Consensus Development Workshop Research Articles

DEVELOPING A HEALTH INEQUALITY/INEQUITY CONCEPTUAL FRAMEWORK TO SUPPORT EVIDENCE SYNTHESIS STUDIES

Abstract This study aimed to develop a conceptual framework to guide people conducting evidence syntheses, to enable them to visualise links, and intersectionality between various factors that affect health inequality or inequity. Currently, there is no clarity or guidance on how health inequality or inequity should be defined or considered in evidence synthesis, despite recent improvement in reporting standards. In addition, current guides are limited in their ability to provide a roadmap for reviewers that enables them to visualise the links and intersectionality between various factors that affect health inequality or inequity. A series of consensus development workshops were conducted in Spring 2023. Experts in evidence synthesis and health inequality or inequity participated. The workshops were based on methods used previously by researchers developing clinical guidelines. Workshop discussions were centred on (1) important issues/barriers that prevent researchers from having a consensus definition for health inequality or inequity, and (2) how researchers could consider intersectionality of factors affecting health inequality or inequity? Thematic analysis of workshop data and a prioritisation workshop informed the development of a novel conceptual framework. This will be presented and address in particular, ideas around the accumulation of advantage and disadvantage across the life course alongside other dimensions of health and health inequality or inequity.

POS0059-PARE DELAY TO DIAGNOSIS IN AXIAL SPONDYLOARTHRITIS – TIME FOR A GOLD STANDARD APPROACH

Background:In the UK, the average time to diagnosis of axial SpA is 8.5 years (1). There is little evidence this has improved, despite the acceptance of MRI use in diagnosis (2). A recent review identified significant clinical, economic and humanistic burden from delayed diagnosis (3). Urgent action is needed to ensure delayed diagnosis is not normalized.Objectives:We created a proposal for a Gold Standard time to diagnosis for axial SpA and a national implementation plan (4) through consensus development with patients, healthcare professionals and professional bodies.Methods:A.A scoping literature review identifying where delays occur, from first symptom onset to diagnosis by a rheumatologist, and potential solutions. From this, a summary report / draft plan was produced for consultationB.A national consultation survey to elicit views on the proposals from clinicians, healthcare professionals, professional societies and patientsC.Structured feedback to written proposals via e-consultation with clinicians and patientsD.A consensus development workshop to finalise the Gold Standard and implementation plan.Results:The literature review identified four delays:1. People do not know axial SpA may be a cause of their chronic back pain2. Primary care practitioners may not recognise features of axial SpA3. People may be referred to non-rheumatologists who may not recognise axial SpA promptly4. Rheumatology and radiology teams may not optimally request or interpret investigations.202 participants responded to the summary report (74% patients, 21% healthcare professsionals, 5% professional societies). All supported the principles behind the gold standard time to diagnosis. Qualitive analysis confirmed agreement with the proposed solutions, underscoring the importance of education and visibility for axial SpA within primary care and increased public awareness. Additional proposals were suggested, including a tool in primary care to run audits on IT systems.40 clinicians contributed to the e-consultation and 55 clinicians, policy makers, social marketing experts, health journalists and patients attended the consensus workshop. Consensus was reached on a gold standard time to diagnosis of one year, and the principles, key components and phasing of the implemention plan. This included: public awareness about axial SpA symptoms; a primary care clinical champions programme; creating a referral pathway from primary care direct to rheumatology; a secondary care service educational programme.Conclusion:There is consensus from UK axial SpA clinicians, patients and professional societies on the need for a Gold Standard time to diagnosis of axial SpA of one year, so that patients can live happy, healthy and productive lives.

Developing a core outcome set for future infertility research: an international consensus development study† ‡.

STUDY QUESTIONCan a core outcome set to standardize outcome selection, collection and reporting across future infertility research be developed?SUMMARY ANSWERA minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential treatments for infertility.WHAT IS KNOWN ALREADYComplex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret.STUDY DESIGN, SIZE, DURATIONA three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries).PARTICIPANTS/MATERIALS, SETTING, METHODSHealthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus science methods.MAIN RESULTS AND THE ROLE OF CHANCEThe core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable.LIMITATIONS, REASONS FOR CAUTIONWe used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition and an arbitrary consensus threshold.WIDER IMPLICATIONS OF THE FINDINGSEmbedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set.STUDY FUNDING/COMPETING INTEREST(S)This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. The funder had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data, or manuscript preparation. B.W.J.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). S.B. was supported by University of Auckland Foundation Seelye Travelling Fellowship. S.B. reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.J.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. A.S. reports consultancy fees from Guerbet. E.H.Y.N. reports research sponsorship from Merck. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form.TRIAL REGISTRATION NUMBERCore Outcome Measures in Effectiveness Trials Initiative: 1023.

Best practice guidance for the use of strategies to improve retention in randomized trials developed from two consensus workshops

ObjectivesTo develop best practice guidance for the use of retention strategies in randomized clinical trials (RCTs). Study Design and SettingConsensus development workshops conducted at two UK Clinical Trials Units. Sixty-six statisticians, clinicians, RCT coordinators, research scientists, research assistants, and data managers associated with RCTs participated. The consensus development workshops were based on the consensus development conference method used to develop best practice for treatment of medical conditions. Workshops commenced with a presentation of the evidence for incentives, communication, questionnaire format, behavioral, case management, and methodological retention strategies identified by a Cochrane review and associated qualitative study. Three simultaneous group discussions followed focused on (1) how convinced the workshop participants were by the evidence for retention strategies, (2) barriers to the use of effective retention strategies, (3) types of RCT follow-up that retention strategies could be used for, and (4) strategies for future research. Summaries of each group discussion were fed back to the workshop. Coded content for both workshops was compared for agreement and disagreement. Agreed consensus on best practice guidance for retention was identified. ResultsWorkshop participants agreed best practice guidance for the use of small financial incentives to improve response to postal questionnaires in RCTs. Use of second-class post was thought to be adequate for postal communication with RCT participants. The most relevant validated questionnaire was considered best practice for collecting RCT data. Barriers identified for the use of effective retention strategies were: the small improvements seen in questionnaire response for the addition of monetary incentives, and perceptions among trialists that some communication strategies are outdated. Furthermore, there was resistance to change existing retention practices thought to be effective. Face-to-face and electronic follow-up technologies were identified as retention strategies for further research. ConclusionsWe developed best practice guidance for the use of retention strategies in RCTs and identified potential barriers to the use of effective strategies. The extent of agreement on best practice is limited by the variability in the currently available evidence. This guidance will need updating as new retention strategies are developed and evaluated.

Best Practice Guidance for the Use of Strategies to Improve Retention in Randomised Trials: Results From Two Consensus Development Workshops

Best Practice Guidance for the Use of Strategies to Improve Retention in Randomised Trials: Results From Two Consensus Development Workshops

Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK.

BackgroundPeople of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK.MethodsWe conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine.ResultsThe BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation.ConclusionWe developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3177-8) contains supplementary material, which is available to authorized users.

Consensus guidelines on management of childhood convulsive status epilepticus.

Status epilepticus has a wide etiological spectrum, and significant morbidity and mortality. Management using a pre-determined uniform protocol leads to better outcomes. Multiple protocols for management of childhood status epilepticus are available, without much consensus. A 'Multi-disciplinary Consensus Development Workshop on Management of Status Epilepticus in Children in India' was organized. The invited experts included Pediatricians, Pediatric neurologists, Neurologists, Epileptologists, and Pediatric intensive care specialists from India, with experience in the relevant field. Experts had previously been divided into focus groups and had interacted on telephone and e-mail regarding their group recommendations, and developed consensus on the topic. During the meeting, each group presented their recommendations, which were deliberated upon by the house and a consensus was reached on various issues; the document was finalized after incorporating suggestions of experts on the draft document. To provide consensus guidelines on evaluation and management of convulsive status epilepticus in children in India (excluding neonatal and super-refractory status epilepticus). Each institution should use a pre-determined protocol for management of status epilepticus; pre-hospital management and early stabilization is the key to a satisfactory outcome of status epilepticus. Pharmacotherapy should not be delayed for any investigations; the initial management should consist of a parenteral benzodiazepine by any route feasible. Subsequent management has been detailed. The group also felt the need for more epidemiological research on status epilepticus from India, and identified certain research areas for the purpose.

Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia.

BackgroundFetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia.MethodAn online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed.ResultsAmong the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the 16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities.ConclusionReferral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia.

Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia

BackgroundFetal alcohol spectrum disorders (FASD) are underdiagnosed in Australia, and health professionals have endorsed the need for national guidelines for diagnosis. The aim of this study was to develop consensus recommendations for the diagnosis of FASD in Australia.MethodsA panel of 13 health professionals, researchers, and consumer and community representatives with relevant expertise attended a 2-day consensus development workshop to review evidence on the screening and diagnosis of FASD obtained from a systematic literature review, a national survey of health professionals and community group discussions. The nominal group technique and facilitated discussion were used to review the evidence on screening and diagnosis, and to develop consensus recommendations for the diagnosis of FASD in Australia.ResultsThe use of population-based screening for FASD was not recommended. However, there was consensus support for the development of standard criteria for referral for specialist diagnostic assessment. Participants developed consensus recommendations for diagnostic categories, criteria and assessment methods, based on the adaption of elements from both the University of Washington 4-Digit Diagnostic Code and the Canadian guidelines for FASD diagnosis. Panel members also recommended the development of resources to: facilitate consistency in referral and diagnostic practices, including comprehensive clinical guidelines and assessment instruments; and to support individuals undergoing assessment and their parents or carers.ConclusionsThese consensus recommendations provide a foundation for the development of guidelines and other resources to promote consistency in the diagnosis of FASD in Australia. Guidelines for diagnosis will require review and evaluation in the Australian context prior to national implementation as well as periodic review to incorporate new knowledge.

Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions

The aim of this paper is to present a set of nursing clinical practice guidelines for individuals undergoing percutaneous coronary interventions (PCIs) together with a summary of the evidence to support these recommendations. Percutaneous coronary intervention is a common procedure requiring expert nursing care delivered within an interdisciplinary team. Although evidence-based medical practice guidelines exist, they include minimal information to guide nursing-specific care. GUIDELINES DEVELOPMENT: The guidelines development process used a framework of the patient journey. Three steps leading up to this paper were undertaken: (1) a comprehensive literature review; (2) a consensus development workshop; and (3) a modified Delphi technique to refine the guideline recommendations. Clinical practice guidelines to support interventional cardiology nursing care are limited. This paper represents an important contribution toward meeting this need. These guidelines, developed within a context of Australian and New Zealand nursing practice, provide an important foundation to enable benchmarking and ongoing developing clinical practice standards.

NEUROSURGEON TRANSITION TO RETIREMENT

Recent studies of age-related effects on cognition and performance have raised concerns about the appropriate timing and regulatory surveillance of retirement for surgeons. Little is known about the practice patterns and retirement plans of aging neurosurgeons. Analyses of informed opinions on possible regulatory options are also lacking. During a consensus development workshop conducted at the 2007 Annual Meeting of the Congress of Neurological Surgeons, participants collected data regarding neurosurgeons' retirement plans, reviewed expert background information, and assessed opinions. Participants submitted data and discussion points throughout the session using digital handheld devices. These data were then statistically analyzed, with particular attention to shifts in opinion and emergence of consensus after the presentation of expert material and discussion. Neurosurgeons strongly oppose government regulation of retirement using uniform retirement age regulations. The most favored policy option, initially, particularly among older neurosurgeons, was status quo. After consensus development, the most favored policy option was local regulation by hospital privileging bodies. Neurosurgeon age, but not perceived ability to reach financial retirement goals, significantly influenced opinions. Retirement age is an area of active government regulation in other professions. Neurosurgeons seem to favor a flexible system of regulation based on local and quality standards, rather than national age-based thresholds. The Congress of Neurological Surgeons Consensus Conference process offers a viable methodology for initiating discussion of important policy issues facing organized neurosurgery, engaging the informed input of practicing neurosurgeons, and formulating preliminary strategies for pursuit by stakeholder neurosurgical policy organizations.

Moving the QALY Forward: Rationale for Change

In November 2007, ISPOR convened the “Building a Pragmatic Road: Moving the QALY Forward” Consensus Development Workshop where thought leaders presented and discussed the following: 1) defining and refining the quality-adjusted life-year (QALY) by analyzing the underlying assumptions; 2) developing alternative paradigms and measures; 3) retaining the QALY and enhancing it with additional methods; and 4) incorporating a variety of decision-makers’ needs. The goal of this workshop on the QALY was to reach consensus among the thought leaders on these broad categories, with recommendations for specific, applicable actions. Workshop participants are listed below. Before this workshop, participants were divided into five groups and each group met via teleconference to develop their arguments on one of the following topics: 1) defining the QALY; 2) considering alternate definitions of the QALY and defining the issues; 3) incorporating an experience-based approach to the QALY; 4) defining the importance of bridging past QALY information to future QALY information; and 5) defining the value of the QALY from a health-care decision-makers’ perspective. Using a modified “forming–storming–norming–performing” model [1] for consensus development during the 2-day workshop, each group presented arguments about the QALY, received feedback on their arguments and modified, if needed. Then a group of representatives from each group was convened to develop consensus statements on “moving the QALY forward” based on the arguments presented. These consensus statements were then debated, and agreed upon by workshop participants, and then formulated into the final article in this Special Issue. This Value in Health Special Issue describes the arguments presented during the consensus development workshop on the QALY. Articles 2–6, “QALYs: The Basics,” “QALYs: Some Challenges,” “A Different Approach to Health State Valuation,” “Retaining, and Enhancing, the QALY,” and “The Use of QALYs in Clinical and Patient Decision-Making: Issues and Prospects,” present the arguments. Article 7, “Towards a Consensus on the QALY,” defines eight consensus statements developed by the “consensus developing group” and presents a way forward. The last two articles in this Special Issue, “Editorial: On The Benefits of Modeling Using QALYs for Societal Resource Allocation: The Model Is the Message” and “Editorial: Moving The QALY Forward or Just Stuck in Traffic?” are provided by two guest editors, selected by the Value in Health Editor-in-Chief to critique this Special Issue. The appointment of guest editors is an important component of Value in Health’s policy on Special Issues and is intended to ensure that a broad range of views is expressed. The guest editors did not participate in the QALY Consensus Development Workshop, so their reactions are based on the written articles alone. Garrison is broadly welcoming of this initiative and considers that the articles in this Special Issue are a fair and useful representation of the current debate about health state utilities and preferences. Nevertheless, he also points out that several important issues were not discussed, or not resolved satisfactorily. He also points out that the relevance of QALYs for resource allocation may depend crucially on the values underlying the organization of the health-care system in a given country. For example, QALYs may have a different relevance in a country like the United Kingdom, with a government-funded national health service, than they may have in a country like the United States. On the other hand, Reed Johnson is much more frustrated with the lack of progress with research within the QALY paradigm and feels that more progress would be made if we looked for alternatives. These could be alternative methods for elucidating preferences, such as contingent valuation and discrete choice experiments, or different decision-making approaches, such as that currently being proposed by the Institute for Quality and Efficiency in Health Care in Germany. We support further research into, and experimentation with, alternatives to the QALY. As these approaches become more often used in practice, their difficulties will become better known and, hopefully, resolved. Nevertheless, the focus on this workshop was on experience with the QALY. Perhaps, similar workshops, discussing experiences with using alternative measures, will be possible in the future. We hope that this Value in Health Special Issue on “Moving the QALY Forward: Building a Pragmatic Road” is both informative and serves as a platform for future debate and consensus development on the QALY.

Editorial: On the Benefits of Modeling Using QALYs for Societal Resource Allocation: The Model Is the Message

While moderating a debate at the recent ISPOR meeting in Athens, Professor Milt Weinstein suggested that maybe we should focus more on the “LY” (life-years) and less on the “QA” (quality-adjusted). I interpreted this comment to mean that health state utilities are only one element in the larger bioclinical models that are at the core of many cost-utility analyses. Typical disease-based cost-utility models also include intermediate end points to reflect disease progression, the probabilities of clinical events, and projected survival, as well as the cost elements. The focus of this quality-adjusted life-years (QALY) consensus development workshop was, however, on health state utilities—one element in the entire model. We have argued elsewhere that similar benefit-risk models, including health state utilities, could be very helpful in making regulatory approval deliberations more systematic and transparent [1]. In my view, the use of integrative, quantitative models to assist health-care decision-makers is more important than precisely how morbidity (i.e., health-related quality of life) is reflected in those models. On the whole, these articles provide a fair and very useful representation of the current state of the debate about health state utilities and preferences in our field: namely, there remain several persistent and contentious issues—both about the theory and the practice. As noted, the ISPOR Consensus Development Workshop was motivated by the challenge that Nobel laureate Daniel Kahneman posed in his ISPOR address in 2005. He reprises that argument about human adaptability to illness in his contribution to this collection. Although these final Workshop articles did not resolve any of these issues, the Consensus Development Group should be congratulated on fashioning eight highlevel principles [2] that capture the state of the debate as well as a way forward, including the pragmatic next step of calling for the development of a reference method for estimating QALYs. In my view, this is a useful goal to pursue, but it will be helpful to keep in mind some higher level distinctions that were either implicit or unaddressed in these articles. The Workshop articles did not explore two related foundational issues in any depth: 1) the use of the QALY in normative versus positive (or behavioral) economics; and 2) welfarism versus extra-welfarism as a basis for the use of the QALY in societal resource allocation.

Editorial: Moving the QALY Forward or Just Stuck in Traffic?

1RTI Health Solutions, ResearchTriangle Institute, RTP, NC, USAThis Special Issue summarizes an ISPOR Consensus Develop-ment Workshop held in November 2007 on methods for estimat-ing and applying quality-adjusted life-years (QALYs) [1–7].Participants were charged with the agenda of “Moving theQALY Forward,” with the primary objective of seeking consen-sus on how to define and refine the QALY. The authors analyzethe underlying assumptions, offer critiques of QALY methods,and propose alternative approaches. Although the contributionsprovide a reasonable overview of the current state of QALYs,they confirm several rather unfortunate truths. First, the scientificfoundations of conventional QALYs remain unsatisfactory—being essentially unchanged since their inception. Second, manypractitioners and policymakers remain content to apply QALYsuncritically and unapologetically for the purposes of health-technology assessment (HTA). As a consequence, one must con-clude that the prospects for moving the science and practice ofQALYs forward are discouraging.It is remarkable that three decades of QALY research haveyielded so little substantive methods development. This lack ofprogress is particularly discouraging in light of the rapid inter-national growth of HTA and increased attention to comparativeeffectiveness issues in the United States. Rather than movingHTA science and practice forward, QALY research appears to bestuck in a methodological traffic jam.

Canadian perspectives in glaucoma management: The role of central corneal thickness

Background: To propose consensus working recommendations for the role of central corneal thickness in the management of open-angle glaucoma.Methods: This work is based on evidence from a review of the glaucoma literature, a Canadian consensus development workshop, and the personal clinical experience of the participating Canadian ophthalmologists.Results: Guidelines were developed to provide eye care practitioners and their patients with support in the decision-making process for management of glaucoma or those at risk for developing glaucoma.Interpretation: Further studies will be helpful in understanding the role of central corneal thickness in glaucoma management, and these guidelines will need to be revised periodically as new information becomes available.

Updating Consensus in Portal Hypertension: Report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension

Portal hypertension is the hemodynamic abnormality associated with the most severe complications of cirrhosis, including ascites, hepatic encephalopathy and bleeding from gastroesophageal varices. Since variceal bleeding is a medical emergency associated with significant morbidity and mortality, the evaluation of diagnostic tools and the design and conduct of good clinical trials for the treatment of this condition have always been difficult. Awareness of these difficulties has led to the organization of a series of meetings aimed at reaching consensus on the definitions of some key events related to portal hypertension and variceal bleeding, and at producing guidelines for the conduct of trials in this field. Such meetings took place in Groningen, the Netherlands in 1986 ( 1. Burroughs AK Methodology and Review of Clinical Trials in Portal Hypertension. Excerpta Medical Congress Service No 763, Amsterdam, New York, Oxford1987 Google Scholar ), in Baveno, Italy in 1990 (Baveno I) ( 2. de Franchis R Pascal JP Ancona E Burroughs AK Henderson JM Fleig W et al. Definitions, methodology and therapeutic strategies in portal hypertension A consensus development workshop. J Hepatol. 1992; 15: 256-261 Abstract Full Text PDF PubMed Scopus (164) Google Scholar ) and in 1995 (Baveno II) ( 3. de Franchis R Developing consensus in portal hypertension. J Hepatol. 1996; 25: 390-394 Abstract Full Text PDF PubMed Scopus (121) Google Scholar , 4. Portal Hypertension II Proceedings of the Second Baveno International Consensus Workshop on Definitions, Methodology and Therapeutic Strategies Oxford, Blackwell Science. 1996 Google Scholar ), in Milan, Italy in 1992 ( 5. Spina GP Arcidiacono R Bosch J Pagliaro L Burroughs AK Santambrogio R et al. Gastric endoscopic features in portal hypertension final report of a consensus conference. J Hepatol. 1994; 21: 461-467 Abstract Full Text PDF PubMed Scopus (103) Google Scholar ), and in Reston, USA ( 6. Grace ND Groszmann RJ Garcia-Tsao G Burroughs AK Pagliaro L Makuch RW et al. Portal hypertension and variceal bleeding an AASLD single topic symposium. Hepatology. 1998; 28: 868-880 Crossref PubMed Scopus (330) Google Scholar ), in 1996. All these meetings were successful and produced consensus statements on some important points, although several issues remained unsettled.

Indian Consensus for Prevention of Hypertension and Coronary Artery Disease: Indian Consensus Group: Report of a Consensus Development Workshop Conducted by the Indian Society of Hypertension and the International College of Nutrition, New Delhi, 1995

There is evidence that rapid changes in diet and lifestyle combined with high levels of lipoprotein (a) are the main genetic causes of coronary artery disease (CAD) in Indians. Although CAD and hypertension have become a public health problem in India, there is no consensus on diet and lifestyle guidelines and desirable levels of risk factors for prevention. In the urban adult population between 25 and 64 years of age, the prevalence of CAD appears to be about 90/1000 and of hypertension about 160/1000. Both hypertension and CAD are three to four times less common in the rural population compared with urban subjects. In view of the lower fat intake in the low-risk rural population compared with those in urban areas (13.8% vs 25% kcal/day), the limit for total energy from fat intake should be 65% kcal/day, mainly from complex carbohydrates. A body mass index of 21 kg m−2 should be c...