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PubMed2006

[Characteristics of mild asthma: clinical signs and medication use. Position statement of the Mild Asthma Working Group (174)].

OBJECTIVE: To update on the state of knowledge in mild asthma (intermittent and persistent mild asthma, according to the GINA classification) review the literature, and the position statement of the French Mild Asthma Working Group. METHODS: The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the descriptive epidemiology, physiopathology, clinical signs, and management of mild asthma. The position of the working group on the descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation has been presented in a previous article. The present article focuses on the clinical features of mild asthma and the use of medication for it. RESULTS: Mild asthma was more frequent, more symptomatic, and less well controlled in children than in adults. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Patients with mild persistent asthma require controller medication every day: permanent low-dose inhaled corticosteroid monotherapy is the reference foundation treatment for persistent mild asthma. CONCLUSIONS: The present findings should help clinicians and guide them in their approach to managing this condition.

Administration, Inhalation↗

PubMedDate not supplied

The impact of the principles of evidence interpretation on the structure and content of statements.

The Forensic Science Service (FSS) has devoted appreciable effort to developing the application of the principles of evidence interpretation. Much of the work has been reported in previous papers in this journal, in particular those that develop a model for Case Assessment and Interpretation (CAI). The principles of interpretation are restated and the implications for structure and content of statements are described.

Bayes Theorem↗

PubMed2002

The SOGC statement on the WHI report on estrogen and progestin use in postmenopausal women.

The recent Women's Health Initiative study report evaluated the long-term benefits and risks of hormone replacement therapy among healthy postmenopausal women. The report showed that the risk-benefit profile of continuous combined hormone replacement therapy was not consistent with the primary prevention of coronary heart disease. The Women's Health Initiative study of continuous combined hormone replacement therapy is a landmark study and the results provide valuable information for patients and clinicians. However, the most common indication for hormone replacement therapy is menopausal symptoms, for which it is effective, not prevention of disease, and the most common use is for less than three years. Nevertheless, even short-term use has small effects on some outcomes. This statement discusses how the findings of the Women's Health Initiative study can be applied to reach appropriate clinical decisions.

Aged↗

PubMed2000

Minimum standards for electromyography in Canada: a statement of the Canadian Society of Clinical Neurophysiologists.

BACKGROUND: Electromyography (EMG) is a widely used diagnostic technique for disorders of the nervous system. The Canadian Society of Clinical Neurophysiologists (CSCN) promotes the education, evaluation and standards of EMG in Canada. A statement of practice standards was needed to clarify the position of the CSCN on several issues relevant to the practice of EMG. METHODS AND RESULTS: A subcommittee of the CSCN reviewed current patterns of practice and established guidelines for review by the CSCN. The guidelines developed by the subcommittee were reviewed by the CSCN and adopted as recommendations for EMG practice. The subcommittee was charged with formulation of a document for publication. CONCLUSIONS: This document deals with minimum standards for electromyographer education, laboratory operation, equipment and a variety of special circumstances relevant to the practice of EMG. The standards can be adopted by EMG laboratories to guide quality assurance.

Canada↗

PubMed1998

Canadian guidelines for intravenous thrombolytic treatment in acute stroke. A consensus statement of the Canadian Stroke Consortium.

BACKGROUND: The thromobolytic drug, tissue plasminogen activator (tPA) has been approved in the United States for the treatment of acute ischemic stroke amid controversy and concern about the balance of risk and benefit. The Canadian Stroke Consortium (CSC), a national network of neurologists who collaborate on joint projects in stroke medicine, including clinical trials and consensus statements, has developed guidelines for the use of tPA in Canada. METHODS AND RESULTS: The CSC Board of Directors wrote a preliminary report based on existing publications, including randomized drug trials and the report of a special committee struck by the Stroke Council of the American Heart Association. This draft was circulated to the CSC membership-at-large for suggestions or amendments, to produce this final draft. CONCLUSIONS: The present guidelines have been devised to represent a Canadian viewpoint of management. The Health Protection Branch of the Ministry of Health of Canada has not yet produced an evaluation. Further modification of these guidelines may be necessary when more data from clinical trials and experience with the drug become available.

Acute Disease↗

PubMed2002

An essay on the Houston Conference policy statement: static yet incomplete or a work in progress?

Ardila (Neuropsychol. Rev. 12: 3, 2002) criticizes the Policy Statement from the Houston Conference on Specialty Education and Training in Clinical Neuropsychology (Hannay et al., Arch. Clin. Neuropsychol. 13: 157-250, 1998) as possessing deficiencies in the training of clinical neuropsychologists in three fundamental knowledge areas: the history of the discipline, neuropsychological syndromes, and neuropsychological theory. These problems are seen here as a result of a more pervasive problem associated with the Houston Conference training model's emphasis on technical skill over science and the attempt to micromanage the training of the clinical neuropsychologist at the administrative level.

Humans↗

PubMed2003

The role of the iminosugar N-butyldeoxynojirimycin (miglustat) in the management of type I (non-neuronopathic) Gaucher disease: a position statement.

N-Butyldeoxynojirimycin (NB-DNJ, miglustat 'Zavesca') is an orally active iminosugar which inhibits the biosynthesis of macromolecular substrates that accumulate pathologically in glycosphingolipidoses. Clinical trials of NB-DNJ in patients with Gaucher's disease demonstrate the therapeutic potential of such substrate inhibitors in the glycolipid storage disorders. However, macrophage-targetted enzyme replacement using intravenous mannose-terminated human glucocerebrosidase (imiglucerase, Cerezyme) is highly effective in ameliorating many of the manifestations of Gaucher's disease and is a treatment in widespread use. Given that imiglucerase and miglustat are now both licensed for the treatment of Gaucher's disease, there is a need to review their therapeutic status. Here the treatment of type 1 (non-neuronopathic) Gaucher disease is evaluated with particular reference to the emerging role of oral N-butyldeoxynojirimycin (miglustat) as a substrate-reducing agent. This position statement represents the consensus viewpoint of an independent international advisory council to the European Working Group on Gaucher Disease.

Clinical Trials as Topic↗

PubMed2004

The structure of negative self-statements in children and adolescents: a confirmatory factor-analytic approach.

The aim of this study was to examine the nature and organization of a range of negative self-statements in children and adolescents, using a structural equations/confirmatory factor-analytic approach. A community sample of 978 children aged 7-16 years completed a questionnaire about the frequency with which they experienced a broad range of negative automatic thoughts. The outcome of comparative modeling provided strongest support for a model in which 4 distinct cognitive factors were all related to a single higher order factor. The 4 lower order factors related to cognitions on social threat, physical threat, personal failure, and hostility. The pattern of results was consistent across age and gender. Results were consistent with assumptions of cognitive specificity models of psychopathology, on the latent structure of automatic thoughts in children and adolescents.

Adolescent↗

PubMed2002

Rating of statements in an internal course evaluation: comparison between different groups of assessors.

The increased concern for accountability and quality improvement is inducing universities throughout Europe to evaluate and control performance. The establishment of criteria for educational quality, a requirement for a successful evaluation, was studied as part of an evaluation of the dental education programme at the Catholic University of Leuven. Criteria suggested by different groups (members of the internal evaluation commission including graduate and postgraduate students; members of the academic staff of the School of Dentistry, Oral Pathology and Maxillo-facial Surgery, and other members of the academic staff, not directly belonging to the school), were analysed by means of ANOVA with Scheffé posthoc tests to identify intergroup differences. It was hypothesized that a closer connection to the dental curriculum or a higher responsibility in the evaluation process would result in stricter criteria. For 108 different questions (in the form of statements with a six point Likert-type scale), members of the three groups had to indicate the score below which the quality would be considered suboptimal. Except for one question, no significant differences were found between ratings given by the members of the internal evaluation commission and other members of the School. Significant differences were found between non-school members and school- and/or commission-members. This study indicates that agreement on educational quality may be presupposed within an academic faculty and between members of the internal evaluation commission. However, the study also indicated that some caution should be exercised when 'external' teachers are included in the evaluation process.

Analysis of Variance↗

PubMed1997

Self-statements of test-anxious children: thought-listing and questionnaire approaches.

Two methods of assessing cognition in high, moderate, and low test-anxious children, thought listing and self-statement questionnaire approaches, were investigated under naturalistic test-taking conditions. The amount of cognition, its content, and its relation to level of anxiety and task performance were examined. States of mind (SOM) analyses were performed. Furthermore, the comparability of findings from both methods was examined. Results showed that, relative to the questionnaire method, the thought-listing procedure underestimated positive and coping cognition. The benefits of the questionnaire approach were seen in the power of its scores to predict task performance. Implications for cognitive assessment and treatment of anxious children are discussed.

Anxiety↗

PubMed1989

Self-statement modification in the treatment of child behavior disorders: a meta-analysis.

Reviews 48 outcome studies that applied self-statement modification (SSM) to childhood behavior disorders. Selection criteria restricted the review to controlled experimental studies and to children with disorders of clinically relevant severity. Meta-analysis was used to provide summary information about the observed effects of SSM. Collectively, SSM outcomes surpassed no treatment and placebo treatment by roughly a half of a standard deviation, on the average. Efficacy varied considerably with length of follow-up, experience level of therapists, age of children, outcome content area, and a number of other clinical and methodological differences among the studies. These qualifiers of observed efficacy are summarized and discussed in terms of implications for further research and application of SSM in child psychotherapy.

Adolescent↗

PubMed2005

Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society.

Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

Aged↗

PubMed2006

Grading evidence and recommendations for clinical practice guidelines in nephrology. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO).

Considerable variation in grading systems used to rate the strength of guideline recommendations and the quality of the supporting evidence in Nephrology highlights the need for a uniform, internationally accepted, rigorous system. In 2004, Kidney Disease: Improving Global Outcomes (KDIGO) commissioned a methods expert group to recommend an approach for grading in future nephrology guidelines. This position statement by KDIGO recommends adopting the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach for the grading of evidence and guidelines on interventions. The GRADE approach appraises systematic reviews of the benefits and harms of an intervention to determine its net health benefit. The system considers the design, quality, and quantity of studies as well as the consistency and directness of findings when grading the quality of evidence. The strength of the recommendation builds on the quality of the evidence and additional considerations including costs. Adaptations of the GRADE approach are presented to address some issues pertinent to the field of nephrology, including (1) the need to extrapolate from studies performed predominantly in patients without kidney disease, and (2) the need to use qualitative summaries of effects when it is not feasible to quantitatively summarize them. Further refinement of the system will be required for grading of evidence on questions other than those related to intervention effects, such as diagnostic accuracy and prognosis.

Global Health↗

PubMed1999

Residency application statements can predict postresidency training.

We sought to evaluate whether residency application statements regarding expected career paths are accurate predictors of early postresidency career paths. We evaluated 162 residents who completed a categorical medicine residency at Georgetown University Hospital between 1990 and 1998 to determine if their stated career plans (generalist practice, subspecialization, or undecided) at application predicted activity immediately after residency. Of 130 residents with defined postresidency plans at application, most 78 (60%) followed those career paths after graduation; 18 (67%) of 27 pursued their initial interest in generalist practice, and 60 (58%) of 103 pursued their stated interest in subspecialty training. We also noted a movement of residents toward generalism (79 [49%] of 162), despite low initial interest (27 [17%] of 162).

Career Choice↗

PubMed2004

Nursing roles in cancer prevention position statements.

Preventing cancer saves the labor of mending social, economic, cultural, and emotional upheaval engendered by a diagnosis of cancer. The four position statements discussed in this article provide a wealth of perspective regarding the professional organizations' views on cancer prevention and the important roles of nurses.

Genetic Counseling↗

PubMed2004

Consensus statements, positions, standards, and guidelines for pain and care at the end of life.

Standards, guidelines, and position and consensus statements by themselves do not change practice or improve pain management and care at the end of life. However, if they are used effectively, they support best practices, provide a forum for discussion of current recommendations, and provide nurses with the latest science and information to advocate for effective pain and symptom management.

Clinical Protocols↗

PubMed2000

Commentary on the workshop statement. Essentiality of and recommended dietary intakes for Omega-6 and Omega-3 fatty acids.

The Workshop document is welcome and important in its content and objectives. My comments deal with three topics, and are intended to set the historical perspective and take the discussion further as regards attitudes to infant nutrition. 1. ADVERSE ARACHIDONIC EFFECTS. I have some difficulty with the statement on the need to reduce LA (linoleic acid) content of the diet because 'This is necessary to reduce adverse effects of excesses of arachidonic acid and its eicosanoid products.'I have no problem with suggesting a reduction in the present level of LA in the USA but consider the expression 'adverse effects of arachidonic acid ...' to be misleading. Linking LA and AA in this way also implies a direct conversion of LA to AA, which is not the case. In fact, a very high dietary LA will reduce membrane AA. 2. EFA RATIOS. I suspect that their choice of omega 3/omega 6 ratio of 5.7 for early life may be high. Their recommendation for adults gives the much lower ratio of about 1.4. In view of the high requirement for DHA during neural development, I would have thought the ratios would have been the other way round or the same for infants as adults but with AA included in the omega 6. Also, I have some difficulty with the concept of a unitary ratio when there is clear disunity in the biological activities of the different parent and LCP EFAs. Hence the concept of omega 6/omega 3 ratio based on activity equality does not reflect the biological reality. 3. FDA RECOMMENDATIONS ON INFANT FORMULA. The Workshop essentially disagrees with the recent FDA recommendations on inclusion of LCPs in infant formula. There is, in addition, a need to re-think the requirements of the preterm infant beyond their recommendation.

Arachidonic Acid↗

PubMed2003

[Aptitude statements after head injury].

In an exemplary way the case study of M. S. shows that the statements concerning aptitude, which are based on intelligence structure tests, lead to false positive judgements under certain preconditions. Particularly if you postulate learning disorder and partial amnesia, the standard status diagnosis via intelligence and achievement tests has to be supplemented by a method of testing by which the dynamics of cognitive processes can be recorded. In the individual case study of M. S., learning disorder and partial amnesia have been disclosed via the dynamic learning test by Seitz (1998). They did not become manifest when only the routine diagnostic methods were applied. Against the background of socio-legal implications of the specific case some demands on psychological diagnosis and valuation are being discussed from the practician's point of view. They subsequently lead to certain demands concerning academic research. This applies above all to the dynamic learning test which is described above. It states as a result a linear relationship between the effort put into learning and the quantity of learning (the slope is interpreted as an individual constant). The dynamic learning test is also likely to be interesting in respect to pure research in general psychology and the formation of theories.

Adult↗