Consensus Questions Research Articles

Consensus Statement on Concussion in Sport: The 3rd International Conference on Concussion in Sport Held in Zurich, November 2008

This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport.1 2 The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document. This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving and therefore management and return to play decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card and neither is subject to any copyright restriction. The authors request, however that the document and/or the SCAT2 card be distributed in their full and complete format. The following focus questions formed the foundation for the Zurich concussion consensus statement: ### Acute simple concussion ### Return to play (RTP) issues

Consensus statement on Concussion in Sport—The 3rd International Conference on Concussion in Sport held in Zurich, November 2008

This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport.1 2 The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document. This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving and therefore management and return to play decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card and neither is subject to any copyright restriction. The authors request, however that the document and/or the SCAT2 card be distributed in their full and complete format. The following focus questions formed the foundation for the Zurich concussion consensus statement: ### Acute simple concussion ### Return to play (RTP) issues

Symptom Management in Cancer

NIH Consensus Statements are prepared by a nonadvocate, non-Federal panel of experts, based on (1) presentations by investigators working in areas relevant to the consensus questions during a 2 day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. The statement reflects the panel's assessment of medical knowledge available at the time the statement was written. Thus, it provides a "snapshot in time" of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research.

Comments on Roger Griffin, `The Primacy of Culture: The Current Growth (or Manufacture) of Consensus within Fascist Studies'

In arguing that a new consensus is emerging in fascist studies, Roger Griffin suggests that, having encountered the limits of such staples as class reaction, petty-bourgeois resentment and irrational activism, we have found not the answers but a more fruitful framework for enquiry and discussion. Basically, we are coming to accept a less reductive approach, as Stanley Payne implied in noting that fascism is increasingly taken as revolutionary in its own right. And for Griffin the minimum content of that revolution entailed, in his own nowfamiliar definition, a quest for national rejuvenation wound around palingenetic myth. More specifically, the new consensus entails a culturalist approach, even the primacy of culture over politics a legacy of the late George Mosse, whose once-heretical notions now offer indications for further research. Moreover, as Mosse himself so well put it in a passage Griffin quotes, only if we read fascism from the inside, in terms of its own selfunderstanding, can we assess its appeal and power. This imperative is surely a corollary of any notion that fascism was revolutionary in its own right. At the same time, we remember that even as revolutionary, fascism proved, at the very least, a catastrophic failure. Since any new consensus will yield new axes of disagreement, we might ask whether our present disagreements seem in fact to operate from within such a new consensus or instead to cut across paradigms thereby suggesting that Griffin may be jumping the gun. Griffin effectively pinpoints some 'doublethink' in those like R.J.B. Bosworth, A.J. Gregor, and Robert Paxton, who question the terms of the new consensus while coming round, in spite of themselves, to embrace much of it. But he is so quick to fasten upon any culturalist hint as evidence of consensus that he may miss the sense in which the rest reflects not simply an incomplete embrace of that consensus but crossparadigm questions that are still on the table. Whatever the limits (even absurdities) of some of Bosworth's characterizations, his concerns more radically elude the new consensus than Griffin suggests. Bosworth is nervous about the interface of the new culturalist approach

Clinical Diagnosis of Dental Caries: A European Perspective

The aim of this paper is to provide a broad international perspective on aspects of the RTI/UNC systematic review, to introduce relevant literature not cited, and to make recommendations for clinical practice education and research suggested by the evidence. Clinical caries diagnosis represents the foundation on which the answers to most of the consensus questions will be based. This paper highlights needs for being clear about definitions and nomenclature; understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review; and appreciating that the diagnostic challenge now faced by clinicians is significant and is becoming more complex as the presentation and distribution of the disease changes over time and the range of preventive and operative treatment options expands. A series of recommendations informed by the evidence are made, including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Finally, it is suggested that dentistry should learn from the developing evidence base in medicine on how best to disseminate the findings of reviews and promote appropriate changes in clinical practice.

“Change in the wind”: report from the 2000 Thoracic Surgery Directors Association Retreat on Thoracic Surgery Graduate Medical Education

In October, 1999, the American Board of Thoracic Surgery (ABTS) resolved that “the ABTS change current policy regarding American Board of Surgery (ABS) certification so that at a point in the future, yet to be determined, ABS certification will become optional.” This position was taken by the ABTS after exhaustive study and debate of the relevant issues and of evolving data pertinent to Thoracic Surgery Graduate Medical Education (TSGME), a topic of three major conferences in the last decade 1 and of the addresses of seven thoracic societal presidents, four of them in the last 6 years. Among the most provocative points that were considered by the Board were: (1) The vast expansion of fundamental knowledge and of operative approaches to cardiothoracic diseases currently required to educate the TS resident in a time-frame essentially unchanged since formal education in TS began in 1928; (2) a total duration of medical school and of GME that obligates the thoracic surgeon entering practice to be older, as compared to peers in other professions, and to be constrained by greater indebtedness; (3) a disturbingly diminished pool of applicants to TS residencies, with fewer US medical graduates applying than residency positions to fill; and (4) diminishing funding for TSGME occurring concomitantly with increasing financial burdens on academic thoracic surgery programs. The specific intent of the ABTS was to facilitate change if change were to be the desire of thoracic surgery educators and of the other parties in organized thoracic surgery vested with interest in, and responsibility for, the process and product of TSGME.

Review of Coherence in thought and action.

PAUL THAGARD Coherence in Thought and Action Cambridge, mA: Massachusetts Institution of Technology Press, 2000, 328 pages (ISBN 0-26220131-3, us$32.95, Hardcover) Reviewed by WILLIAM E. SMYTHE This volume is a comprehensive presentation of the latest work of Paul Thagard and his research group on coherence theory, an area of inquiry to which the author has made ground-breaking contributions for over a decade. Coherence theory is a peculiar synthesis of philosophy and cognitive science that approaches problems in terms of the satisfaction of multiple constraints within networks of highly interconnected elements. The basic ideas of coherence theory would seem to have broad appeal across a number of areas of contemporary thought. They clearly resonate with the meaning holism of Quine's two dogmas of empiricism in philosophy, with notions of distributed cognition and constraint satisfaction models of decision-making in human cognition, with the current popularity of neural network and connectionist models in the cognitive and neurosciences, and, more generally, with the growing interest in nonlinear dynamics and related phenomena across a wide range of disciplines. The main aim of the present work is to extend the reach of coherence theory beyond its usual applications in cognition and epistemology to questions of ontology, ethics, politics, emotion, social consensus, and probabilistic reasoning. Thagard makes a persuasive if not wholly convincing argument that all of these domains can be thought about in roughly similar ways. At the heart of Thagard's main argument is a surprisingly simple conceptual structure. One begins with a set of elements - propositional and other types of representations - that are linked via numerically weighted relations of coherence (positive constraints) and incoherence (negative constraints). The goal of coherence-based reasoning is to partition the elements into two disjoint sets - accepted and rejected elements - in such a way that overall coherence within each set is maximized. Connectionist algorithms can be applied to compute coherence in an iterative fashion for any completely specified network of elements. The underlying simplicity of this explanatory framework is at first striking, given the wide range of problems to which Thagard subsequently applies it. This initial impression of simplicity quickly evaporates, however, as one reads beyond the introductory chapters. Thagard's basic conceptual structure requires substantial embellishment to deal with various specific issues and areas of application. Thus, we learn that epistemological issues require one to distinguish among five distinct types of coherence: explanatory, analogical, deductive, perceptual, and conceptual. Ethical reasoning adds considerations of deliberative coherence. Understanding emotion requires supplementing relations of cognitive coherence with valence relations and introduces considerations of metacoherence. Consensus formation is based, not just on coherence, but on the vicissitudes of communication and information exchange. Then there is the matter of probabilistic reasoning which, as Thagard shows, can be accommodated within coherence networks only with considerable difficulty. Despite the complexity of the issues it treats, this is not at all a difficult book to read. Thagard has the knack for explaining difficult ideas in readily understandable language. However, his frequent crossing of disciplinary boundaries makes it a challenging task at times to evaluate his theory. Is it primarily a theory of human cognition, of philosophical epistemology, or is it mainly intended as a new procedure for addressing philosophical questions? It is perhaps all of these at once. This kind of blending of psychological and philosophical issues is a familiar feature of the work of contemporary philosophers writing about cognitive science. It is also somewhat reminiscent of the style of thought of many of the great philosophers of the past, who presented their epistemologies as part and parcel of their theories of mind. …

Effective Medical Treatment of Opiate Addiction

Objective.—To provide clinicians, patients, and the general public with a responsible assessment of the effective approaches to treat opiate dependence.Participants.—A nonfederal, nonadvocate, 12-member panel representing the fields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, epidemiology, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 600. Presentations and discussions were divided into 3 phases over 212 days: (1) presentations by investigators working in the areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of a third day. The conference was organized and supported by the Office of Medical Applications of Research, National Institutes of Health.Evidence.—The literature was searched through MEDLINE and other National Library of Medicine and online databases from January 1994 through September 1997 and an extensive bibliography of 941 references was provided to the panel and the conference audience. Experts prepared abstracts for their presentations as speakers at the conference with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.Consensus Process.—The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions.Conclusions.—Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it. All persons dependent on opiates should have access to methadone hydrochloride maintenance therapy under legal supervision, and the US Office of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation. There is a need for improved training for physicians and other health care professionals. Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance programs.

Does symbolism ‘construct an urban mesocosm’? Robert Levy’s Mesocosm and the question of value consensus in Bhaktapur

It has become almost a truism in recent anthropological writing to say that cultures are not coherent but are made up of conflicting ideas, symbols, and discourses; that concepts are essentially contested; that societies do not just endow people with a way of viewing the world but force problematic choices upon them. In short, cultures are 'constructed,9 conflict-ridden? and perpetually changing. Some anthropologists have gone so far as to say that we should dispense with the concepts of 'culture9 and 'society* altogether because they imply a degree of systematic integration that never in fact obtains. ' This way of thinking rejects in its entirety a theoretical vision, or cluster of theoretical visions, that derive in one way or another from ?mile Durkheim. It has been one of the ambitions of social and cultural anthropologists since Durkheim to produce a coherent account of the people they study, an account that reveals their worldview or cosmology as a systematic, interlocking set of concepts. Such an account is produced either as an end in itself or in ordo* to relate the worldview to the underlying social structure. It is certainly true that Durkheim took the division of die world into national and ethnic units vary much for granted; this is somewhat ironic given that he spent much of his life teaching and providing a moral framework for school teachers, that is, helping to create the very French nation whose existence he never questioned. Unlike Durkheim. and more perhaps than their structural func tionalist and structuralist forebears, most anthropologists today have a lively

Communications and ALS trial

DR. LUDWIG GUTMANN: This panel discussion will deal with communications, ALS trial information sharing, and how we may want to conduct ALS trials in the future. There are a number of important issues to discuss, including the issue of national, international, or regional study groups and consortia. ALS CARE is a very exciting step forward into the same kind of arena that oncologists developed years ago in the United States. I hope we will deal with the question of consensus on outcome. We have all been impressed by not only the quality of some of the research trials, but also that we are looking at different outcome measurements. Dr. Brooke will comment on the use of Internet and the project he is developing for the American Academy of Neurology. We need to address the importance of physiciandriven research consortia, and Dr. Mitsumoto will discuss the pharmaceutical company consortia with which he is involved. DR. DANIEL DRACHMAN: Virtually everybody who is here has either witnessed or been involved in a number of these sponsored trials: three on CNTF, two on riluzole, two on BDNF, one on gabapentin, and one on IGF-1. All these trials have been driven by the industry. In most cases, trial designs differ from one another; they are not comparable. As a rule, data are managed by the company, not by the investigators who eventually get to see it, although somewhat after the data have been released by the Wall Street Journal to stockholders (which is required by law) or by press conferences. This has caused some problems; the data have been presented in other than a strictly peer-reviewed scientific manner. Another issue is that of combinations. If there are two drugs, you may wish to compare A with A plus B, and B with A plus B. …

Cochlear Implants in Adults and Children

Objective. —To provide clinicians and other health care providers with a current consensus on the benefits, limitations, and technical and safety issues that need to be considered in the use of cochlear implants. Participants. —A nonfederal, nonadvocate, 14-member consensus panel representing the fields of otolaryngology, audiology, speech-language pathology, pediatrics, psychology, and education, and including a public representative. In addition, 24 experts in auditory anatomy and physiology, otolaryngology, audiology, aural rehabilitation, education, speech-language pathology, and bioengineering presented data to the consensus panel and a conference audience of 650. Evidence. —The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. Consensus. —The panel, answering predefined consensus questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. Consensus Statement. —The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. Conclusions. —Cochlear implantation improves communication ability in most adults with severe-to-profound deafness and frequently leads to positive psychological and social benefits as well. Currently, children at least 2 years old and adults with profound deafness are candidates for implantation. Cochlear implant candidacy should be extended to adults with severe hearing impairment and open-set sentence discrimination that is less than or equal to 30% in the best-aided condition. Access to optimal education and (re)habilitation services is important for adults and is critical for children to maximize the benefits available from cochlear implantation. (JAMA. 1995;274:1955-1961)

NIH consensus conference. Cochlear implants in adults and children

To provide clinicians and other health care providers with a current consensus on the benefits, limitations, and technical and safety issues that need to be considered in the use of cochlear implants.A nonfederal, nonadvocate, 14-member consensus panel representing the fields of otolaryngology, audiology, speech-language pathology, pediatrics, psychology, and education, and including a public representative. In addition, 24 experts in auditory anatomy and physiology, otolaryngology, audiology, aural rehabilitation, education, speech-language pathology, and bioengineering presented data to the consensus panel and a conference audience of 650.The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.The panel, answering predefined consensus questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature.The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.Cochlear implantation improves communication ability in most adults with severe-to-profound deafness and frequently leads to positive psychological and social benefits as well. Currently, children at least 2 years old and adults with profound deafness are candidates for implantation. Cochlear implant candidacy should be extended to adults with severe hearing impairment and open-set sentence discrimination that is less than or equal to 30% in the best-aided condition. Access to optimal education and (re)habilitation services is important for adults and is critical for children to maximize the benefits available from cochlear implantation.

Infectious disease testing for blood transfusions. NIH Consensus Development Panel on Infectious Disease Testing for Blood Transfusions

To provide physicians and other transfusion medicine professionals with a current consensus on infectious disease testing for blood transfusions.A non-Federal, nonadvocate, 12-member consensus panel representing the fields of hematology, infectious disease, transfusion medicine, epidemiology, and biostatistics and a public representative. In addition, 23 experts in hematology, cardiology, transfusion medicine, infectious disease, and epidemiology presented data to the consensus panel and a conference audience of 450.The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.The serum alanine aminotransferase test should be discontinued as a surrogate marker for blood donors likely to transmit posttransfusion non-A, non-B hepatitis infection since specific hepatitis C anti-body testing has eliminated more than 85 percent of these cases. Anti-hepatitis B core antigen testing should continue as it may prevent some cases of posttransfusion hepatitis B; it also may act as a surrogate marker for HIV infection in donors and may prevent a small number of cases of transfusion-transmitted HIV infection. Syphilis testing should continue until adequate data can determine its effect on the rarity of transfusion-transmitted syphilis. Vigilant public health surveillance is critical in responding to emerging infectious disease threats to the blood supply.

Infectious Disease Testing for Blood Transfusions

To provide physicians and other transfusion medicine professionals with a current consensus on infectious disease testing for blood transfusions.A nonfederal, nonadvocate, 12-member consensus panel representing the fields of hematology, infectious disease, transfusion medicine, epidemiology, and biostatistics and a public representative. In addition, 23 experts in hematology, cardiology, transfusion medicine, infectious disease, and epidemiology presented data to the consensus panel and a conference audience of 450.The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.The serum alanine aminotransferase test should be discontinued as a surrogate marker for blood donors likely to transmit posttransfusion non-A, non-B hepatitis infection since specific hepatitis C antibody testing has eliminated more than 85% of these cases. Antibody to hepatitis B core antigen testing should continue as it may prevent some cases of posttransfusion hepatitis B; it may also act as a surrogate marker for human immunodeficiency virus (HIV) infection in donors and may prevent a small number of cases of transfusion-transmitted HIV infection. Syphilis testing should continue until adequate data can determine its effect on the rarity of transfusion-transmitted syphilis. Vigilant public health surveillance is critical in responding to emerging infectious disease threats to the blood supply.

NIH consensus conference: Total hip replacement. NIH Consensus Development Panel on Total Hip Replacement

To provide physicians with a current consensus on total hip replacement.A nonfederal, nonadvocate, 13-member consensus panel representing the fields of orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, internal medicine, public health, geriatrics, biostatistics, and a public representative. In addition, 27 experts in orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, rheumatology, geriatrics, and epidemiology presented data to the consensus panel and a conference audience of 425.The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.Total hip replacement is an option for nearly all patients with diseases of the hip that cause chronic discomfort and significant functional impairment. Most patients have an excellent prognosis for long-term improvement in symptoms and physical function. At this time, a cemented femoral component using modern cementing techniques, paired with a porous-coated acetabular component, can give excellent long-term results. Revision of a total hip replacement is indicated when mechanical failure occurs. Continued periodic follow-up is necessary to identify early evidence of impending failure so as to permit remedial action before a catastrophic event.

Total Hip Replacement

Objective. —To provide physicians with a current consensus on total hip replacement. Participants. —A nonfederal, nonadvocate, 13-member consensus panel representing the fields of orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, internal medicine, public health, geriatrics, biostatistics, and a public representative. In addition, 27 experts in orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, rheumatology, geriatrics, and epidemiology presented data to the consensus panel and a conference audience of 425. Evidence. —The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. Consensus. —The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. Consensus Statement. —The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. Conclusions. —Total hip replacement is an option for nearly all patients with diseases of the hip that cause chronic discomfort and significant functional impairment. Most patients have an excellent prognosis for long-term improvement in symptoms and physical function. At this time, a cemented femoral component using modern cementing techniques, paired with a porous-coated acetabular component, can give excellent long-term results. Revision of a total hip replacement is indicated when mechanical failure occurs. Continued periodic follow-up is necessary to identify early evidence of impending failure so as to permit remedial action before a catastrophic event. (JAMA. 1995;273:1950-1956)

Consensus Conference Statement: Escherichia coli O157:H7 infections—An Emerging National Health Crisis, July 11–13, 1994

This statement was prepared by a nonadvocate panel of experts based on (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session, (2) questions and statements from conference attendees during open discussion periods that are part of the public session, and (3) closed deliberations by the panel during the remainder of the second day and the morning of the third. This statement is an independent report of the panel and is not a policy statement of the American Gastroenterological Association, the American Gastroenterological Association Foundation (now known as the American Digestive Health Foundation), or the cosponsors listed at the end of this statement.

NIH consensus conference. Ovarian cancer. Screening, treatment, and follow-up. NIH Consensus Development Panel on Ovarian Cancer

To provide physicians with a current consensus on screening, prevention, diagnosis, and treatment of ovarian cancer.A nonfederal, nonadvocate, 14-member consensus panel representing the fields of gynecologic, medical, and radiation oncology, obstetrics/gynecology, and biostatistics; 25 experts in obstetrics/gynecology and gynecologic, medical, and radiation oncology who presented data to the consensus panel; and a conference audience of approximately 500.The literature was searched through MEDLINE, and an extensive bibliography of references was produced for the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given priority over clinical anecdotal experience.The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. The panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.There is no evidence available yet that the current screening modalities of CA-125 and transvaginal ultrasonography can be effectively used for widespread screening to reduce mortality from ovarian cancer nor that their use will result in decreased rather than increased morbidity and mortality. Women with stage IA grade 1 and stage IB grade 1 ovarian cancer do not require postoperative adjuvant therapy. Many remaining stage I patients do require chemotherapy. Subsets of stage I must be fully defined and ideal treatment determined. Women with stages II, III, and IV epithelial ovarian cancer (other than low malignant potential tumors) should receive postoperative chemotherapy.

Ovarian Cancer

<h3>Objective.</h3> —To provide physicians with a current consensus on screening, prevention, diagnosis, and treatment of ovarian cancer. <h3>Participants.</h3> —A nonfederal, nonadvocate, 14-member consensus panel representing the fields of gynecologic, medical, and radiation oncology, obstetrics/ gynecology, and biostatistics; 25 experts in obstetrics/gynecology and gynecologic, medical, and radiation oncology who presented data to the consensus panel; and a conference audience of approximately 500. <h3>Evidence.</h3> —The literature was searched through MEDLINE, and an extensive bibliography of references was produced for the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given priority over clinical anecdotal experience. <h3>Consensus.</h3> —The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. <h3>Consensus Statement.</h3> —The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. The panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. <h3>Conclusions.</h3> —There is no evidence available yet that the current screening modalities of CA-125 and transvaginal ultrasonography can be effectively used for widespread screening to reduce mortality from ovarian cancer nor that their use will result in decreased rather than increased morbidity and mortality. Women with stage IA grade 1 and stage IB grade 1 ovarian cancer do not require postoperative adjuvant therapy. Many remaining stage I patients do require chemotherapy. Subsets of stage I must be fully defined and ideal treatment determined. Women with stages II, III, and IV epithelial ovarian cancer (other than low malignant potential tumors) should receive postoperative chemotherapy. (<i>JAMA</i>. 1995;273:491-497)

Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes

<h3>Objective.</h3> —To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants. <h3>Participants.</h3> —A nonfederal, nonadvocate, 16-member consensus panel including representatives from neonatology, obstetrics, family medicine, behavioral medicine, psychology, biostatistics, and the public; 19 experts in neonatology, obstetrics, and pharmacology presented data to the consensus panel and a conference audience of approximately 500. <h3>Evidence.</h3> —An extensive bibliography of references was produced for the consensus panel and the conference audience using a variety of on-line databases including MEDLINE. The consensus panel met several times prior to the conference to review the literature. It also commissioned an updated meta-analysis, a neonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evidence using the grading system developed by the Canadian Task Force on the Periodic Health Examination and adapted by the US Preventive Services Task Force. <h3>Consensus.</h3> —The consensus panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. <h3>Consensus Statement.</h3> —The consensus panel composed a draft statement that was read in its entirety at the conference for comment. The panel released a revised statement at the end of the conference and finalized the revisions a few weeks after the conference. <h3>Conclusions.</h3> —Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health. (<i>JAMA</i>. 1995;273:413-418)