Development Of Consensus Statement Research Articles

Development of consensus statements for pregnancy screening in diagnostic nuclear medicine: a Delphi study.

Current radiation protection recommendations do not provide clear guidelines or advice on pregnancy screening strategies for diagnostic nuclear medicine procedures. Previous studies have reported on variations in current practice for pregnancy screening before diagnostic nuclear medicine procedures. The development of consensus statements aims to provide a consistent approach and assist nuclear medicine personnel to confidently question patients about their pregnancy status. The Delphi technique was chosen for the research design. A panel consisting of 10 experienced nuclear medicine personnel from Australia and New Zealand was recruited. Panel members were provided with a summary of existing research. Consensus agreement was predefined as 80%. Questionnaires were developed and distributed to the panel members, with iterative analysis and feedback between survey rounds. Three survey rounds were conducted online using SurveyMonkey between December 2013 and June 2014. The round 1 questionnaire was developed from the results of a previous survey. It consisted of 30 questions designed to gather the opinions of the expert panel. After analysis of the round 1 responses, consensus statements were developed for round 2 and revised in round 3. Consensus was achieved for 16 statements. The statements recommend using verbal questioning with patient signature, defining the age range for questioning as 12-55 y, providing advice on the use of pregnancy testing, and questioning potentially difficult groups such as teenagers. A flowchart was included for comment in round 3. This was the first Australian study to develop consensus statements and a flowchart to assist nuclear medicine personnel in consistently and confidently questioning patients about their pregnancy status before diagnostic procedures. Implementation of these statements into clinical practice guidelines should reduce the possibility of inadvertent fetal irradiation.

Developing guidelines for return to play: Consensus and evidence-based approaches

Background: Sports-related concussions are commonplace at all levels of play and across all age groups. The dynamic, evolving nature of this injury coupled with a lack of objective biomarkers creates a challenging management issue for the sports medicine team. Athletes who return to play following a concussion are known to be at higher risk for an additional brain injury, which necessitates a careful, informed return to play (RTP) process.Aim: The goal of this paper is to outline historical attempts at developing RTP guidelines and trace their evolution over time, culminating in a discussion of the process and outcomes of the most recent consensus statements/guidelines published by the international Concussion In Sport Group (CISG), the American Academy of Neurology (AAN), the National Athletic Trainers’ Association, and the 2013 Team Physician Consensus Statement Update.Method: An evaluation of the pros and cons of these guidelines is presented along with suggestions for future directions. In addition, the Institute of Medicine recently conducted a comprehensive report outlining the current state of evidence regarding youth concussions, which provides specific recommendations for future research.Conclusions: The different methodologies utilized in the development of consensus statements have distinct advantages and disadvantages, and both approaches add value to the everyday management of sports concussions. Importantly, the overall approach for management of sports concussion is remarkably similar using either consensus-based or formal evidence-based methods, which adds confidence to the current guidelines and allows practitioners to focus on accepted standards of clinical care. Moving forward, careful study designs need to be utilized to avoid bias in selection of research subjects, collection of data, and interpretation of results. Although useful, clinicians must venture beyond consensus statements to examine reviews of the literature that are published in much greater frequency than consensus statements

Engagement and Education: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement

BACKGROUNDEngagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials.METHODSA systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process.RESULTSTwenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care.CONCLUSIONSThe optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians.

System-Level Planning, Coordination, and Communication: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement

System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises.

Methodology: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement

Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government officials. The field of disaster medicine does not have the required body of evidence needed to undergo a traditional guideline development process. In result, consensus statement-development methodology was used to capture the highest-caliber expert opinion in a structured, scientific approach. Task Force Executive Committee members identified core topic areas regarding the provision of care to critically ill or injured patients from pandemics or disasters and subsequently assembled an international panel for each identified area. International disaster medicine experts were brought together to identify key questions (in a population, intervention, comparator, outcome [PICO]-based format) within each of the core topic areas. Comprehensive literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions that are presented in this supplement using a modified Delphi process. A total of 315 suggestions were drafted across all topic groups. After two rounds of a Delphi consensus-development process, 267 suggestions were chosen by the panel to include in the document and published in a total of 12 manuscripts composing the core chapters of this supplement. Draft manuscripts were prepared by the topic editor and members of the working groups for each of the topics, producing a total of 11 papers. Once the preliminary drafts were received, the Executive Committee (Writing Committee) then met to review, edit, and promote alignment of all of the primary drafts of the manuscripts prepared by the topic editors and their groups. The topic editors then revised their manuscripts based on the Executive Committee's edits and comments. The Writing Committee subsequently reviewed the updated drafts and prepared the final manuscripts for submission to the Guidelines Oversight Committee (GOC). The manuscripts subsequently underwent review by the GOC, including external review as well as peer review for the journal publication. The Writing Committee received the feedback from the reviewers and modified the manuscripts as required. Based on a robust and transparent process, this project used rigorous methodology to produce clinically relevant, trustworthy consensus statements, with the aim to provide needed guidance on treatment and procedures for practitioners, hospital administrators, and public health and government officials when addressing the care of critically ill or injured patients in disasters or pandemics.

Consensus ad idem: a protocol for development of consensus statements

Consensus ad idem: a protocol for development of consensus statements

Emergency care in sub-Saharan Africa: Results of a consensus conference

The communities of sub-Saharan Africa face a disproportionate burden of acute injury and illness. While acute care systems can substantially lower the morbidity and mortality associated with a wide range of medical and surgical conditions in adults and children, few healthcare facilities in the region adopt an integrated approach to resuscitation and stabilization. The term acute care encompasses the health system components used to treat patients with urgent or emergent conditions, and governments, health care facilities, funders, and academic institutions would benefit from a clearer understanding of acute care in an African context. In November 2011, the African Federation of Emergency Medicine held the first in a series of conferences on acute care in Africa to engage stakeholders in the development of consensus statements for the region. This first meeting engaged a range of acute and emergency care providers working in sub-Saharan Africa, and effective acute care was defined as:

Patellofemoral pain: proximal, distal, and local factors, 2nd International Research Retreat.

Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in orthopaedic practice. The mission of the second International Patellofemoral Pain Research Retreat was to bring together scientists and clinicians from around the world who are conducting research aimed at understanding the factors that contribute to the development and, consequently, the treatment of PFP. The format of the 2.5-day retreat included 2 keynote presentations, interspersed with 6 podium and 4 poster sessions. An important element of the retreat was the development of consensus statements that summarized the state of the research in each of the 4 presentation categories. In this supplement, you will find the consensus documents from the meeting, as well as the keynote addresses, schedule, and platform and poster presentation abstracts.

Physical Health and Schizophrenia in Clinical Practice Guidelines and Consensus Statements

Research about the epidemiology of physical health problems in schizophrenia, as well as the development of consensus statements and recommendations to deal with it, has increased in recent years. The objective of this study is to identify, review and compare the clinical practice guidelines and consensus statements on physical health problems in people with schizophrenia that have developed over the last five years. We conducted a computerized search in PubMed of the literature regarding the management of schizophrenia. We identified 8 clinical practice guidelines or expert consensus statements, including recommendations for monitoring the physical health of people with schizophrenia. We extracted descriptive information from each article and established the level of consensus between them regarding the physical health parameters that they recommend monitoring. Most of the studies identified were conducted by multidisciplinary groups from European countries between 2010 and 2012. Their recommendations were agreed upon and evidence based and all of them concurred in that the study population is especially vulnerable to physical illness. Although there was a high degree of agreement on most of the physical health parameters that they recommend monitoring, their degree of agreement regarding regular check-ups, including blood tests and renal, hepatic and thyroid function tests, was low. This lack of agreement may be related to the specificity of their approach. There is a need to include all components of physical health as a key part of the management of schizophrenia, which requires comprehensive guidelines and systematic and evidence-based assessments and interventions, but also changes in care professionals’ attitudes, stigma and the organization of health care services.

Development of Consensus Statement on Definitions for Consistent Emergency Department Metrics

One of the Emergency Nurses Association's (ENA) top three clinical priorities is crowding in the emergency department (ED). Crowding, which is defined as an excessive number of patients, was brought to the forefront of health care discussion via the 2006 Institute of Medicine report The Future of Emergency Care. 1 Institute of Medicine Committee on the Future of Emergency Care in the United States Health System. Hospital Based Emergency Care: At the Breaking Point. Institute of Medicine, National Academies Press, Washington, DC2007 Google Scholar Crowding is becoming progressively worse as the current recession creates additional pressure on our already strained health care system. Whether it is state funding cuts that result in closing psychiatric care facilities, individuals losing health care coverage, or individuals not being able to afford the medications that they or their families need, all of these situations result in more people coming to the emergency department for their health care of last resort. Response to: “Development of Consensus Statement on Definitions for Consistent Emergency Department Metrics”Journal of Emergency NursingVol. 38Issue 6PreviewI am writing with regard to the article “Development of Consensus Statement on Definitions for Consistent Emergency Department Metrics.”1 I work in a 28-bed, Level III trauma center north of Houston. Our department sees 90 to 120 patients daily, and we continue to have patients leaving without medical screening examinations as we remain saturated. Most of our beds remain occupied with patients holding for admission or with psychiatric patients boarding in the emergency department for 12 to 48 hours awaiting psychiatric placement. Full-Text PDF

Part 4: Conflict of Interest Management Before, During, and After the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Part 4: Conflict of Interest Management Before, During, and After the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Part 4: Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Part 4: Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Scapular Summit 2009, July 16, 2009, Lexington, Kentucky

This was the third research meeting focused on scapular function and dysfunction, following similar meetings in 2003 and 2006. The purpose of this meeting, hosted by the Shoulder Center of Kentucky, was to continue to examine the biomechanical and clinical factors thought to be associated with the role of the scapula in shoulder function and dysfunction. Since the last Summit, much more information has been created in this area, and it was thought that enough progress had been made that an organized overview of current knowledge could provide some consensus statements to guide further research and provide assessment and treatment guidelines. A call for abstracts was extended to researchers with proven interest and published research on the scapula. The meeting was organized around 3 primary categories of information: scapular kinematics and dysfunction, clinical evaluation of the scapula, and interventions. The last session of the meeting involved development of consensus statements for each category. This document represents the current state of knowledge concerning the aspects of scapular function and dysfunction discussed at the Summit. It is expected that, as more knowledge is developed, the gaps will be filled in and a clearer understanding of the roles of the scapula in shoulder function will emerge. This issue includes the consensus statements and abstracts from the Summit.

Prevention of intra-abdominal adhesions in gynaecological surgery

Important progress has been made in the field of post-surgical adhesion prevention with the development of consensus statements in gynaecology from the United Kingdom, Germany, the European Society of Gynaecological Endoscopy, Call for Action in Colorectal Surgery and a recent Technical Bulletin from The Practice Committee of the American Society of Reproductive Medicine. These reports suggest that the application of adhesion reduction devices together with the use of microsurgical principles reduces the formation of post-operative adhesions. This commentary provides additional information to assist gynaecologists in making surgical decisions. However, variation in adhesion classifications, mode of device application, lack of uniformity in surgical approaches and variations in interpretation of results make comparative assessment of the efficacy of adhesion reduction devices and surgical techniques difficult. Considering the choice of an adhesion-reduction device, one has to evaluate the cost and its clinical impact carefully. This is particularly important if one were to support routine, prophylactic use of adhesion-reduction devices. Healthcare providers should take into account the needs of individual patients, available resources, and institutional or clinical practice limitations. Good surgical technique and perhaps the use of approved devices for adhesion reduction would give patients the best chance to benefit from reproductive and gynaecological surgery.

Development of consensus statements for the diagnosis and management of intestinal Behçet's disease using a modified Delphi approach

Although intestinal Behçet's disease has been treated anecdotally with various therapeutic modalities, clinical evidence regarding management of intestinal Behçet's disease is lacking. The objective of this study was to develop consensus-based practice guidelines for diagnosis and treatment of intestinal Behçet's disease by using a modified Delphi approach. Three groups of Japanese gastroenterology specialists were involved in the study: moderators, an expert panel, and a professional group. Clinical statements for ratings were extracted from relevant literature, a survey of the professional group, and by discussion among the expert panel. The expert panel rated the clinical statements according to a nine point scale. After the first round of ratings, a panelist meeting was held to discuss areas of disagreement and to clarify areas of uncertainty. The list of clinical statements was revised after the panelist meeting, and a second round of rating was conducted. Thirty-two relevant articles were selected in a literature search, and 35 clinical statements were extracted. An additional 209 clinical statements were developed from the survey and discussion among gastroenterology specialists. In the first and second rounds, 56% and 60% of statements, respectively, received median scores > or =7. The range of scores decreased considerably from the first to the second round. 5-Aminosalycylic acid, corticosteroids, immunosuppressants, enteral nutrition, total parenteral nutrition, and surgical therapy were considered standard therapy for intestinal Behçet's disease. Infliximab, colchicines, thalidomide, other pharmacological therapy, endoscopic therapy, and leukocytapheresis were deemed experimental therapy. Based on a two-round modified Delphi approach, practice guidelines for diagnosis and treatment of intestinal Behçet's disease were developed.

Interfacility Transport of Patients With Decompression Illness: Literature Review andConsensus Statement

Objective. Decompression illness (DCI) is a potentially lethal complication of diving andmay occur far from hyperbaric facilities. The need for prompt transport to a hyperbaric facility often involves air medical transport, but this may exacerbate DCI. The authors reviewed available literature to establish evidence-based transport strategies utilizing safe altitudes for patients, with DCI. Methods. MEDLINE, EMBASE, andmaterials from organizations with expertise in diving medicine were searched for the following terms: decompression sickness, caisson disease, hyperbaric oxygenation, depth intoxication, or diving. Two reviewers independently selected relevant citations involving patients with DCI andair medical transport for review andconsensus statement development by an expert working group. Results. A total of 341 citations were identified, and53 unique citations were reviewed. Nine relevant citations were selected for consensus statement development. There were no clinical trials or prospective cohort studies. Only two retrospective case series, including nine patients, specifically examined the effect of altitude on patients with DCI during transport. No symptom recurrence occurred when the cabin altitude remained within 500 feet of ground level. Seven citations were either letters or statements of expert opinion, recommending a maximum cabin altitude of 500–1000 feet (152–305 meters). Conclusions. The working group identified the paucity of clinical studies andevidence-based recommendations for air medical transport of patients with DCI. Transport selection should be based on minimizing total transport time and, when transporting by air, ensuring that a cabin altitude of the transporting vehicle does not exceed 500 feet (152 meters) above the departure point. Key words: decompression sickness; atmospheric pressure; depth intoxication; air ambulance; emergency medical services.

Greater KC APIC Chapter Taking the Lead in Collaborative Efforts Regarding Artificial Nails with Metropolitan Area Healthcare Facilities

ISSUE: The Greater Kansas City APIC Chapter collaborated to develop a position statement in response to the JCAHO Patient Safety Goal # 7.a “Comply with current CDC hand hygiene guidelines.” A consensus statement was developed to provide area hospitals with direction regarding the use of artificial nails in by direct patient-care providers. Without consensus of the majority of hospitals, concern was raised that nurses would choose hospitals that allowed artificial fingernails. PROJECT: An APIC task force met to review current medical literature, HICPAC's Hand Hygiene Guideline, and the JCAHO's patient safety goals. The task force developed a questionnaire and asked all members of the APIC chapter to interview the director of nursing and the human resources director in their facilities. A consensus statement was written and approved by the APIC chapter and sent to all area hospitals as well as to the Missouri and Kansas Hospital Associations. RESULTS: Prior to the initiative, 33% of area hospitals had a “no artificial fingernail” policy. Following consensus statement development and dissemination, 70% of hospitals planned to implement such a policy.

Management of otitis media with effusion in young children.

To summarize and critique the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for the management of otitis media with effusion (OME) in children. The AHCPR Clinical Practice Guideline, Otitis Media with Effusion in Young Children; the Quick Reference Guide for Clinicians, Managing Otitis Media with Effusion in Young Children; and the Parent Guide, Middle Ear Fluid in Young Children, were the primary data sources. The AHCPR developed the Guideline based on a comprehensive literature review from multiple bibliographic databases, including the National Library of Medicine. Data were also collected during open hearings and from unpublished sources derived from a call in the Federal Register. Additional citations from the biomedical literature were used for supporting evidence. Peer-reviewed reports of controlled, randomized studies were preferred, but other study designs were considered. Over 3000 abstracts were identified, of which 378 articles were used for data extraction, and an additional 100 articles were included from bibliography review and panel recommendations. An expert panel reviewed the data and incorporated clinical expertise into the development of consensus statements. Data were extracted to apply to a base case with OME to narrow the scope of the Guideline. The base case was defined as a child who is 1-3 years old, is otherwise healthy, and has no underlying craniofacial, neurologic, or sensory conditions. Multiple meta-analyses were done to help the panel come to conclusions on several issues. The Guideline documents carefully outlined treatment algorithms for the management of OME in otherwise healthy children. The main areas that need to be further clarified are the role of more aggressive identification of causative pathogens, when antimicrobial therapy should be initiated, and which antimicrobial agents are preferred for the treatment of OME. There are many vague areas in the Guideline that allow for multiple interpretations. Data regarding the use of corticosteroids were influenced heavily by the expert opinion of the panel rather than the literature-based evidence and potential cost implications. The Guideline provided specific recommendations for the surgical management of OME. Confounding patient factors that would affect decisions on management of OME, such as underlying disease states and physical or mental abnormalities, were not addressed in the Guideline. The documents were well organized and provide detailed explanation of the recommendations. The Guideline provides specific criteria for the surgical management of OME, but is vague in its recommendations on the medical management of OME with antibiotics, corticosteroids, and the use of invasive tympanocentesis in the evaluation of OME in otherwise healthy children.