND: The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). METHODS: The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. FINDINGS: The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with "trial flow", study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. INTERPRETATION: We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.

Authorship↗

PubMed2000

Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group.

BACKGROUND: The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). METHODS: The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. FINDINGS: The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with 'trial flow', study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. INTERPRETATION: We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.

Data Collection↗