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PubMedDate not supplied

Traumatic brain injury research since the 1998 NIH Consensus Conference: accomplishments and unmet goals.

In 1998, an NIH sponsored Consensus Conference on Traumatic Brain Injury (TBI) Rehabilitation identified 30 different areas of needed research. A comprehensive review of recently generated research knowledge in the field of TBI has shown that a large number of Class III and IV evidence studies have been published, but relatively few of the more scientifically rigorous Class I or II studies. A rapid growth of publications on TBI rehabilitation has generated new knowledge in the epidemiology of TBI, the management of TBI and its secondary medical complications, rehabilitation of cognitive impairment, impact of TBI on community integration and quality of life, incidence of psychiatric dysfunction, and how caregivers and family members are affected. However, there is need to replicate many of these studies using more scientifically rigorous methodologies, while other areas of important TBI research remain largely unexplored.

Brain Injuries↗
PubMedDate not supplied

Use of acupuncture for chronic pain: optimizing clinical practice.

Increasingly, individuals are turning to complementary therapies to reduce or cope with chronic pain. Acupuncture, one of the oldest complementary therapies, originated from China more than 2500 years ago. It has steadily gained popularity in the United States over the last few decades as a modality for pain relief among both practitioners and patients. A 1997 National Institutes of Health consensus conference concluded that acupuncture needling releases endorphins and other neurotransmitters in the brain and should be considered as an appropriate pain treatment option. This article will provide an overview about acupuncture principles, discuss current clinical evidence, and identify acupuncture resources to optimize practice for chronic pain management.

Acupuncture Therapy↗
PubMed1998

Influence of the NIH Consensus Conference on Helicobacter pylori on physician prescribing among a Medicaid population.

OBJECTIVES: In February 1994, an National Institutes of Health (NIH) Consensus Development Conference panel unequivocally recommended antimicrobial therapy to eradicate Helicobacter pylori in the treatment of peptic ulcer disease. The goal of this study was to determine if these recommendations resulted in a change in physician prescribing among an underserved population. METHODS: Computerized Pennsylvania Medicaid data from January 1993 through February 1996 were used to evaluate prescribing patterns in the year before and 2 years after the NIH conference. An interrupted time series model, based on 12,737 outpatient peptic ulcer disease encounters, assessed the impact of the conference in influencing physician prescribing. RESULTS: The prescription of antimicrobial agents for the treatment of peptic ulcer disease significantly increased across the study period, from 6.5% in January 1993 to 10.2% in February 1996. Similarly, the prescription rate for the proton pump inhibitor, omeprazole, significantly increased from 9.4% in January 1993 to 25.6% in February 1996. Neither trend, however, could be attributed to the NIH Consensus Development Conference. Stratification by physician specialty, ulcer type, nonsteroidal anti-inflammatory drug use, and patient demographics did not affect these results. The traditional treatment approach, using H2-receptor antagonists, remained the preferred pharmacotherapy (72% of all prescriptions). CONCLUSIONS: Two years after the highly publicized NIH conference on the eradication of Helicobacter pylori, antimicrobial agents were not widely prescribed among the Pennsylvania Medicaid population. In treating this underserved population, physicians do not appear to be using recommendations developed by an NIH expert panel based on recent scientific advances.

Adult↗
PubMedDate not supplied

Revision of the Facts on Osteoporosis Quiz.

BACKGROUND: Few instruments exist that measure knowledge of osteoporosis, a health risk for 28 million Americans. The original Facts on Osteoporosis Quiz (FOOQ), which was theoretically informed by Orem's (1995) Self-Care Theory, was published in 1998. In 2000, the National Institutes of Health (NIH) held a consensus conference on osteoporosis in which previous knowledge was modified based on current science. OBJECTIVES: The goal was to update the original instrument based on the latest scientific evidence and to determine its psychometric properties. METHOD: The quiz content was validated by osteoporosis experts and is theoretically informed by Orem's (2001) Self-Care Theory. An iterative process was used to design an instrument with an acceptable reading level. Reliability, item discrimination, and item difficulty were assessed in a convenience sample of 256 participants. RESULTS: The revised quiz, content-based on the 2000 NIH osteoporosis consensus conference, includes 20 questions. The quiz has a content validity index of.87, an internal consistency reliability of.76 and a 6th grade reading level. Item difficulty and item discrimination are also reported. CONCLUSIONS: The revised version of the FOOQ provides a valid, reliable, and theoretically informed instrument with acceptable psychometric properties.

Bias↗
PubMed2001

Historical controversy in health technology assessment: the case of electronic fetal monitoring.

Electronic fetal monitoring (EFM) was introduced in the late 1950s as an alternative to traditional auscultation by stethoscope or fetoscope in the management of labor and delivery. The new technology was seen as a valuable tool in the prevention of cerebral palsy and other adverse fetal outcomes and diffused rapidly into clinical practice. In the late 1970s, some scepticism began to be voiced about the evidence for the effectiveness of EFM. The authors published a systematic review of the evidence in 1979 that concluded that there was insufficient evidence for the effectiveness of the routine use of EFM and a clear rise in the cesarean delivery rate associated with its use. The analysis was based on a thorough review of approximately 600 books and articles, but focused heavily on the evidence of four randomized clinical trials (RCTs) that had been published. An economic analysis further underscored the importance of this issue. The report was met with harsh ad hominem criticism from clinicians both in public venues and in the medical literature. Subsequently, additional RCTs were conducted and other analyzes were published, and in 1987 the American College of Obstetricians and Gynecologists recommended that auscultation was an acceptable alternative to EFM in routine labor and delivery. Yet, today EFM continues to be the standard of practice, used in 80% of labors in this country. The most important conclusion drawn from this experience is the need to evaluate new technologies before their widespread diffusion into clinical practice.

Attitude of Health Personnel↗
PubMed1998

Traditional and evidence-based acupuncture: history, mechanisms, and present status.

BACKGROUND: In 1983, the Southern Medical Journal advised its readers that a scientific basis might underlie the popular practice of ancient Chinese acupuncture. Recent studies have proven this to be correct, and a 1997 National Institutes of Health consensus panel recommended acupuncture as a useful clinical procedure. METHODS: Pertinent articles in the literature were reviewed, including our own research. Significantly, we had access to recent important studies from China. RESULTS AND CONCLUSIONS: Most of the 10,000 acupuncturists in the country today practice metaphysically explained "meridian theory" acupuncture using needles to supposedly remove blockages of a hypothesized substance "Qi." Scientific research has shown that healing is not by manipulating Qi but rather by neuroelectric stimulation for the gene expression of neuropeptides. Needles are not necessary. Evidence-based neuroelectric acupuncture requires no metaphysical rituals. It is a simple, useful clinical tool for pain modulation and other conditions and can be easily taught to physicians.

Acupuncture Therapy↗
PubMed1997

Consensus or confusion: a review of existing national guidelines on Helicobacter pylori-related disease.

Since the discovery of Helicobacter pylori, a considerable amount of progress has been made in our understanding of H. pylori-related conditions. However, considerable confusion exists in relation to the optimal application of these findings to clinical practice, particularly at a primary care setting. In the USA the National Institutes of Health published guidelines outlining the role of H. pylori in peptic ulcer disease in 1994. Since then at least eight European countries have issued guidelines. The differences that exist between these documents reflect the rapid evolution of opinion on how the diagnosis and treatment of H. pylori should influence the traditional management of conditions presenting with dyspepsia. It is clear that little controversy surrounds the approach to duodenal and gastric ulceration. Patients with gastric mucosa-associated lymphoid tissue lymphoma need careful follow-up. The greatest level of disagreement exists in relation to the management of non-ulcer dyspepsia and dyspepsia in the community. These areas, in addition to the role of H. pylori eradication when non-steroidal antiinflammatory drugs or long-term acid suppressor are considered, need further evaluation. Most countries now recommend proton pump-based triple therapy regimes as first-line treatment for the eradication of H. pylori.

Consensus Development Conferences, NIH as Topic↗