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PubMed1993

[Changes in sales of estrogens 1989-1992. Effects of a national consensus conference?].

In November 1990 a consensus conference was held in Norway on the use of oestrogens for perimenopausal and postmenopausal complaints, and for preventive purposes. The sales statistics reveal an increase in sales of drugs for hormone replacement therapy after the conference, but the trend had already started before the conference was held. We found the conference had had a statistically significant impact on sales of some of the drugs. We also collected information on marketing campaigns before and after the conference. Only a modest change was found in marketing efforts by the pharmaceutical industry. Presentations in the media were considered to have a strong impact on oestrogen promotion.

Adult↗
PubMed1993

Current recommendations of the joint national high blood pressure committee.

A great deal of new information has become available in the field of hypertension since the JNC report of 1988. The JNC V report has changed the categorization of blood pressure, modified suggested drugs for initial therapy, and recommended that diuretics or beta blockers be considered the first-line drugs of choice. Information concerning the J curve and end-stage renal disease has made therapeutic goals more challenging. One of the most important additions to this report is the new information on treating elderly patients, which had been lacking until last year. The report calls on pharmacists to assist with detecting, evaluating, and referring hypertensive patients. Pharmacists must take a leadership role in promoting compliance with antihypertensive therapy and can assist other health-care professionals by suggesting therapeutic alternatives to improve efficacy, reduce the frequency of administration, and lower costs. The complete JNC V report is an essential reference for the files of any pharmacist who is responsible for the care of hypertensive patients.

Blood Pressure↗
PubMedDate not supplied

Interlaboratory variability of the antiperinuclear factor (APF) test for rheumatoid arthritis.

The antiperinuclear factor (APF) test is as sensitive and specific for rheumatoid arthritis as the classical rheumatoid factor tests. Five European laboratories decided to perform a consensus study on the interlaboratory variability of the APF test. They used different donor cells, different conjugates and different criteria for positivity. However, the results differed by not more than one two-fold dilution step, when expressed in international units using WHO reference rheumatoid arthritis serum as the standard.

Antibodies, Antinuclear↗
PubMed1993

Cesarean section: analysis of the experience before and after the National Consensus Conference on Aspects of Cesarean Birth.

OBJECTIVE: To examine the effect of recommendations to reduce the cesarean section rate issued by the National Consensus Conference on Aspects of Cesarean Birth in 1986 on obstetric practices and to identify current patient factors that predict cesarean section. DESIGN: Descriptive retrospective cross-sectional study. SETTING: A tertiary care perinatal referral centre and a general teaching hospital with a level 2 nursery in Hamilton, Ont. PATIENTS: All patients who gave birth at the two hospitals in 1982 (4121 women) and 1990 (4431). MAIN OUTCOME MEASURES: Cesarean section rates and indications and predictors of cesarean section. RESULTS: Although a trial of vaginal delivery after cesarean section was offered 93% more often in 1990 than in 1982 (p = 0.0002), the rate of vaginal delivery increased only 2.6%, for a reduction of 8.7% in the total cesarean section rate and of 15% in the repeat cesarean section rate. The incidence rate and treatment of dystocia did not change. The rate of cesarean section for breech presentation remained unchanged, and fetal distress was rarely confirmed with pH measurement in scalp blood before cesarean section. The most important predictors of cesarean section in 1990 were previous cesarean section and labour induction. For the nulliparous women and the multiparous women with no previous cesarean section labour induction was the most important predictor. CONCLUSIONS: The rate at which patients with previous cesarean section are offered a trial of vaginal delivery has increased significantly since 1982; however, the total and repeat cesarean section rates have not decreased proportionally. Induction of labour is currently the most important correctable predictor of cesarean section. The active management of dystocia, efforts to increase the rate of vaginal breech delivery and appropriate methods to diagnose fetal distress need to be improved; such improvements should reduce the cesarean section rate further.

Adult↗
PubMed1996

Do consensus conferences influence their participants?

OBJECTIVE: To determine whether participation in a consensus conference on the assessment of dementia would influence conference participants with respect to their recommendations to primary care physicians for the assessment of dementia. DESIGN: Questionnaire before and after the conference. SETTING: Canadian Consensus Conference on the Assessment of Dementia, held in Montreal, Oct. 5 and 6, 1989. PARTICIPANTS: All 38 experts representing relevant health disciplines who participated in the consensus conference; 36 completed both questionnaires. OUTCOME MEASURES: Participants' opinion before and after the conference as to how frequently each of 28 manoeuvres (12 blood tests, 4 neurologic imaging procedures, 4 types of consultation and 8 "other" tests) should be ordered by primary care physicians as part of an assessment of a patient with dementia suspected in clinical grounds. RESULTS: For 18 (64%) of the 28 manoeuvres (10 of the 12 blood tests, 3 of the 4 neurologic imaging procedures and 5 of the 8 "other" tests), there was a shift in opinion after the conference toward recommending that primary care physicians order them less often; for 10 of these 18 (5 blood tests and 5 "other" tests) the shift was statistically significant. For the remaining 10 manoeuvres (36%) the shift in opinion was toward a recommendation that primary care physicians order them more often; the shift was not statistically significant for any of these 10 manoeuvres. CONCLUSION: Expert members of a consensus conference are influenced by the process of having participated in such a conference and are capable and willing to chance their initial recommendations when confronted with relevant data.

Clinical Laboratory Techniques↗