Conference Of Experts Research Articles

Scalp psoriasis: European consensus on grading and treatment algorithm

The scalp is a common site of involvement of psoriasis and, for many patients, is a challenging aspect of their disease. This can be attributed not only to the scaling, itching and cosmetic embarrassment that go with scalp psoriasis, but also to the fact that the scalp skin is relatively inaccessible, making topical therapies difficult to apply. The proximity of sensitive facial skin can also limit the use of potentially irritating topical treatments. Nevertheless, the specific challenges of scalp psoriasis are often neglected by treatment guidelines. This paper summarizes the discussions that took place at an international conference of experts convened in Geneva, Switzerland, in March 2008. The objective of the meeting was to review the available treatments for scalp psoriasis in terms of efficacy, safety, convenience, and the implications for patient compliance with treatment. In addition, definitions of mild, moderate and severe scalp psoriasis were agreed. This paper presents a treatment algorithm that includes recommendations for patients in all three categories. It considers the role of potent topical corticosteroids, vitamin D3 derivatives, salicylic acid preparations, and photo- and radiotherapy, as well as systemic therapies, including newer biological agents, for patients with widespread psoriasis with scalp involvement. Data from clinical trials indicate that a potent topical corticosteroid in a short-contact formulation is the most appropriate treatment for most patients with scalp psoriasis.

INTRA-ABDOMINAL AND ABDOMINAL PERFUSION PRESSURE IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY

BACKGROUND. In 2006, the International Conference of Experts on Intra-abdominal Hypertension defined abdominal perfusion pressure (APP) as the difference between mean arterial pressure (MAP) and intra-abdominal pressure (IAP). The aim of the study was to analyse changes in IAP and APP in patients undergoing elective coronary artery bypass grafting (CABG).PATIENTS AND METHODS. Fifty patients undergoing CABG with extracorporeal circulation (ECC) and normovolemic haemodilution (NH) under general anaesthesia were studied. IAP and APP were measured during CABG and in the early postoperative period. Changes in IAP and APP were analysed according to degree of normovolemic haemodilution, age, body weight, body mass index (BMI), duration of anaesthesia, surgery, ECC, aorta clamping and other haemodynamic parameters.RESULTS. The induction of anaesthesia decreased IAP. Extracorporeal circulation resulted in IAP elevation, which was dependent on the degree of blood dilution. At any time point of the postoperative period IAP higher than 12 mmHg was noted in 22 patients (44%). Abdominal perfusion pressure decreased during ECC and on the morning of the first postoperative day. Intra-abdominal pressure strongly correlated with BMI and central venous pressure. The correlation between IAP and APP and other haemodynamic parameters was poor.CONCLUSIONS. 1) The induction of anaesthesia decreased IAP. 2) ECC resulted in an increase in IAP. 3) IAP increased in 44% of patients. 4) IAP strongly correlated with BMI and central venous pressure. 5) CABG with ECC resulted in a decrease in APP. 6) Changes in APP strongly correlated with MAP and poorly correlated with other haemodynamic parameters. 7) The changes in APP demonstrated a double-phase character.

Making good research useful: Another step on the journey

Making good research useful: Another step on the journey

ICF-Core-Sets im Akutkrankenhaus und in der Frührehabilitation für Patienten mit Erkrankungen des muskuloskelettalen Systems

Fragestellung: Die Internationale Klassifikation der Funktionsfähigkeit Behinderung und Gesundheit hat die theoretische Grundlage der Rehabilitation deutlich verändert, indem ein komplexes psychosoziales Modell unter Einbeziehung der Kontextfaktoren definiert wurde. Die ICF-Klassifikation ist für den Gebrauch in der Rehabilitationspraxis allerdings zu umfangreich. Um die wichtigsten Kategorien für die klinische Praxis sowie für rehabilitationswissenschaftliche Studien zu identifizieren, wurden ICF-Core-Sets entwickelt. Dabei wurden nach Vorstudien (systematische Reviews, Patientenbefragung, Delphi-Prozess) in Expertengruppen mit multiplen Abstimmungsprozessen die wichtigsten ICF-Core-Sets für bestimmte Krankheitsbilder identifiziert. Da nach Maßgabe der ICF die Kontextfaktoren sowie das Krankheitsstadium die Funktionsfähigkeit und damit die Rehabilitation wesentlich beeinflussen, wurden für das Setting Akutkrankenhaus sowie die Frührehabilitation Core-Sets erarbeitet.

Allogeneic hematopoietic cell transplantation for primary immune deficiency diseases: Current status and critical needs

Allogeneic hematopoietic cell transplantation (HCT) has been used for 40 years to ameliorate or cure primary immune deficiency (PID) diseases, including severe combined immunodeficiency (SCID) and non-SCID PID. There is a critical need for evaluation of the North American experience of different HCT approaches for these diseases to identify best practices and plan future investigative clinical trials. Our survey of incidence and prevalence of PID in North American practice sites indicates that such studies are feasible. A conference of experts in HCT treatment of PID has recommended (1) a comprehensive cross-sectional and retrospective analysis of HCT survivors with SCID; (2) a prospective study of patients with SCID receiving HCT, with comparable baseline and follow-up testing across participating centers; (3) a pilot study of newborn screening for SCID to identify affected infants before compromise by infection; and (4) studies of the natural history of disease in patients who do or do not receive HCT for the non-SCID diseases of Wiskott-Aldrich syndrome and chronic granulomatous disease. To accomplish these goals, collaboration by a consortium of institutions in North America is proposed. Participation of immunologists and HCT physicians having interest in PID and experts in laboratory methods, clinical outcomes assessment, databases, and analysis will be required for the success of these studies.

La place de l'information dans la décision en santé publique

Public health, prevention, health education and health promotion are inseparable from the concepts of information and communication. Information should respond as much as possible to the needs of professionals, decision-makers, and consumers who are more and more concerned and conscious of its importance in light of "information overload", various dissemination channels and the multiplicity of its sources. There are numerous issues at stake ranging from comprehension, to the validation of health information, health education, health promotion, prevention, decision-making, as well as issues related to knowledge and power. Irrespective of the type of choice to be made, the need for information, knowledge, and know-how is inseparable from that of other tools or regulatory measures required for decision-making. Information is the same as competence, epidemiological and population data, health data, scientific opinion, and expert conferences--all are needed to assist in decision-making. Based on the principle of precaution, information must increasingly take into account the rejection of a society which often reasons on the basis of a presumption of zero-risk, in an idealistic manner, and which also excludes the possibility of new risks. The consumer positions himself as the regulator of decisions, specifically those with regard to the notion of acceptable level of risk. All of the actors involved in the health system are or become at one moment or another public health decision-makers. Their decision might be based either on an analytical approach, or on an intuitive approach. Although the act of decision-making is the least visible part of public health policy, it is certainly the driving force. This process should integrate the perspective of all of the relevant players, including consumers, who are currently situated more and more frequently at the heart of the health system. Public health decision-making is conducted as a function of political, strategic and environmental issues; of lobbies and their power; and of social maturation. Decision-making is a necessity. Making the right choice at the right time requires high quality information, and it is often necessary to respect a certain amount of time for reflection and ripening of an issue in order to make the best possible decision. The media and consumers play an increasingly significant role in public health decision-making and in the ensuing legislative consequences and debates which come as a result. Access to information is changing, especially thanks to the Internet which is completely modifying the global scenery of knowledge and know-how. Information supports decision-making with calculated risk, and it offers the opportunity to make choices and decisions, recognising that "to choose, is sometimes to relinquish".

Novel Treatment Approaches for Refractory Anxiety Disorders

The Anxiety Disorders Association of America convened a conference of experts to address treatment-resistant anxiety disorders and review promising novel approaches to the treatment of refractory anxiety disorders. Workgroup leaders and other participants reviewed the literature and considered the presentations and discussions from the conference. Authors placed the emerging literature on new therapeutic approaches into clinical perspective and identified unmet needs and priority areas for future research. There is a relative paucity of efforts addressing inadequate response to anxiety disorder treatment. Systematic efforts to exhaust all therapeutic options and overcome barriers to effective treatment delivery are needed before patients can be considered treatment refractory. Cognitive behavioral therapy, especially in combination with pharmacotherapy, must be tailored to accommodate the effects of clinical context on treatment response. The literature on pharmacologic treatment of refractory anxiety dis...

The unintended consequences of computerized provider order entry: Findings from a mixed methods exploration

Objective To describe the foci, activities, methods, and results of a 4-year research project identifying the unintended consequences of computerized provider order entry (CPOE). Methods Using a mixed methods approach, we identified and categorized into nine types 380 examples of the unintended consequences of CPOE gleaned from fieldwork data and a conference of experts. We then conducted a national survey in the U.S.A. to discover how hospitals with varying levels of infusion, a measure of CPOE sophistication, recognize and deal with unintended consequences. The research team, with assistance from experts, identified strategies for managing the nine types of unintended adverse consequences and developed and disseminated tools for CPOE implementers to help in addressing these consequences. Results Hospitals reported that levels of infusion are quite high and that these types of unintended consequences are common. Strategies for avoiding or managing the unintended consequences are similar to best practices for CPOE success published in the literature. Conclusion Development of a taxonomy of types of unintended adverse consequences of CPOE using qualitative methods allowed us to craft a national survey and discover how widespread these consequences are. Using mixed methods, we were able to structure an approach for addressing the skillful management of unintended consequences as well.

Asthma and allergy: Short texts and recommendations of the expert conference of the French Speaking Pneumology Society (SPLF), in partnership with the French Society of Allergology and Clinical Immunology (SFAIC), the French Society of Occupational Medicine (SFMT) and the “Asthma–Allergy” association

The Asthma Plan published by the French Health Ministry in 2002, the experts conferences edited by ANAES on therapeutic education and follow-up of asthma, the inclusion of this disease in the Public Health Law have been remarkable steps in France during the last few years. The medical community, more particularly the pneumological community, has shown its commitment in the treatment of this public health problem. But allergy was not sufficiently taken into account, although it is responsible for nearly 50 to 60% cases of asthma. In most so-called developed countries the prevalence of asthma and of allergies has increased in the last twenty years. Its progress varies according to country and age group: the increased prevalence of allergy, more specifically of rhinitis and eczema, is most marked in children aged 6-7 year. The prevalence of asthma seems to have reached a plateau in certain northern countries or seems to have decreased in 13-14 year olds (Anglo-Saxon countries). There were multiple reasons, generally attributed to changes in life-style. Asthma is the result of an interaction between a genetic predisposition and the environment, where allergens are present, but also smoking. The relationships between allergy and asthma are complex. This conference discussed the various essential issues that face doctors who treat patients with asthma in their daily practice. The risk factors, the methods of exploration in children and adults and the specific treatments are, indeed, essential issues to be evaluated in a frequent pathology that interests a large number of physicians. The variety of experts is wide, representing pneumology (French Speaking Pneumology Society), the occupational medicine world (French Society of Occupational Medicine), the allergic pathology (French Society of Allergology and Clinical Immunology), and patients with the patient association "Asthma & Allergy", physicians belonging to the general medicine community, general hospitals, private hospitals and academic hospitals in France. The proposed guidelines are aimed at helping practitioners in distinguishing what is established from what remains to be demonstrated and/or assessed with respect to the different modalities for the exploration or treatment of allergic asthma.

The Limits of Russian Democratisation: Emergency Powers and States of Emergency by Alexander Domrin (review)

584 SEER, 86, 3, JULY 2008 There ismuch that is new and interesting in this book. The author in corporates a broad knowledge of the comparative research on constitution making, and his approach is creative and ambitious. Unfortunately, the cen tral thrust of the argument is often hidden by over-elaborate comparative examples, and many of the subtleties of the argument are lost in the English translation of the text. Most surprisingwas the limited use made of the con siderable documentary, stenographic and interview evidence that is available on the post-Soviet period. This may lead the reader to question some of Medushevsky's empirical claims, as well as his assertion that 'since informa tion on the constitution drafting is restricted,we stilldo not know much about the motives and nature of major borrowings in the Russian Constitution' (p. 203). Yet, as an interpretive analysis of Russian constitutionalism from a Russian perspective, it isan important contribution to scholarship in this field. For Western students and scholars who are not familiar with Russian political science, itwill provide an insight into the tools of analysis used by one of the leading Russian authorities in this field. StAntony'sCollege Paul Chaisty UniversityofOxford Domrin, Alexander. The Limits ofRussian Democratisation: EmergencyPowers and States of Emergency. BASEES/Routledge Series on Russian and East European Studies, 22. Routledge, London and New York, 2006. xiv +188 pp. Notes. Index. ?60.00. Commendable as much for the interesting information in forty-fivepages of endnotes as for its main text, thiswork is a worthy addition to theBASEES/ Routledge Series on Russian and East European Studies. The subtitle ? 'Emergency Powers and States of Emergency' ? ismore illustrative of itscontent than the headline title.One of themain strengthsof the book is its review of the differentprovisions world wide required for the imposition of a state of emergency (or equivalent; the range of nomenclature is almost as broad as the variety of required procedures). In the Introduction there are also some astonishing revelations about the uses of 'states of emergency'. 'It came as a shock to many members of US Congress in 1971 to learn that the United States had been in a state of national emergency since 9March 1933' (p. 5). 'The US Senate Special Committee [...] stated in 1973: "A majority of the people of the United States have lived all their lives under emergency rule. For 40 years, freedoms and governmental procedures guaranteed by the Constitution have, in varying degrees, been abridged by laws brought into force by states of national emergency'" (p. 6). The US is not unique in its derogation of constitutional rights: 'Leandro Despouy, Special Rapporteur of theUN Sub-Committee [...], listed 80 [!] states that had, since 1 January 1985 "taken measures which constituted the proclama tion, extension, maintenance or termination of emergency relations in various forms'" (p. 6). Clearly this book is timely in highlighting a frequent phenomenon, both dejure and de facto. reviews 585 The firstchapter gives an historical account of the development of the concept, including discussion of Hampden's case in seventeenth-century England. Alexander Domrin's thesis is that 'Evolution of "emergency powers", as a legal institution, inEuropean countries (first of all, inEngland) is inseparable from the development of the Rule of Law' (p. 17).The sec ond chapter overviews world practice and international legal considerations. Domrin notes that the 'Siracusa principles' formulated in 1984 at a presti gious conference of international experts considering the 'grounds for per missible limitations and derogations enunciated in the ICCPR' [International Covenant on Civil and Political Rights] were mistranslated intoRussian ? or was substituted for and in the definition of a threat to the life of a nation, diminished the cumulative requirement of 'affecting the whole of the population and either thewhole or part of the territory' (p. 52). In the third chapter 'Legal regulation of emergency powers in Imperial Russia' Domrin cogently argues that Imperial Russian penal law was 'one of themildest in Europe' (p. 70, quoting Albert Heard in 1887/8) and that Russia was comparatively enlightened in its treatment of dissent. 'In the whole body ofRussian Imperial legislation [. . . ] one can hardly find a statute that has been as much misinterpreted and misrepresented [. . .] as the emergency law of...

Pharmaceutical innovation: Possibilities and limits of personalised medicine1, 2

In the framework of the German EU Council Presidency, the Federal Ministry of Health and the Federal Institute for Drugs and Medical Devices, an expert conference on Pharmaceutical Innovation - Possibilities and Limits of Personalised Medicine was held in Bonn, on June 11-12, 2007. It was financially supported by the European Commission. The conference aimed to intensify a sustainable networking among the participants and develop robust concepts for the future design of pharmaceutical research and production within the EU. To this end, various stakeholders from the fields of pharmaceutical research, production and licensing were brought together. This publication summarises the main results of the conference. It may reflect the personal views of the individual contributors and is not necessarily the perspective of the Federal Ministry of Health or of the Federal Institute for Drugs and Medical Devices.

Native hyaluronic acid in dermatology – results of an expert meeting

The glycosaminoglycan hyaluronic acid (HA) is a major component of the extracellular matrix of the skin and plays an important role in the metabolism of the dermis.HA is responsible for hydration,nutrient exchange and protects against free radical damage;via signaling pathways it is also involved in biologic processes like cell differentiation and motility. Native HA has been employed for several years to help the skin to regain elasticity,turgor and moisture. In a clinical study an increase in elasticity and turgor following repeated injections with HA could be demonstrated, but this treatment approach is discussed controversially. An expert conference took place to find a consensus regarding use, aims of treatment, indications and limitations of this therapy. The decisions of the expert meeting are presented in this report.

Diagnosing the diagnosis: why we must standardize the defining features of polycystic ovary syndrome

Barth and colleagues have recently reviewed the diagnosis of polycystic ovary. In their insightful examination, they conclude that the current diagnostic criteria are insufficiently robust for clinical research. In fact, I would argue that currently available diagnostic criteria at present are insufficiently robust even for clinical care. We should note that this argument has significant economic and health-care consequences. Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies of women, affecting between 7 and 10% of all reproductive-aged women, with significant associated morbidities. However, as for many other syndromes, the disorder is diagnosable only by a collection of signs and features, and no single test is available for its diagnosis. There are currently three principal definitions of PCOS in widespread use. The core group of patients diagnosable as having the disorder are those demonstrating: (1) clinical or biochemical evidence of hyperandrogenism; and (2) ovulatory dysfunction; after (3) exclusion of other similarly appearing disorders (e.g. non-classic adrenal hyperplasia, Cushing’s syndrome, androgen-secreting tumours, etc.). This definition was first described in the proceedings of a 1990 National Institutes of Health (NIH)-sponsored expert conference on the subject. A second expert conference was convened by the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) in Rotterdam in May 2003, which defined the disorder as affecting any individual that had two out of the following three features: (1) clinical and/or biochemical hyperandrogenism; (2) ovulatory dysfunction or (3) polycystic ovarian morphology. Like the NIH 1990 criteria, the diagnosis of PCOS was one of exclusion and required ruling out similarly presenting disorders. This definition basically expanded the original NIH 1990 criteria by considering two additional phenotypes of the disorder, namely women who had ovulatory dysfunction and hyperandrogenism, but normal ovulation, and women who had ovulatory dysfunction and polycystic ovarian morphology, but no clinical or biochemical evidence of hyperandrogenism. Finally, the Androgen Excess Society convened an expert taskforce to review published literature and arrived at a somewhat more evidence-based contemporary definition of the disorder. The recommendations of this taskforce represented a compromise between the NIH 1990 and the Rotterdam 2003 criteria in that they suggested that PCOS be defined by the presence of: (1) clinical and/or biochemical hyperandrogenism; (2) ovarian dysfunction, including ovulatory dysfunction and/or polycystic ovarian morphology; and (3) the exclusion of related or similarly appearing disclosures. What criteria to use for defining PCOS has significant implications for patient care, clinical research and public health. For example, the prevalence of PCOS as defined by the NIH 1990 criteria appears to be approximately 6.5% among reproductive-aged women. Alternatively, the prevalence of the disorder as defined by the Rotterdam 2003 criteria could be almost twice as high. Use of a broader definition could make it more difficult to complete meaningful research on PCOS. Most affected would be large populational genetic studies, whose ability to detect the role of candidate genes is predicated on the inclusion of large numbers of relatively homogeneous patients. Comparability between studies is also detrimentally affected by the great variability in potential phenotypes that are included in different studies. Finally, clinical practice, diagnosis and counselling will be affected by the criteria selected, as the incidence of associated morbidities with PCOS, such as insulin resistance and risk of diabetes, are more prevalent with certain phenotypes of PCOS. Notwithstanding the ongoing debate regarding which specific criteria should be used for diagnosing PCOS, it is clear that a much more fundamental problem has been mostly ignored and has been brought to our attention by Dr Barth and his colleagues. They eloquently note that if the features themselves are not well-defined, meaningful use of the proposed diagnostic criteria are severely hampered. For example, biochemical evidence of hyperandrogenism is a criterion that has been present in all three currently used definitions of PCOS. However, what does this exactly mean? We need to clearly define which androgens are being measured. Should we include total testosterone (T)? Or free T? Or DHEAS? Or androstenedione? Or other lesserknown androgen metabolites? Should we define biochemical hyperandrogenism as the collection or combination of

Novel treatment approaches for refractory anxiety disorders

The Anxiety Disorders Association of America convened a conference of experts to address treatment-resistant anxiety disorders and review promising novel approaches to the treatment of refractory anxiety disorders. Workgroup leaders and other participants reviewed the literature and considered the presentations and discussions from the conference. Authors placed the emerging literature on new therapeutic approaches into clinical perspective and identified unmet needs and priority areas for future research. There is a relative paucity of efforts addressing inadequate response to anxiety disorder treatment. Systematic efforts to exhaust all therapeutic options and overcome barriers to effective treatment delivery are needed before patients can be considered treatment refractory. Cognitive behavioral therapy, especially in combination with pharmacotherapy, must be tailored to accommodate the effects of clinical context on treatment response. The literature on pharmacologic treatment of refractory anxiety disorders is small but growing and includes studies of augmentation strategies and non-traditional anxiolytics. Research efforts to discover new pharmacologic targets are focusing on neuronal systems that mediate responses to stress and fear. A number of clinical and basic science studies were proposed that would advance the research agenda and improve treatment of patients with anxiety disorders. Significant advances have been made in the development of psychotherapeutic and pharmacologic treatments for anxiety disorders. Unfortunately, many patients remain symptomatic and functionally impaired. Progress in the development of new treatments has great promise, but will only succeed through a concerted research effort that systematically evaluates potential areas of importance and properly uses scarce resources.

Screening

Screening is the only practical approach for improving the management of hepatocellular carcinoma (HCC) patients, as early detection increases the application of curative treatments. A conference of experts from Japan, USA, and Europe (Barcelona 2005) advised surveillance every six months for patients with chronic liver disease at increased risk of HCC with abdominal US. Whether this approach benefits HCC patients in terms of survival is still uncertain, since available data are retrospective and biased by lead-time factors in the calculation of patient survival. Only one randomized controlled study in China showed the benefit of surveillance for HCC; however, in a population-based setting. Today, clinic-based, randomized studies are unfeasible for ethical reasons. In a cohort of 447 Italian patients with compensated cirrhosis, we compared the survival of HCC patients identified along three consecutive quinquennia of surveillance. HCC developed in 112 patients (3.4% per year) and was the prime cause of death. Forty-six patients (41%) had a single tumor with mean sizes of 3.7, 3.0, and 2.2 cm in the three quinquennia (first vs third, P = 0.0147; second vs third, P = 0.02) and 38(44%) underwent radical therapies. Mortality rates in HCC patients fell from 45% in the first quinquennium to 10% in the third (P = 0.0009), in parallel with a reduction in mortality of treated patients (34, 28, and 5%) (first vs third, P = 0.0024). Cirrhotic patients developing HCC during the last five years of surveillance survived longer than previously, as a consequence of improved management of the tumor and complications of cirrhosis. It remains controversial whether HCC screening is cost-effective, i.e. whether the cost of detection, confirmatory studies, and treatment are outbalanced by the number of life-years gained. In a retrospective study of Italian patients with cirrhosis, there was an incremental cost-efficacy ratio of surveillance vs no surveillance to be $USD 112 993 per liver-year saved. The cost of surveillance was increased by surgery applied to 15 patients with HCC detected during surveillance.

Defining common infections in children and neonates

Until the landmark consensus conference of experts organized by Roger Bone in 19911 almost everyone defined infection and sepsis as they pleased akin to Humpty Dumpty in Alice in Wonderland; “When I use a word it means just what I choose it to mean, neither more nor less.” The aim of that conference was to establish simple, clinically applicable and widely acceptable definitions. Definitions which would not only categorise patients for clinical studies but also identify those who were at high risk of a poor outcome. While the experts provided definitions for a few clinical conditions, they realized that the definitions were bound to be imperfect as clinical sepsis was dependent on an individual host’s response to infection.2 Nevertheless, these definitions though imperfect have provided a very useful framework over the past fifteen years. Perhaps based on the consideration that there were no substantial differences in the diagnosis or treatment of infection and sepsis between adults and children, except for the diagnostic criteria

Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.

Tendencias y contextos en la práctica de la cardiología en los próximos 15 años: La Declaración de Madrid: un documento de la Conferencia Europea sobre el Futuro de la Cardiología, Madrid, 2-3 de junio de 2006

In the near future, the practice of the cardiology in Europe will be strongly influenced by a complex interplay of epidemiological, social, economical, professional, and technological evolving factors. The present report summarizes the conclusions of an expert conference organized by the European Society of Cardiology to discuss the interactions between these phenomena, in an attempt to foresee the potential scenario in which cardiovascular healthcare and research will develop in the near future, and to anticipate solutions to the identified problems.

Millennium Conference 2005 on Medical Simulation: A Summary Report

Medical simulation takes advantage of contextual and experiential learning by allowing trainees to practice in realistic environments prior to actual patient care. Although proponents argue that patient simulation can fundamentally enhance both medical education and patient safety, large-scale experience with advanced simulation technologies is limited. To explore expert opinion on the topic, we convened a conference of educational leaders and simulation experts to provide recommendations for how this field should be directed on a broad scale to improve the training of future health professionals. This document summarizes the proceedings of that conference. We issued a request for applications to all U.S. and Canadian medical schools within the Association of American Medical Colleges (AAMC), seeking a diverse group of institutional teams committed to an in-depth exploration of the topic. Of 33 applications, nine medical schools were selected to participate. Once on site, eight working groups were formed, each comprised of representatives across sites and roles, including deans, clerkship and program directors, content experts, and trainees. We addressed four key topics, which are subsequently summarized for presentation in this report: 1) education (How can medical simulation contribute to the education of trainees?), 2) assessment (What is the role of simulation in evaluating trainees in the context of general competencies?), 3) research (How should we develop a research agenda to evaluate simulation?), and 4) implementation (How should simulation technologies be developed and managed within and across institutions?). Participants in the conference generally agreed that simulation offers a conducive environment for focused reflection and critical thought. Although there was consensus that medical simulation can provide a robust platform for performance assessment, most participants thought that the research basis for high-stakes assessment was still too immature for widespread implementation. Participants generally agreed that sufficiently powered research will require interinstitutional collaboration on uniform curricula and meaningful outcome tools, and that both biomedical and social science research paradigms will need to be applied to the questions at hand. Common barriers to medical simulation include both real and perceived lack of resources, poor understanding among faculty regarding the nature of the tools and techniques, and the inherent complexity of multidisciplinary collaboration. Medical simulation can and should be used to complement current methods of medical education. Educators should make thoughtful choices among simulation modalities to help trainees most effectively achieve learning objectives. Simulation researchers should prioritize the development and validation of clinical performance tools and other defined outcome measures on which meaningful large-scale research can be anchored. Finally, national collaboration should be encouraged and fostered by institutions and funding agencies.

Trends and contexts in European cardiology practice for the next 15 years: The Madrid Declaration: a report from the European Conference on the Future of Cardiology, Madrid, 2-3 June 2006

In the near future, the practice of cardiology in Europe will be strongly influenced by a complex interplay of epidemiological, social, economical, professional, and technological evolving factors. The present report summarizes the conclusions of an expert conference organized by the European Society of Cardiology to discuss the interactions between these phenomena, in an attempt to foresee the potential scenario in which cardiovascular healthcare and research will develop in the near future, and to anticipate solutions to the identified problems.