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PubMed2000

[Organization of health care in geriatric psychiatry: a consensus statement].

This consensus statement, originally published in English by the World Health Organization (WHO), has been produced in collaboration with the Section of Geriatric Psychiatry of the World Psychiatric Association (WPA). During a meeting in Lausanne, Switzerland, from November 14 to 16, 1997, led by Dr Nori Graham, the final declaration was prepared by an interdisciplinary group of representatives from the principle international associations concerned. Professor Cornelius Katona and Dr Nori Graham were Co-Rapporteurs. This statement follows an initial consensus document published by the WHO and the WPA defining geriatric psychiatry (1).

Aged↗

PubMed2000

Interventions to prevent HIV risk behaviors. National Institutes of Health Consensus Development Conference Statement February 11-13, 1997.

OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of behavioral intervention methods that may reduce the risk of HIV infection. PARTICIPANTS: A non-Federal, nonadvocate, 12-member panel representing the fields of psychiatry, psychology, behavioral and social science, social work, and epidemiology. In addition, 15 experts in psychiatry, psychology, behavioral and social science, social work, and epidemiology presented data to the panel and a conference audience of 1000. 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 its 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: Behavioral interventions to reduce risk for HIV/AIDS are effective and should be disseminated widely. Legislative restriction on needle exchange programs must be lifted because such legislation constitutes a major barrier to realizing the potential of a powerful approach and exposes millions of people to unnecessary risk. Legislative barriers that discourage effective programs aimed at youth must be eliminated. Although sexual abstinence is a desirable objective, programs must include instruction on safer sex behaviors. The erosion of funding for drug abuse treatment programs must be halted because research data clearly show that such programs reduce risky drug abuse behavior and often eliminate drug abuse itself. Finally, new research must focus on emerging risk groups such as young people, particularly those who are gay and who are members of ethnic minority groups, and women, in whom transmission of HIV virus to their children remains a major public health problem.

Female↗

PubMed2001

Making mistakes in practice. Developing a consensus statement.

OBJECTIVE: To develop a reference statement for the appropriate management of mistakes in the general practice training environment. METHOD: The setting was a series of focus groups held during workshops with The Royal Australian College of General Practitioners Training Program in the Northern Territory (NT). The participants included NT supervisors and registrars, and representatives of the Consumer Reference Group, Top End Division of General Practice. RESULTS: A reference statement and mutually agreed list of duties for registrars, their supervisors and patients. CONCLUSION: Mistakes are a part of the practice of medicine and can impact on everyone. An appropriate response and the opportunity to reflect and learn from the experience are important elements in minimising the adverse impact. We recommend that the issue of mistakes be considered a priority in the teaching of medicine.

Consensus Statements as Topic↗

PubMed2001

Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: To provide primary care clinicians with a better understanding of management issues in generalized anxiety disorder (GAD) and guide clinical practice with recommendations on the appropriate treatment strategy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R.T. Davidson, Yves Lecrubier, and David J. Nutt. Four additional faculty members invited by the chair were Karl Rickels, Hans-Ulrich Wittchen, Dan J. Stein, and Thomas D. Borkovec. EVIDENCE: The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSIONS: GAD is the most common anxiety disorder in primary care and is highly debilitating. Furthermore, it is frequently comorbid with depression and other anxiety disorders, which exacerbates functional impairment. Antidepressants (serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and nonsedating tricyclic antidepressants) are generally the most appropriate first-line pharmacotherapy for GAD, since they are also effective against comorbid psychiatric disorders and are suitable for long-term use. Cognitive-behavioral therapy is the preferred form of psychotherapy for GAD, although when GAD is comorbid with depression, pharmacotherapy is increasingly indicated.

Age of Onset↗

PubMed2004

Consensus statement for the prevention of vascular disease.

This consensus statement for the prevention of vascular disease in people over 50 years of age aims to consolidate key messages from a number of evidence based guidelines and studies. It addresses the assessment and principles of management of risk factors for vascular disease, including those developed by Diabetes Australia, Kidney Health Australia, the National Heart Foundation of Australia, and the National Stroke Foundation of Australia. For more detailed information, particularly concerning treatments and levels of evidence to support the recommendations outlined in this statement, refer to the source guidelines and literature (see References).

Aged↗

PubMed1991

Competence statements for differentiated nursing practice in critical care.

The demand for high-quality patient care in the current complex health care environment and the variety of today's available nursing education programs dictate a need to differentiate nursing practice into technical and professional roles. These roles are based on competencies acquired in ADN and BSN degree programs and implemented in practice settings where the contributions of all nurses are valued. To create a preferred future, AACN has developed a model for differentiated nursing practice in critical care. The model is a guideline for those nurses and institutions who may be or will be involved in changing practice patterns. The model does not support or encourage the elimination or disenfranchisement of any individual or groups of nurses. These statements were developed to address specific behavior that reflects the valuable contributions of each category of nurses within critical care nursing. The statements provide a model for creating efficient and effective practice patterns that may contribute to high-quality outcomes for critically ill patients and their families.

Clinical Competence↗

PubMed1993

Diagnosis and treatment of depression in late life: the NIH Consensus Development Conference Statement.

The National Institutes of Health Consensus Development Conference on Diagnosis and Treatment of Depression in Late Life brought together biomedical and behavioral scientists, surgeons, and other health care professionals as well as the public to address the epidemiology, pathogenesis, pathophysiology, prevention, and treatment of depression in the elderly and to alert both the professional and lay public to the seriousness of depression in late life, to its manifestations and useful treatments, and to areas needing further study. Following 1 1/2 days of scientific presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) depression in late life occurs in the context of numerous social and physical problems that often obscure or complicate diagnosis and impede management of the illness; (2) because there is no specific diagnostic test for depression, an attentive and focused clinical assessment is essential for diagnosis; (3) depressed elderly people should be treated vigorously with sufficient doses of antidepressants and for a sufficient length of time to maximize the likelihood of recovery; (4) electroconvulsive therapy and psychosocial treatments also can be effective in the treatment of elderly depressed patients; and (5) estimates of the prevalence of depression vary widely, but the highest rates are in nursing homes and other residential settings, and staff in many of these facilities are not equipped to recognize or treat depressed patients. The full text of the consensus panel's statement follows.

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PubMed1996

National Institutes of Health Consensus Development Conference Statement: cervical cancer, April 1-3, 1996. National Institutes of Health Consensus Development Panel.

OBJECTIVE: The objective was to provide physicians and the general public with a responsible assessment of current screening, prevention, and treatment approaches to cervical cancer. PARTICIPANTS: A non-Federal, nonadvocate, 13-member panel representing the fields of obstetrics and gynecology, gynecologic oncology, radiation oncology, and epidemiology participated. 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. Papanicolaou smear screening remains the best available method of reducing the incidence of and mortality from 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 other stage I or stage IIA disease, radical surgery or radiation treatment is equally effective. These patients should be carefully selected to receive one treatment or the other but not both, because their combined use substantially increases the cost of and morbidity from 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 therapy is recommended to palliate symptoms in patients with metastatic disease.

Female↗

PubMed1997

Diagnosis and treatment of depression in late life. Consensus statement update.

OBJECTIVE: To reexamine the conclusions of the 1991 National Institutes of Health Consensus Panel on Diagnosis and Treatment of Depression in Late Life in light of current scientific evidence. PARTICIPANTS: Participants included National Institutes of Health staff and experts drawn from the Planning Committee and presenters of the 1991 Consensus Development Conference. EVIDENCE: Participants summarized relevant data from the world scientific literature on the original questions posed for the conference. PROCESS: Participants reviewed the original consensus statement and identified areas for update. The list of issues was circulated to all participants and amended to reflect group agreement. Selected participants prepared first drafts of the consensus update for each issue. All drafts were read by all participants and were amended and edited to reflect group consensus. CONCLUSIONS: The review concluded that, although the initial consensus statement still holds, there is important new information in a number of areas. These areas include the onset and course of late-life depression; comorbidity and disability; sex and hormonal issues; newer medications, psychotherapies, and approaches to long-term treatment; impact of depression on health services and health care resource use; late-life depression as a risk factor for suicide; and the importance of the heterogeneous forms of depression. Depression in older people remains a significant public health problem. The burden of unrecognized or inadequately treated depression is substantial. Efficacious treatments are available. Aggressive approaches to recognition, diagnosis, and treatment are warranted to minimize suffering, improve overall functioning and quality of life, and limit inappropriate use of health care resources.

Age Factors↗

PubMed1998

[Consensus statement of an interdisciplinary group of French experts on modalities of diagnosis and medical treatment of Alzheimer's disease at a treatable stage].

A group of French expert met on the 7th and 8th of February 1998 in order to establish a consensus attitude for Alzheimer's disease diagnosis and treatment. Members were drawn from primary care, geriatrics, neurology and psychiatry. They used the consensus statement of the American Association for Geriatrics, the Alzheimer's Association and the American Geriatrics Society published in JAMA, in October 1997 as a source of data for further consideration. Alzheimer's disease in the most common etiology of dementia. Main clinical features are cognitive impairment and psycho-behavioral disorders. Diagnosis must be one of inclusion and not exclusion. It is based on interviews of informants and family members and office-based clinical assessment. After a physical examination, cognitive function must be evaluated using the Mini-Mental State Examination. A laboratory evaluation should include a complete blood cell count, blood chemistry and determination of thyroid-stimulating hormone. In addition, noncontrast computed tomography head scans are adequate in most cases. Available pharmacologic treatments are not curative but are given to improve quality of life and enhance cognition and behavior. Two cholinesterases inhibitors, tacrine and donepezil, are the only agents officially authorized for treatment of the cognitive impairment in Alzheimer's disease. Mood and behaviour disorder also have to be treated by both pharmacologic and nonpharmacologic strategies. Only pharmacologic treatments will be detailed here. The consensus statements established by this group of experts will be reevaluated each year, considering the new available data on Alzheimer's disease.

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PubMed1994

Patients' interpretation of qualitative probability statements.

BACKGROUND: Physicians often use qualitative probability statements to compare treatment options or describe risks of treatment, especially if exact numerical information is not readily available. OBJECTIVES: To determine (1) the effect of context, experience, age, gender, race, occupation, and education on patients' numerical interpretation of probability terms and (2) patient preferences for information about side effects (qualitative or numerical). DESIGN: Cross-sectional survey. SETTING: A university-based family practice in Ann Arbor, Mich. PARTICIPANTS: Patients 18 years of age and older and parents of patients younger than 18 years of age seen during January and February 1993 for any reason except complete physical examination. METHODS: A questionnaire presented scenarios of minor and major complications related to four different medical conditions. Participants were asked to estimate how many people of 100 would have a complication if their physician described the risk for the complication in each scenario as unlikely. Participants were then asked whether they preferred receiving information from their physician about the risk for complications in words or numbers. RESULTS: Of 345 questionnaires distributed, 307 patients (89%) completed them. The rates assigned to the minor complications were significantly higher than the rates assigned to the major complications (P = .0001). Participants who had experienced the described complication reported significantly higher rates for the minor complications of vaccination and surgery (P = .0001 and P = .0235, respectively). Education had a significant effect only on the rates assigned to vaccination complications (P = .0069). Occupation had a significant effect only on the rates assigned to antibiotic side effects (P = .0090). CONCLUSIONS: When a physician uses qualitative probability statements, he or she must be sensitive to the patient's previous experience with that procedure or medication. Also, if one wants to convey the same potential rate of occurrence for major and minor side effects, then one needs to use different words for each.

Adult↗

PubMed1978

The effect of test taking on acceptance of bogus personality statements.

Ss received either positively or negatively toned feedback after taking a projective test. Other Ss merely received the feedback statements without taking the test. All Ss rated the feedback statements individually and as a unit as to how well they described their personality and the personality of people in general. Feedback as a unit was more acceptable when (a) the test was taken, and (b) when positively toned feedback was received. Collapsing across feedback conditions, personal acceptability was higher for those who took the test than for those who did not take the test. The method allowed for analysis of individual items and thereby provided an additional measure of acceptability than simply using the overall acceptability score.

Adolescent↗

PubMed2005

Intraoperative monitoring using somatosensory evoked potentials. A position statement by the American Society of Neurophysiological Monitoring.

OBJECTIVE: To provide an educational service to the intraoperative neurophysiologist community by publishing a position statement by the American Society of Neurophysiological Monitoring on the recommended appropriate and correct use of somatosensory evoked potentials as an intraoperative neurophysiological monitoring tool to protect patient well-being during surgery. This position statement presents the somatosensory evoked potential utilization basis, relevant anatomy, patient preparation, important systemic factors, anesthesia considerations, safety and technical considerations, documentation requirements, neurophysiologist credentials and staffing practice patterns, and monitoring applications for protecting brain, spinal nerve root, peripheral nerve, plexus and spinal cord function. In conclusion, a summary of major recommendations regarding the use of somatosensory evoked potentials in intraoperative neurophysiological monitoring is presented.

Electric Stimulation↗

PubMed1994

Validity issues in self-statement measures of social phobia and social anxiety.

Measures to assess internal dialogue or self-statements in socially phobic or anxious clients are now frequently used in clinical and research settings. Such cognitive assessment techniques are rarely considered, however, with regard to psychometric criteria. This article reviews the literature on self-statement assessment of social phobia and social anxiety from the perspective of content, criterion, convergent and discriminant validity. In general, most measures have shown good evidence of validity. Different scoring systems in addition to thought valence appear worthwhile, and multiple measures and assessment occasions should be considered.

Anxiety Disorders↗

PubMed2005

Prevention and control of coronary heart disease and stroke--nomenclature for prevention approaches in public health: a statement for public health practice from the Centers for Disease Control and Prevention.

Successful prevention and control of coronary heart disease and stroke requires extensive collaboration and strategic partnerships with many health and non-health-related organizations and agencies in the voluntary, public, and private sectors. To assure a common language and purpose and to facilitate communication in these multiple settings, a simplified classification of prevention levels for public health practice is essential. This statement proposes three levels of prevention (health promotion, primary prevention, and secondary prevention) as a guide for public health practice. This statement is also intended to inform the design, implementation, and evaluation of programs and research initiatives that address the prevention and control of coronary heart disease and stroke, and to enhance communication and dialogue among health professionals, policymakers, and the public.

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

PubMed2003

Statement on the Scope and Standards of Medical Dosimetry Practice.

As healthcare delivery systems and technology continue to evolve, the role and responsibilities of the medical dosimetrist need to be delineated. The Scope and Standards of Medical Dosimetry Practice is design to provide a statement of competence in medical practice; define the practice of medical dosimetry; and provide a useful guide for medical dosimetrists and others in evaluating the quality, effectiveness, and appropriateness of health care services provided. In the process of developing the statement, the profession of medical dosimetry and credentialing are described; and a decision-making model to guide medical dosimetrists in determining scope of practice is provided.

Humans↗

PubMed2026

Guidance (challenges and priorities) in the assessment of children with low vision: ERN-EYE clinical consensus statement.

Across Europe, children living with low vision often face inconsistent approaches to the assessment of their visual function, leading to delays in diagnosis and unequal access to care. To address this gap, a multidisciplinary group of experts from 8 European countries developed a clinical consensus statement (CCS), using a modified Delphi process. This CCS provides guidance on evaluation of primary visual functions in children with low vision, regardless of etiologies. Assessing visual function can be challenging and cannot be limited to testing visual acuity. It requires a comprehensive approach that takes into account the child's developmental age and necessary adjustments for vision loss. This consensus statement presents different validated tools to evaluate visual acuity, contrast sensitivity, visual field, and color vision. It provides practical guidance for their use across developmental stages, including infancy and in children with syndromic or neurodevelopmental conditions, and highlights the critical role of caregivers in ensuring reliable assessments. The recommendations emphasize the need for age-appropriate testing strategies, tailored adaptations for low vision and additional impairment, and the importance of early assessment to support timely habilitation and optimize developmental outcomes.

Assessment↗

PubMed1999

Cystic fibrosis and the National Institutes of Health consensus statement: are obstetrician-gynecologists ready to comply?

OBJECTIVE: To determine if obstetrician-gynecologists are ready to comply with the April 1997 National Institutes of Health (NIH) consensus statement regarding carrier screening for cystic fibrosis. METHODS: A multiple-choice questionnaire was mailed to all active North Carolina nonfederal physicians with a primary specialty of obstetrics and gynecology. Ten questions surveyed the participants' knowledge about cystic fibrosis. RESULTS: Two hundred eighty-six surveys were returned for a response rate of 30.4%. The respondents differed in their knowledge base depending on their specialty, age, and number of years of experience as a physician. The youngest physicians and the least experienced yielded the highest percentage correct. The questions most frequently answered correctly dealt primarily with clinical information about cystic fibrosis, whereas the questions most often answered incorrectly dealt with carrier frequency and testing information. CONCLUSION: The obstetrics-gynecology community is not yet prepared to comply with the NIH Consensus Statement to offer cystic fibrosis carrier screening to couples preconceptionally or prenatally. Further education is necessary before obstetrician-gynecologists can counsel patients adequately.

Adult↗