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PubMed1990

EPA's control technology approach to assisting states and regions with air toxics problems: five case studies.

The Environmental Protection Agency (EPA) announced in June 1985 a new strategy to reduce public exposure to toxic air pollutants in the ambient air. Over the next 5-8 years, the strategy called for State and Local authorities to take on more of the lead regulatory role, with the Agency providing technical and financial assistance to their efforts. The shift in emphasis and responsibility from the Federal level to State and Local air toxics programs and the need to transfer expertise from the Federal level to the appropriate State or Local level prompted EPA's Office of Research and Development (ORD) and EPA's Office of Air Quality Planning and Standards (OAQPS) to develop and implement an innovative technical assistance program. This program is called the Control Technology Center (CTC). It has since been expanded to include technical assistance in the area of control of air toxics, particulate matter, and volatile organic compounds (VOCs); emission measurements; and other areas where expertise is available to ORD and OAQPS. During the CTC's first year of operation, operating guidelines were developed and three categories of technical assistance were established. These categories are telephone HOTLINE calls, direct engineering assistance, and technical guidance projects. The CTC HOTLINE is a special telephone number which State and Local Agencies can call for easy access to EPA personnel who can provide prompt assistance in a variety of ways including discussions, references to pertinent literature, and referrals to other EPA personnel. In some cases, a HOTLINE call will require more in-depth engineering analysis indicating a need for direct engineering assistance. These projects tend to be short-term (2 to 3 months) and specific in nature. In some cases, several agencies may indicate a need for information on the same source, or a group of Agencies may make a joint request. In these cases, the CTC Steering Committee, a group who advises the CTC managers, may decide that a technical guidance project is indicated. Technical guidance projects are longer-term and are intended to be of broad interest, useful to many agencies. This paper discusses the development of the CTC, experience to date with its operation, and future plans. In addition, five CTC projects are discussed to illustrate the assistance provided.

Air Pollutants↗
PubMed1988

The role of evidence in the consensus process. Results from a Canadian consensus exercise.

As part of a consensus conference on cesarean birth, the ten-member consensus panel rated 224 clinical scenarios on their appropriateness for a cesarean section. Ratings were obtained before and immediately after the consensus conference. The level of agreement (consensus) among panelists was assessed separately for scenarios with good research evidence (evidence scenarios) and for those with conflicting, poor, or no evidence (nonevidence scenarios). For each scenario, consensus between panelists was measured as total agreement, partial agreement, or disagreement on the appropriateness of a cesarean section. Before the conference, total or partial agreement existed for a larger percentage of evidence than nonevidence scenarios (85% vs 30%), with the pattern reversed for disagreements (15% vs 70%). After the conference, possible improvement in the level of consensus actually occurred for 71% of the evidence and only 24% of the nonevidence scenarios. Thus, the consensus process, as structured here, was sensitive to the availability of good evidence and suggests that aspects of both expert and public processes can successfully be combined. However, an improvement could be made in the process by grading final recommendations according to the availability of rigorous research evidence.

Breech Presentation↗
PubMed1987

Effects of the National Institutes of Health Consensus Development Program on physician practice.

The effects of the National Institutes of Health Consensus Development Program on physician behavior were investigated. The medical records of 2770 patients treated in ten hospitals throughout the state of Washington were reviewed to determine if quality of care improved with respect to 12 recommendations put forth by four consensus panels concerning surgical management of primary breast cancer, the use of steroid receptors in breast cancer, cesarean childbirth, and coronary artery bypass surgery. Care was studied during 24 months before and 13 to 24 months after each consensus conference. Results showed that the conferences mostly failed to stimulate change in physician practice, despite moderate success in reaching the appropriate target audience. It was concluded that the consensus development conference is an important educational tool whose effects might be enhanced by focusing on areas of practice that need improvement and by encouraging follow-up programs at the state and local level.

Breast Neoplasms↗
PubMed1987

Consensus conferences.

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Consensus Statements as Topic↗