Task Force Review Research Articles

Implementation of a tier system for IVIG indications to address IVIG shortage at a tertiary care pediatric medical center.

Drug shortages are a common issue that healthcare systems face and can result in adverse health outcomes for patients requiring inferior alternate treatment. The United States recently experienced a national drug shortage of intravenous immunoglobulin (IVIG). Several reported strategies to address the IVIG and other drug shortages have been proposed; however, there is a lack of evidence-based methods for protocol development and implementation. To evaluate the efficacy of introducing a multidisciplinary task force and tier system of indications and to minimize adverse effects during a shortage of IVIG. Faculty members across disciplines with expertise in IVIG use were invited to participate in a task force to address the shortage and ensure adequate supply for emergent indications. A tier system of IVIG indications was established according to the severity of diagnosis, urgency of indication, and quality of supporting evidence. Based on inventory, indications in selected tiers were auto-approved. Orders that could not be automatically approved were escalated for task force review. Overall, there were 342 distinct requests for IVIG during the study period (August 1, 2019 to December 31, 2019). All Tier 1 indications were approved. Of all requests, only 2.6% (9) of requests were denied, none of which resulted in adverse effects based on retrospective chart review. Seven patients who regularly receive IVIG had possible adverse effects due to dose reduction or spacing of treatment; however, each complication was multifactorial and not attributed to the shortage or tier system implementation alone. Implementation of a multidisciplinary task force and tier system to appropriately triage high-priority indications for limited pharmaceutical agents should be considered in health institutions faced with a drug shortage.

American society of pediatric otolaryngology vascular anomalies task force review of tongue venous malformations: Techniques, pearls, and pitfalls.

Management of tongue venous malformations can be challenging in the pediatric population due to their heterogeneity in presentation, extent of involvement and functional compromise. It is important to recognize the value of various treatment options in order to guide management of each patient in an individualized fashion. Here we describe a series of patients with tongue venous malformations that are managed using diverse modalities to illustrate the relative benefits and risks of each technique. The challenges of venous malformation treatment can be mitigated by tailoring the approach to each individual patient and malformation. This case series also emphasizes the need and importance of working in the setting of a multidisciplinary vascular anomalies team.

Abstract WP26: Multidisciplinary Case Reviews Reduce "Door-to" Times

Background: Rapid reperfusion is critical for positive outcomes in stroke patients. To improve patient outcomes, the organization reduced program goals for all door-to metrics. To reach the aggressive new goals, a door-to task force led by the Stroke Program Coordinator was created. The multidisciplinary task force meets monthly and consists of members from Pre-Hospital, ED, Stroke, CT, and Neurointerventional Radiology (NIR). Interventions: Door-to data is shared monthly and case reviews on all door-to fall-outs are performed. The task force reviews door-to-CT, door-to-thrombolytics, and door-to-puncture metrics. An RCA is conducted on each case that exceeds our time goals looking for areas for improvement. Each case is evaluated from initial EMS contact through initiation of treatment; with all members of the multidisciplinary team participating. A trend in prolonged door-to-puncture was seen; so further investigation into the causes for the delays was done by the task force. This led to several improvement initiatives that addressed each of the delays. Education was completed for ED, CT, and NIR staff on the significance of a rapid initial evaluation and transport to NIR. An outside hospital (OSH) transfer notification process was created for OSH transfers eligible for thrombectomy. A direct-to-angio process was also developed to allow transport from CT to the NIR suite without stopping in an ED room. Results: The combination of these initiatives had a positive impact on door-to-puncture times. When comparing 2021 data to year-to-date 2022 post-implementation data, a reduction in door-to-puncture has been seen. Median time for door-to-puncture in 2021 was 60 minutes. This time has reduced to 48 minutes for the January through June 2022 timeframe. Conclusion: A multidisciplinary door-to task force reduces door-to-puncture times by keeping constant focus on door-to metrics and by creating a shared accountability for the process. With the door-to task force, real-time case reviews can be completed to allow for rapid identification of areas of opportunities and initiation of process improvement initiatives to reduce door-to times.

APA Task Force Reviews Digital Tools for Mental Health Care

APA Task Force Reviews Digital Tools for Mental Health Care

Existing Transplant Nephrology Compensation Models and Opportunities for Equitable Pay.

The American Society of Nephrology (ASN) formed the ASN Task Force on Academic Nephrologist Compensation and Productivity in 2020 to understand how the subspecialty is evolving and where there are needs for alignment in compensation in US transplant centers. The task force's review of the roles and

Updated Competency Model for Professional Rehabilitation Nursing: Practice Applications.

The Competency Model for Professional Rehabilitation Nursing is a lens through which nurses can view their practice; the four domains provide a template that guides that practice. The aim of this study was to describe a task force's review procedures and share the updated model. A rehabilitation nursing task force appraised the model over the course of 1 year. The original four domains remain, with wording changes for content and clarity throughout. Notable changes include (1) new competency for Domain 1 that focuses on the understanding of the worldview of individuals who are culturally different and (2) case stories for each domain related to nurses' proficiency (beginner, intermediate, and expert). This updated model can be used to explicate the rehabilitation nurses' role on intra/interprofessional teams, as well as provide a framework for education and staff orientation/performance evaluation. This competency model reflects the current practice and advances of the specialty practice of rehabilitation nursing.

Faculty peer review of teaching taskforce: A quantitative descriptive research study for the peer review process

BackgroundPeer review of teaching is important for both the faculty and student experience. Enhanced awareness of student learning experiences and a deeper reflection on teaching makes this process attractive to faculty leaders, staff and students. Evidence suggests that teachers who are reviewed gain confidence, anticipate improvement in teaching and are inclined to discuss their teaching with colleagues in the future. ObjectiveTo describe the development of a peer review of teaching process by the Faculty Peer Review of Teaching Taskforce at a school of nursing. MethodsA five-step Design for Six Sigma methodology was used and includes: Define, Measure, Analyze, Design, Verify (DMADV). In keeping with this methodology we: (1) established a Faculty Peer Review of Teaching Taskforce; (2) conducted a literature review on best practices; (3) reviewed peer institution practices; and (4) surveyed faculty to obtain their perspectives on the qualities of good teaching and the peer review of teaching process. Twenty-seven of the 68 full-time faculty members returned Qualtrics surveys (return rate = 39.7%). ResultsReview of the literature yielded four major themes, including post-observation discussion and systematic assignment of peer review pairs. Variation in practices across institutions was identified, from formal structured processes, to peer review conducted only in special circumstances. Survey findings revealed that faculty members overwhelmingly endorse the qualities of good teaching, agree that the peer review process should be required, and that peer reviewers should have several years of teaching experience. ConclusionsOur faculty were supportive of a peer review teaching process. As teaching demands continue to increase given the evolving complexities of nursing care, teaching platforms (i.e. online, hybrid), and diverse student body, we hope the process we develop may serve as a model for other higher education schools to enhance and maintain excellence in teaching for both the faculty and student experience.

EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization - Position Statement.

The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.

Clinical Nutrition Research and the COVID-19 Pandemic: A Scoping Review of the ASPEN COVID-19 Task Force on Nutrition Research.

The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID-19) Nutrition Task Force was to examine nutrition research applicable to the COVID-19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID-19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO-T) questions. The aggregated data were analyzed by clinical stage: pre-COVID-19, acute COVID-19, and chronic/post-COVID-19. Research gaps were discovered for all PICO-T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre-COVID-19); cardiometabolic-based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID-19); registered dietitian nutritionist counseling (chronic/post-COVID-19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO-T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre-COVID-19); enteral nutrition, protein-energy requirements, and glycemic control with nutrition (acute COVID-19); and home enteral and parenteral nutrition support (chronic/post-COVID-19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID-19.

Second Dose of Epinephrine for Anaphylaxis in the First Aid Setting: A Scoping Review.

Anaphylaxis is a life-threatening hypersensitivity reaction where rapid, early administration of epinephrine (adrenaline) can be lifesaving in the first aid setting. There are instances where a single dose of epinephrine does not relieve symptoms and a second dose may be required to further mitigate symptoms and preserve life.We performed a scoping review as part of an update to a previously conducted International Liaison Committee on Resuscitation First Aid Task Force (ILCOR) review. PubMed and Embase were searched using the strategy from the 2015 ILCOR review (dates January 1, 2015 to October 22, 2019) and a review of the grey literature (all dates up to November 18, 2019) was performed to identify data on the requirement, use, and effectiveness of a second dose of epinephrine. Each search was rerun on June 26, 2020. We included all human studies of adults and children with an English abstract. Critical outcomes included resolution of symptoms, adverse effects, and complications of second dosing of epinephrine in the treatment of acute anaphylaxis. Included studies are presented descriptively.Our updated search identified 909 potential sources, 890 from the published literature and 19 from the grey literature. After full text review, two studies met our eligibility criteria (Campbell et al. and Akari et al.). For the outcome of resolution of symptoms, both studies found that two or more doses of epinephrine were required in 8% of 582 patients and 28% of 18 patients, respectively, with anaphylaxis requiring treatment with epinephrine. The other a priori outcomes were not reported.This scoping review identified limited evidence regarding the use of a second dose of epinephrine for anaphylaxis in the first aid setting, however, due to the potential benefit, it is reasonable to administer a second dose when symptoms of severe anaphylaxis fail to resolve following an initial dose. Given the potential mortality associated with anaphylaxis, further research is needed to better identify individuals who may benefit from a second dose of epinephrine.

Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease: ASCO Clinical Practice Guideline.

The aim of this work is to provide evidence-based guidance on the management of osteoporosis in survivors of adult cancer. ASCO convened a multidisciplinary Expert Panel to develop guideline recommendations based on a systematic review of the literature. The literature search of the 2018 systematic review by the US Preventive Services Task Force in the noncancer population was used as the evidentiary base upon which the Expert Panel based many of its recommendations. A total of 61 additional studies on topics and populations not covered in the US Preventive Services Task Force review were also included. Patients with cancer with metastatic disease and cancer survival outcomes related to bone-modifying agents are not included in this guideline. Patients with nonmetastatic cancer may be at risk for osteoporotic fractures due to baseline risks or due to the added risks that are associated with their cancer therapy. Clinicians are advised to assess fracture risk using established tools. For those patients with substantial risk of osteoporotic fracture, the clinician should obtain a bone mineral density test. The bone health of all patients may benefit from optimizing nutrition, exercise, and lifestyle. When a pharmacologic agent is indicated, bisphosphonates or denosumab at osteoporosis-indicated dosages are the preferred interventions.

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS)

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS).Objective: To explore the usefulness within the National Health Service (NHS) of a brief (four week, ten hour) course based upon the Mindfulness Based Childbirth and Parenting (MBCP) programme (Duncan and Bardacke, 2010) described here as MBCP-4-NHS.Background: The National Maternity Review (2016) and report of The Independent Mental Health Taskforce to the NHS (2016a, 2016b) in England highlight the need for significant investment into perinatal mental health services, with the Government pledging funding to improve such services through a range of measures. Whilst the field of mindfulness during the perinatal period is in need of well controlled trials and studies exploring the mechanisms of action (Hall et al., 2016) the limited research to date supports the potential for mindfulness based interventions in pregnancy and the need for further scientific study in this area (Dhillon et al., 2017; Shi and Macbeth, 2017). Particularly because it may broaden women's repertoire of coping strategies with the potential to improve the developmental trajectory of both parents and infants (Dunn et al., 2012; Duncan and Bardacke, 2010; Vieten and Astin, 2008). However, most of the studies to date have involved lengthy courses of around 8–9 weeks (24 h) duration, which may not be feasible or economical within a UK NHS setting and therefore, would be unlikely to be adopted as routine practice.Design: An initial pilot study to discover if MBCP-4-NHS is acceptable and feasible within NHS maternity services, comparing maternal and paternal pre and post intervention self-report measures of mental health to begin to explore the effectiveness of this intervention.Setting: NHS antenatal education classes held in children's centres for expectant parents across Oxfordshire.Participants: All expectant parents receiving Oxfordshire maternity services between October 2014 and January 2015 were invited to self-refer into the intervention, of which 155 individuals (86 women and 69 men) took part.Intervention: ‘MBCP-4-NHS’ – A brief (four week, ten hour) course developed from the nine week Mindfulness Based Childbirth and Parenting (MBCP) intervention.Measures: Self-report measures of mental health including low mood/depression, mindfulness, stress, anxiety, pregnancy related distress and experiences.Findings: The results showed a significant increase in both maternal and paternal mental health with women demonstrating a significant improvement in symptoms of stress, anxiety, depression, pregnancy-related distress, labour worry and positive and negative pregnancy experiences; and men improving significantly in symptoms of anxiety, depression and showing a trend for improvement in self-reported symptoms of perceived stress.Conclusions: This is a promising antenatal intervention that can be feasibly implemented within NHS which might have the potential to impact upon parental mental health and, therefore, possibly also the health of next generation. However, caution is needed interpreting these findings given that this study did not include an active control group.Implications for practice: This research provides a clear rationale and justification for a large randomised control trial of this intervention within the NHS, which should include a more diverse population, across multiple centres and should explore both the potential health benefits for parents and infants/children as well as potential economic costs/benefits.

Update for Canadian NRP providers: A case-based review.

The International Liaison Committee on Resuscitation (ILCOR) Neonatal Task Force reviews available resuscitation science every 5 years and develops guidelines which are integrated into educational programs such as the Neonatal Resuscitation Program (NRP). The most recent ILCOR Neonatal Task Force consensus guidelines were published in October 2015. The Canadian Paediatric Society's NRP Steering Committee has reviewed ILCOR guidelines alongside the 7th edition (2016) NRP materials. Using a case-based approach, this practice point highlights the main changes relating to the delivery of NRP, within the Canadian context.

Be Careful What You Wish For: An Insider's Perspective on Licensure of I-O Psychologists

At first blush, licensing industrial and organizational (I-O) psychologists seems like a worthy pursuit. The work we do is important, can affect many lives for better or worse, and (we believe) requires a high level of education, training, and competence. Given a deeper look, however, we believe that the Licensure of Consulting and I-O Psychologists (LCIOP) Joint Task Force (2017) review overestimated the benefits of licensure, which are substantially outweighed by the practical challenges associated with a licensure program. Our response to the LCIOP represents two perspectives that can inform the feasibility of such an undertaking: a view from the inside of a federation of regulatory boards and a view from the world of certification as an alternative approach for ensuring quality in a diverse, complex profession.

Abstract 233: Practice Process Variability and Outcomes, Relation to Interventionalist Volume

Background: For the hospital, the cardiac catheterization lab is a high risk, high volume, high cost center. With the evolving imperative to provide value over volume, cardiac catheterization lab utilization, processes, and outcomes are an increasing focus of both internal and external scrutiny on an individual operator and aggregate basis. A hospital initiated multidisciplinary task force reviews real time and quarterly data from the NCDR and New York State to provide operator and cath lab managerial feedback, modify practice, and to assess progress. Ongoing interventions include; worksheets, EMR and Cath Lab templates, timely data review and feedback to managerial staff and operators. Methods: Stony Brook University has an open Cardiac Cath Lab with services provided by 5 full time faculty and 12 voluntary (private practice) interventional cardiologists. Using internal, NYS [2009-2015], and 2015 NCDR data, utilization, processes, and outcomes of high volume [HV] operators [>100 PCI/yr] and those with a disproportionate rate of cath to PCI conversions [>50%] were compared to lower volume [LV] and low conversion rate operators. Results: High volume operators [6] performed an average of 171 interventions compared to an average of 36 for LV operators [11]. Cases rated appropriate increased from 26% (102 of 391) in 2010 to 96.4% (1448 of 1502) in 2015. Cases rated inappropriate decreased from 24.8% (97 of 391) in 2010 to 1.0% (15 of 1502) in 2015; HV operators 0.5% versus 2.2% LV operators in 2015. The cases rated uncertain also decreased from 49% (192 of 391) in 2010 to 2.6% (39 of 1502) in 2015; HV operators 1.6% versus 5.1% for LV operators in 2015. This is statistically significant with p < 0.05 by chi-square. Process indicators of stent utilization/case [1.8 vs 1.6] and contrast use [179 vs 166 cc/case] were similar in HV and LV operators with an increase in fluoroscopy times [20.2 vs 18.3 min], Total Area Dose [11,017 vs 9,154], Skin Dose 1,759 vs 1,536] in the LV operators. Bleeding complications were higher [5.8% vs 2.1%] in HV operators and mortalities were confined to the HV operators and those performing STEMI interventions. Conclusions: A multidisciplinary task force is an effective method of targeting multiple variables impacting on cath lab value metrics. Marked progress has been made towards the consistent and appropriate use of cardiac catheterization and angioplasty. The highest rates of cath-PCI conversion, bleeding complications and mortality were for HV full time cardiologists, providing 7x24 coverage for STEMI interventions and caring for a disproportionate number of ACS patients. Initiated processes, oversight and feedback changes have effectively minimized process and potential outcome differences between high and low volume operators.

American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features.

American Thyroid Association (ATA) leadership asked the ATA Thyroid Nodules and Differentiated Thyroid Cancer Guidelines Task Force to review, comment on, and make recommendations related to the suggested new classification of encapsulated follicular variant papillary thyroid carcinoma (eFVPTC) without capsular or vascular invasion to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The task force consists of members from the 2015 guidelines task force with the recusal of three members who were authors on the paper under review. Four pathologists and one endocrinologist were added for this specific review. The manuscript proposing the new classification and related literature were assessed. It is recommended that the histopathologic nomenclature for eFVPTC without invasion be reclassified as a NIFTP, given the excellent prognosis of this neoplastic variant. This is a weak recommendation based on moderate-quality evidence. It is also noted that prospective studies are needed to validate the observed patient outcomes (and test performance in predicting thyroid cancer outcomes), as well as implications on patients' psychosocial health and economics.

Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians

To determine pediatricians' practices, attitudes, and barriers regarding screening for and treatment of pediatric dyslipidemias in 9- to 11-year-olds and 17- to 21-year-olds. American Academy of Pediatrics (AAP) 2013-2014 Periodic Survey of a national, randomly selected sample of 1627 practicing AAP physicians. Pediatricians' responses were described and modeled. Of 614 (38%) respondents who met eligibility criteria, less than half (46%) were moderately/very knowledgeable about the 2008 AAP cholesterol statement; fewer were well-informed about 2011 National Heart, Lung, and Blood Institute Guidelines or 2007 US Preventive Service Task Force review (both 26%). Despite published recommendations, universal screening was not routine: 68% reported they never/rarely/sometimes screened healthy 9- to 11-year-olds. In contrast, more providers usually/most/all of the time screened based on family cardiovascular history (61%) and obesity (82%). Screening 17- to 21-year-olds was more common in all categories (P?<?.001). Only 58% agreed with universal screening, and 23% felt screening was low priority. Pediatricians uniformly provided lifestyle counseling but access to healthy food (81%), exercise (83%), and adherence to lifestyle recommendations (96%) were reported barriers. One-half of pediatricians (55%) reported a lack of local subspecialists. Although 62% and 89% believed statins were appropriate for children and adolescents with high low-density lipoprotein cholesterol (200?mg/dL) unresponsive to lifestyle, a minority initiated statins (8%, 21%). US pediatricians report lipid screening and treatment practices that are largely at odds with existing recommendations, likely because of lack of knowledge and conflicts among national guidelines, and concern about treatment efficacy and harms. Education regarding pediatric lipid disorders could promote guideline implementation.

Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force.

Dyslipidemia may occur in younger adults (defined as persons aged 21 to 39 years) and is an important risk factor for cardiovascular disease. Screening might identify younger adults with asymptomatic dyslipidemia who may benefit from lipid-lowering therapies. To update the 2008 U.S. Preventive Services Task Force review on dyslipidemia screening in younger adults. The Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and MEDLINE through May 2016, and reference lists. Randomized, controlled trials; cohort studies; and case-control studies on screening for or treatment of asymptomatic dyslipidemia in adults aged 21 to 39 years. The plan was for 1 investigator to abstract data and a second to check their accuracy, and for 2 investigators to independently assess study quality; however, no studies met the inclusion criteria. No study evaluated the effects of lipid screening versus no screening, treatment versus no treatment, or delayed versus earlier treatment on clinical outcomes in younger adults. In addition, no study evaluated the diagnostic yield of alternative screening strategies (such as targeted screening of persons with a family history of hyperlipidemia vs. general screening) in younger adults. No direct relevant evidence. Direct evidence on the benefits and harms of screening for or treatment of dyslipidemia in younger adults remains unavailable. Estimating the potential effects of screening for dyslipidemia in this population requires extrapolation from studies performed in older adults. Agency for Healthcare Research and Quality.

State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now.

Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016;66:460-480. © 2016 American Cancer Society.

U.S. Agricultural Productivity: A Review of USDA Economic Research Service Methods

AbstractThe USDA Economic Research Service has emerged as an acknowledged intellectual leader in the construction and integration of national and state‐level productivity accounts in agriculture. The national and state‐level ERS productivity measures are widely referred to and used, and international sectoral comparisons rely on the ERS production accounts for foundation methodology in constructing agricultural productivity accounts in other countries. This leadership role has endured for many decades and accelerated in response to the AAEA‐USDA Task Force review of the agricultural productivity accounts (Gardner et al. 1980). It is against this backdrop of vigorous intellectual leadership that an external review committee has examined the data sources, methodology, ongoing research, documentation, and reporting of the ERS agricultural productivity accounts. Our recommendations are many and some are substantial. Two of the most important recommendations address overarching concerns of documentation and efficiency, two more consider website communication of methods and data, and four focus on the renewal and construction of the state‐level accounts.