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PubMed1997

The primary care of patients with schizophrenia: a search for good practice.

The proportion of patients with schizophrenia who lose contact with the secondary services is between 25% and 40%. The general practitioner remains the health care professional most likely to be in contact with such patients. A consensus group of 14 members met on four occasions, reviewed the relevant literature, and developed good-practice guidelines in five areas: establishing a register and organizing regular reviews; comprehensive assessments; information and advice for patients and carers; indications for involving specialist services; and crisis management. The guidelines are presented and their supporting evidence summarized.

Consensus Statements as Topic↗
PubMed1997

Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy.

OBJECTIVES: To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS: To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES: 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE: Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and classification, as well as documents on diagnosis and classification from authorities in the United States, Europe and Australia and from special interest groups. VALUES: High priority was given to the principle of preventing adverse maternal and neonatal outcomes through the provision of diagnostic criteria for severity and prognosis and through dissemination of reliable and pertinent information and research results using a common language. BENEFITS, HARMS AND COST: Higher degree of vigilance in diagnosing hypertensive disorders in pregnancy, allowing for earlier assessment and intervention, and more efficient dissemination of comparative information through common language. No harm or added cost is perceived at this time. RECOMMENDATIONS: (1) A diastolic blood pressure of 90 mm Hg or more should be the criterion for a diagnosis of hypertension in pregnancy and should trigger investigation and management. Except for very high diastolic readings (110 mm Hg or more), all diastolic readings of 90 mm Hg or more should be confirmed after 4 hours. (2) A regularly calibrated mercury sphygmomanometer, with an appropriate-sized cuff, is the instrument of choice. A rest period of 10 minutes should be allowed before taking the blood pressure. The woman should be sitting upright and the cuff positioned at the level of the heart. (3) Both Korotkoff phase IV and V sounds should be recorded, but the phase IV sound should be used for initiating clinical investigation and management. (4) A urine protein level of more than 0.3 g/d should be the criterion for a diagnosis of proteinuria; 24-hour urine collection should be the standard method for determining proteinuria. (5) Edema and weight gain should not be used as diagnostic criteria. (6) Hypertensive disorders diagnosed during pregnancy should be classified as pre-existing hypertension; gestational hypertension with or without proteinuria; pre-existing hypertension with superimposed gestational hypertension with proteinuria; and unclassifiable antenatally but final classification 42 days after delivery. VALIDATION: Except for expert opinions and reviews solicited for this project, these recommendations need to be field tested and validated in Canada. Guidelines endorsed by the Canadian Hypertension Society and the Society of Obstetricians and Gynaecologists of Canada.

Blood Pressure Determination↗
PubMed1997

Guidelines of the previous consensus conference and recent developments.

This article reviews the major changes that have occurred since the last Canadian consensus conference on gastroesophageal reflux disease (GERD), which was held four years ago. There were developments in the understanding of the pathophysiology of this disease and improvements in the methods of its investigation and management. Esophageal and extraesophageal complications have also been better defined. Since 1992 new knowledge on nitric oxide has been gained and several new inflammatory cytokines have been developed. Improved understanding of the mechanism of the hypersensitive esophagus helped to explain the presence of clinical symptoms with normal endoscopic findings. This also improved interpretation of the role of 24 h pH monitoring and 24 h pH with motility recording. There is better understanding of the role of H2 receptor antagonists and prokinetics and an increasing confidence in the long term safety of proton pump inhibitors (PPIs). The most important changes occurred in surgery with the introduction of laparoscopic fundoplication. Patients with Barrett's esophagus who are too ill for esophagectomy may now be enrolled in surveillance because it is possible to deal with dysplasia and small cancers with photodynamic therapy. As an introductory lecture to the consensus conference, this article also deals with the subject of health economics and discusses the necessity and the dangers involved in devising treatment guidelines. It indicates that guidelines change with advancing knowledge, and emphasizes that physicians' primary duty is toward their patients. Therefore, guidelines devised here should be adjusted to the individual needs of patients. Organizational aspects of the present conference are also described.

Canada↗
PubMed1997

Measuring multidrug resistance expression in human malignancies: elaboration of consensus recommendations.

Before the prognostic significance of P-glycoprotein (P-gp) expression can be properly evaluated in prospective clinical trials of P-gp modulators, standard techniques for the measurement of P-gp must be widely accepted. Several multicenter trials have demonstrated large discrepancies in the observed levels of P-gp expression in the same clinical samples evaluated at different centers. The greatest discrepancies occurred with samples that expressed low levels of P-gp. Although standardized procedures have dramatically increased the interlaboratory reproducibility of flow cytometry and polymerase chain reaction assays, data from immunocytochemistry remain difficult to interpret. Consensus recommendations are presented for improving data reproducibility. These recommendations emphasize the importance of using calibrated batches of antibodies and two different antibodies for immunocytochemistry, the need for an internal standard for reverse transcriptase-polymerase chain reaction (RT-PCR) assays, the need for the presentation of data as a continuous variable, and the need for setting standard parameters for flow cytometry. It is also extremely important for the success of clinical trials that multiple techniques be employed to insure accurate measurement of P-gp expression.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1997

[Catheter infections: before and after the Consensus Conference].

The use of intravascular devices in the usual and daily clinical practice, used as diagnostic or as therapeutic means, is a reality nowadays, present in all hospitals of our medium, and it is increasing. In the area of intensive care, it constitutes a routine and prolonged procedure, and its contribution within the hospitality area, in the context of complications derived from its use, is important. The most frequent complication derived from the use of intravascular catheters or devices, is infection, which manifests itself either locally or systemically. At present it is considered that the bacteremia associated with a catheter, is by far the most common nosocomial cause of bacteremia in our environment, along with the associated morbido-mortality which this implies, the prolonged hospitalization, and the increased cost of health care. The connection of these catheters is an entry site which should be considered, and it is taking on greater significance in these past years. As always, the prophylaxis measures which are applied rigorously and on a daily manner, are the corner stone on which the possibility of minimizing these complications rests.

Bacteremia↗
PubMed1997

[Modification of the prescribing practice of the physician by decisions of drug committees, specialty groups and consensus conferences].

The Drug Commission of the Medical Profession influences the prescribing behaviour of physicians operating under the National Health Scheme in various ways with various grades of obligation: 1. via announcements in the journal of the society of physicians of Germany "Deutsches Arzteblatt" with particular focus on aspects of drug safety which the German physician to consider according to the legal opinion has; 2. via the "therapeutic guidelines" according No. 14 of "the guidelines for drug therapy" which the physician operating under the National Health Scheme has to take into account; 3. via a "compendium about drug prescriptions", edited by members of the Drug Commission listing ca. 800 recommended drugs from a total of ca. 2600 individual drugs on the national market: 4. via other means of via other means of communication such as fax-on-demand-service or the bulletin "drug prescription in the medical practice" with contents of significantly less definite character.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

[Guidelines in surgery: from the viewpoint of clinical research].

The concept of clinical practice guidelines is full of sociological conditions which cannot be transferred from one country to another without local tailoring. The quality of health care emphasizes both individuals and groups, defines the probability of desired health outcomes, and requires concordance with contemporary professional knowledge. In this context, the experience-based, intuitive judgement of experts is heavily underestimated in the Angloamerican literature. Clinical guidelines are systematically developed statements which assist doctors and patients in finding appropriate health care. They are not dictatory in nature. In Germany, a three-phase model is preferred: check lists immediately, consensus-processes for intermediate time periods, and finally consensus with best-evidence synthesis.

Consensus Statements as Topic↗