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Sample records for implementing group consensus

  1. Expert systems for implementing group consensus opinion in complex, weighted decisions

    SciTech Connect

    Carr, K.R.

    1990-01-01

    The development of an expert system for instrumentation and control operations is sometimes particularly difficult because (a) the expert system must implement the consensus opinion of a group of several human experts in all circumstances, (b) there may be 20 or more complex, dynamic, interrelated factors that influence the decision, each of which must be properly considered and weighed, and (c) the decision may involve choosing from several alternative courses of action, rather that a simple yes-no'' choice. These demanding requirements can discourage or, in some cases, prevent altogether the development of expert systems that are seriously needed and would by highly beneficial. However, the integration of a formal decision analysis method into the expert system as described in this paper can smooth the development phase of the expert system and provide high assurance of the success of the project. In virtually every case, regardless of the complexity of the problem, the approach outlined will provide an expert system to function on every decision just as if the human experts had assembled and performed a formal analysis to reach the overall best balanced decision. 6 refs., 8 figs.

  2. Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: A consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia.

    PubMed

    Alsop, David C; Detre, John A; Golay, Xavier; Günther, Matthias; Hendrikse, Jeroen; Hernandez-Garcia, Luis; Lu, Hanzhang; MacIntosh, Bradley J; Parkes, Laura M; Smits, Marion; van Osch, Matthias J P; Wang, Danny J J; Wong, Eric C; Zaharchuk, Greg

    2015-01-01

    This review provides a summary statement of recommended implementations of arterial spin labeling (ASL) for clinical applications. It is a consensus of the ISMRM Perfusion Study Group and the European ASL in Dementia consortium, both of whom met to reach this consensus in October 2012 in Amsterdam. Although ASL continues to undergo rapid technical development, we believe that current ASL methods are robust and ready to provide useful clinical information, and that a consensus statement on recommended implementations will help the clinical community to adopt a standardized approach. In this review, we describe the major considerations and trade-offs in implementing an ASL protocol and provide specific recommendations for a standard approach. Our conclusion is that as an optimal default implementation, we recommend pseudo-continuous labeling, background suppression, a segmented three-dimensional readout without vascular crushing gradients, and calculation and presentation of both label/control difference images and cerebral blood flow in absolute units using a simplified model.

  3. Using Consensus Groups in Online Learning

    ERIC Educational Resources Information Center

    Smith, Regina O.; Dirkx, John M.

    2007-01-01

    This chapter describes online consensus group work, a form of collaborative learning. It discusses collaborative learning, small group work, and consensus learning, with recommendations for their use in online contexts.

  4. Prospective Randomized Double-Blind Pilot Study of Site-Specific Consensus Atlas Implementation for Rectal Cancer Target Volume Delineation in the Cooperative Group Setting

    SciTech Connect

    Fuller, Clifton D.; Nijkamp, Jasper; Duppen, Joop C.; Rasch, Coen R.N.; Thomas, Charles R.; Wang, Samuel J.; Okunieff, Paul; Jones, William E.; Baseman, Daniel; Patel, Shilpen; Demandante, Carlo G.N.; Harris, Anna M.; Smith, Benjamin D.; Katz, Alan W.; McGann, Camille

    2011-02-01

    Purpose: Variations in target volume delineation represent a significant hurdle in clinical trials involving conformal radiotherapy. We sought to determine the effect of a consensus guideline-based visual atlas on contouring the target volumes. Methods and Materials: A representative case was contoured (Scan 1) by 14 physician observers and a reference expert with and without target volume delineation instructions derived from a proposed rectal cancer clinical trial involving conformal radiotherapy. The gross tumor volume (GTV), and two clinical target volumes (CTVA, including the internal iliac, presacral, and perirectal nodes, and CTVB, which included the external iliac nodes) were contoured. The observers were randomly assigned to receipt (Group A) or nonreceipt (Group B) of a consensus guideline and atlas for anorectal cancers and then instructed to recontour the same case/images (Scan 2). Observer variation was analyzed volumetrically using the conformation number (CN, where CN = 1 equals total agreement). Results: Of 14 evaluable contour sets (1 expert and 7 Group A and 6 Group B observers), greater agreement was found for the GTV (mean CN, 0.75) than for the CTVs (mean CN, 0.46-0.65). Atlas exposure for Group A led to significantly increased interobserver agreement for CTVA (mean initial CN, 0.68, after atlas use, 0.76; p = .03) and increased agreement with the expert reference (initial mean CN, 0.58; after atlas use, 0.69; p = .02). For the GTV and CTVB, neither the interobserver nor the expert agreement was altered after atlas exposure. Conclusion: Consensus guideline atlas implementation resulted in a detectable difference in interobserver agreement and a greater approximation of expert volumes for the CTVA but not for the GTV or CTVB in the specified case. Visual atlas inclusion should be considered as a feature in future clinical trials incorporating conformal RT.

  5. A local consensus process making use of focus groups to enhance the implementation of a national integrated health care standard on obesity care.

    PubMed

    Derksen, R E; Brink-Melis, W J; Westerman, M J; Dam, J J M Ten; Seidell, J C; Visscher, T L S

    2012-04-01

    Recent guidelines on obesity management promote integrated care. There is little knowledge about local opportunities and barriers, faced by health care professionals and patients, that affect implementation of an integrated national health care standard in a local setting. Our aim is to understand experiences and expectations of health care professionals and patients as part of the local implementation process. Eight focus groups and two interviews have been conducted among 24 patients (60+) and 29 professionals from seven different care disciplines. Both patients and professionals have identified serious barriers to implement the national standard: older adults do not feel taken seriously and experience lacking support from professionals. Professionals give contradictory advice and recommendations do not match needs of older adults. Professionals actually feel reluctant to discuss weight-related topics due to several reasons: they do not consider obesity being a chronic disease, lack of qualifications to support self-management and perceived lack of awareness and motivation among patients. Focus groups have proven their value to ascertain the opportunities and barriers older adults and professionals foresee while improving obesity care in order to meet the standards as required in a national guideline. Our research provides an emerging picture of health care professionals and patients having contradictory views and expectations about 'the others' role and their notions on the capability to intervene on patient's weight problems. Without this emerging picture, we would have missed important information on barriers to overcome. The likelihood of successful implementation would then have been small.

  6. The Spanish human papillomavirus vaccine consensus group: a working model.

    PubMed

    Cortés-Bordoy, Javier; Martinón-Torres, Federico

    2010-08-01

    Successful implementation of Human Papillomavirus (HPV) vaccine in each country can only be achieved from a complementary and synergistic perspective, integrating all the different points of view of the diverse related professionals. It is this context where the Spanish HPV Vaccine Consensus Group (Grupo Español de Consenso sobre la Vacuna VPH, GEC-VPH) was created. GEC-VPH philosophy, objectives and experience are reported in this article, with particular attention to the management of negative publicity and anti-vaccine groups. Initiatives as GEC-VPH--adapted to each country's particular idiosyncrasies--might help to overcome the existing barriers and to achieve wide and early implementation of HPV vaccination.

  7. Radiologist Peer Review by Group Consensus.

    PubMed

    Harvey, H Benjamin; Alkasab, Tarik K; Prabhakar, Anand M; Halpern, Elkan F; Rosenthal, Daniel I; Pandharipande, Pari V; Gazelle, G Scott

    2016-06-01

    The objective of this study was to evaluate the feasibility of the consensus-oriented group review (COGR) method of radiologist peer review within a large subspecialty imaging department. This study was institutional review board approved and HIPAA compliant. Radiologist interpretations of CT, MRI, and ultrasound examinations at a large academic radiology department were subject to peer review using the COGR method from October 2011 through September 2013. Discordance rates and sources of discordance were evaluated on the basis of modality and division, with group differences compared using a χ(2) test. Potential associations between peer review outcomes and the time after the initiation of peer review or the number of radiologists participating in peer review were tested by linear regression analysis and the t test, respectively. A total of 11,222 studies reported by 83 radiologists were peer reviewed using COGR during the two-year study period. The average radiologist participated in 112 peer review conferences and had 3.3% of his or her available CT, MRI and ultrasound studies peer reviewed. The rate of discordance was 2.7% (95% confidence interval [CI], 2.4%-3.0%), with significant differences in discordance rates on the basis of division and modality. Discordance rates were highest for MR (3.4%; 95% CI, 2.8%-4.1%), followed by ultrasound (2.7%; 95% CI, 2.0%-3.4%) and CT (2.4%; 95% CI, 2.0%-2.8%). Missed findings were the most common overall cause for discordance (43.8%; 95% CI, 38.2%-49.4%), followed by interpretive errors (23.5%; 95% CI, 18.8%-28.3%), dictation errors (19.0%; 95% CI, 14.6%-23.4%), and recommendation (10.8%; 95% CI, 7.3%-14.3%). Discordant cases, compared with concordant cases, were associated with a significantly greater number of radiologists participating in the peer review process (5.9 vs 4.7 participating radiologists, P < .001) and were significantly more likely to lead to an addendum (62.9% vs 2.7%, P < .0001). COGR permits departments

  8. Consensus statement update on posttraumatic stress disorder from the international consensus group on depression and anxiety.

    PubMed

    Ballenger, James C; Davidson, Jonathan R T; Lecrubier, Yves; Nutt, David J; Marshall, Randall D; Nemeroff, Charles B; Shalev, Arieh Y; Yehuda, Rachel

    2004-01-01

    To provide an update to the "Consensus Statement on Posttraumatic Stress Disorder From the International Consensus Group on Depression and Anxiety" that was published in a supplement to The Journal of Clinical Psychiatry (2000) by presenting important developments in the field, the latest recommendations for patient care, and suggestions for future research. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty who were invited by the chair were Randall D. Marshall, Charles B. Nemeroff, Arieh Y. Shalev, and Rachel Yehuda. The consensus statement is based on the 7 review articles in this supplement and the related scientific literature. Group meetings were held over a 2-day period. On day 1, the group discussed topics to be represented by the 7 review articles in this supplement, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all faculty. There have been advancements in the science and treatment of posttraumatic stress disorder. Attention to this disorder has increased with recent world events; however, continued efforts are needed to improve diagnosis, treatment, and prevention of posttraumatic stress disorder.

  9. Effect of group means on the probability of consensus.

    PubMed

    Arima, Yoshiko

    2012-04-01

    In this study, groups who could not reach a consensus were investigated using the group polarization paradigm. The purpose was to explore the conditions leading to intragroup disagreement and attitude change following disagreement among 269 participants. Analysis indicated that the probability of consensus was low when the group means differed from the grand mean of the entire sample. When small differences among group members were found, depolarization (reverse direction of polarization) followed disagreement. These results suggested the groups which deviated most from the population tendency were the most likely to cause within-group disagreement, while within-group variances determined the direction of attitude change following disagreement within the group.

  10. Forging Consensus for Implementing Youth Socialization Policy in Northwest China

    ERIC Educational Resources Information Center

    Fairbrother, Gregory P.

    2011-01-01

    The goal of this article is to examine how the provincial education media in China play a role of forging consensus among local actors responsible for the implementation of new centrally-promulgated youth socialization policy. In doing so, it also explores the tension among three of the Chinese state's claims to legitimacy: economic development,…

  11. ABC3 Consensus: Assessment by a German Group of Experts

    PubMed Central

    Thomssen, Christoph; Augustin, Doris; Ettl, Johannes; Haidinger, Renate; Lück, Hans-Joachim; Lüftner, Diana; Marmé, Frederik; Marschner, Norbert; Müller, Lothar; Overkamp, Friedrich; Ruckhäberle, Eugen; Thill, Marc; Untch, Michael; Wuerstlein, Rachel; Harbeck, Nadia

    2016-01-01

    Summary The Advanced Breast Cancer Third International Consensus Conference on the diagnosis and treatment of advanced breast cancer took place in Lisbon, Portugal, on November 5-7, 2015. This year's conference (ABC3) was focused on the treatment of metastatic breast cancer (stage IV), as it was 4 years ago at the first consensus meeting (ABC1). A matter of particular interest was the patients’ perspective. Thus, patient-relevant issues were addressed by the consensus discussions, such as those on treatment goals, quality of life, care of long-term survivors (‘survivorship issues’), and coping with disease-related symptoms and the side effects of treatment. Further important issues on the agenda were the use of standardized instruments for the assessment of individual treatment success (‘patient-reported outcome measures’) and the evaluation of the benefit of novel drugs (e.g. the European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale). Diagnosis and treatment of inoperable locally advanced breast cancer had already been discussed 2 years earlier at the ABC2 Consensus and were not dealt with in the framework of this year's ABC3 Consensus. With regard to country-specific peculiarities, which unavoidably found their way into the ABC Consensus, a working group of German breast cancer experts commented on the voting results of the ABC panelists. As for the past consensus, the group specially considered the German guidelines for the diagnosis and treatment of breast cancer (AGO (Gyneco-Oncology Working Group), S3, DGHO (German Society of Hematology and Medical Oncology)) in order to adapt the ABC3 consensus for everyday therapy in Germany. PMID:27051399

  12. Toward a sustainable biomedical research enterprise: Finding consensus and implementing recommendations.

    PubMed

    Pickett, Christopher L; Corb, Benjamin W; Matthews, C Robert; Sundquist, Wesley I; Berg, Jeremy M

    2015-09-01

    The US research enterprise is under significant strain due to stagnant funding, an expanding workforce, and complex regulations that increase costs and slow the pace of research. In response, a number of groups have analyzed the problems and offered recommendations for resolving these issues. However, many of these recommendations lacked follow-up implementation, allowing the damage of stagnant funding and outdated policies to persist. Here, we analyze nine reports published since the beginning of 2012 and consolidate over 250 suggestions into eight consensus recommendations made by the majority of the reports. We then propose how to implement these consensus recommendations, and we identify critical issues, such as improving workforce diversity and stakeholder interactions, on which the community has yet to achieve consensus.

  13. Standardised neonatal parenteral nutrition formulations - an Australasian group consensus 2012.

    PubMed

    Bolisetty, Srinivas; Osborn, David; Sinn, John; Lui, Kei

    2014-02-18

    Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors.

  14. Consensus-oriented group peer review: a new process to review radiologist work output.

    PubMed

    Alkasab, Tarik K; Harvey, H Benjamin; Gowda, Vrushab; Thrall, James H; Rosenthal, Daniel I; Gazelle, G Scott

    2014-02-01

    The Joint Commission and other regulatory bodies have mandated that health care organizations implement processes for ongoing physician performance review. Software solutions, such as RADPEER™, have been created to meet this need efficiently. However, the authors believe that available systems are not optimally designed to produce changes in practice and overlook many important aspects of quality by excessive focus on diagnosis. The authors present a new model of peer review known as consensus-oriented group review, which is based on group discussion of cases in a conference setting and places greater emphasis on feedback than traditional systems of radiology peer review. By focusing on the process of peer review, consensus-oriented group review is intended to optimize performance improvement and foster group standards of practice. The authors also describe the software tool developed to implement this process of enriched peer review. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  15. Collective learning and optimal consensus decisions in social animal groups.

    PubMed

    Kao, Albert B; Miller, Noam; Torney, Colin; Hartnett, Andrew; Couzin, Iain D

    2014-08-01

    Learning has been studied extensively in the context of isolated individuals. However, many organisms are social and consequently make decisions both individually and as part of a collective. Reaching consensus necessarily means that a single option is chosen by the group, even when there are dissenting opinions. This decision-making process decouples the otherwise direct relationship between animals' preferences and their experiences (the outcomes of decisions). Instead, because an individual's learned preferences influence what others experience, and therefore learn about, collective decisions couple the learning processes between social organisms. This introduces a new, and previously unexplored, dynamical relationship between preference, action, experience and learning. Here we model collective learning within animal groups that make consensus decisions. We reveal how learning as part of a collective results in behavior that is fundamentally different from that learned in isolation, allowing grouping organisms to spontaneously (and indirectly) detect correlations between group members' observations of environmental cues, adjust strategy as a function of changing group size (even if that group size is not known to the individual), and achieve a decision accuracy that is very close to that which is provably optimal, regardless of environmental contingencies. Because these properties make minimal cognitive demands on individuals, collective learning, and the capabilities it affords, may be widespread among group-living organisms. Our work emphasizes the importance and need for theoretical and experimental work that considers the mechanism and consequences of learning in a social context.

  16. Collective Learning and Optimal Consensus Decisions in Social Animal Groups

    PubMed Central

    Kao, Albert B.; Miller, Noam; Torney, Colin; Hartnett, Andrew; Couzin, Iain D.

    2014-01-01

    Learning has been studied extensively in the context of isolated individuals. However, many organisms are social and consequently make decisions both individually and as part of a collective. Reaching consensus necessarily means that a single option is chosen by the group, even when there are dissenting opinions. This decision-making process decouples the otherwise direct relationship between animals' preferences and their experiences (the outcomes of decisions). Instead, because an individual's learned preferences influence what others experience, and therefore learn about, collective decisions couple the learning processes between social organisms. This introduces a new, and previously unexplored, dynamical relationship between preference, action, experience and learning. Here we model collective learning within animal groups that make consensus decisions. We reveal how learning as part of a collective results in behavior that is fundamentally different from that learned in isolation, allowing grouping organisms to spontaneously (and indirectly) detect correlations between group members' observations of environmental cues, adjust strategy as a function of changing group size (even if that group size is not known to the individual), and achieve a decision accuracy that is very close to that which is provably optimal, regardless of environmental contingencies. Because these properties make minimal cognitive demands on individuals, collective learning, and the capabilities it affords, may be widespread among group-living organisms. Our work emphasizes the importance and need for theoretical and experimental work that considers the mechanism and consequences of learning in a social context. PMID:25101642

  17. Making psychological theory useful for implementing evidence based practice: a consensus approach

    PubMed Central

    Michie, S; Johnston, M; Abraham, C; Lawton, R; Parker, D; Walker, A; on, b

    2005-01-01

    Background: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. Methods: Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a "psychological theory" group (n = 18), a "health services research" group (n = 13), and a "health psychology" group (n = 30). Results: Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. Conclusions: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains. PMID:15692000

  18. Using consensus group methods such as Delphi and Nominal Group in medical education research().

    PubMed

    Humphrey-Murto, Susan; Varpio, Lara; Gonsalves, Carol; Wood, Timothy J

    2017-01-01

    Consensus group methods are widely used in research to identify and measure areas where incomplete evidence exists for decision-making. Despite their widespread use, these methods are often inconsistently used and reported. Using examples from the three most commonly used methods, the Delphi, Nominal Group and RAND/UCLA; this paper and associated Guide aim to describe these methods and to highlight common weaknesses in methodology and reporting. The paper outlines a series of recommendations to assist researchers using consensus group methods in providing a comprehensive description and justification of the steps taken in their study.

  19. Melanoma: diagnosis, staging, and treatment. Consensus group recommendations.

    PubMed

    Berrocal, Alfonso; Cabañas, Luis; Espinosa, Enrique; Fernández-de-Misa, Ricardo; Martín-Algarra, Salvador; Martínez-Cedres, José Carlos; Ríos-Buceta, Luis; Rodríguez-Peralto, José Luis

    2014-09-01

    The incidence of malignant melanoma is increasing worldwide. In Spain, its incidence is increasing faster than any other cancer type, with a 5-year survival rate of about 85%. The impact and characteristics of malignant melanoma in the Spanish population can be ascertained from the national melanoma registry of the Academia Española de Dermatología y Venereología. This review presents consensus group recommendations for the diagnosis, staging and treatment of malignant melanoma in Spain. Incidence and mortality are discussed, as well as evaluation of various prevention and treatment strategies. Prognostic factors, such as BRAF and C-KIT mutations, which are expected to become routine staging procedures over the next few years, are outlined, especially in relation to treatment options. The use of recently approved targeted agents such as ipilimumab, a cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitor, and vemurafenib, a BRAF inhibitor, in metastatic disease are also discussed.

  20. Consensus or Deadlock? Consequences of Simple Behavioral Rules for Coordination in Group Decisions

    PubMed Central

    McCreery, Helen F.; Correll, Nikolaus; Breed, Michael D.

    2016-01-01

    Coordinated collective behaviors often emerge from simple rules governing the interactions of individuals in groups. We model mechanisms of coordination among ants during cooperative transport, a challenging task that requires a consensus on travel direction. Our goal is to determine whether groups following simple behavioral rules can reach a consensus using minimal information. Using deterministic and stochastic models, we investigate behavioral factors that affect coordination. We define and investigate three types of behavioral rules governing individual behavior that differ in the information available: individuals either 1) have no information, 2) can measure transport success, or 3) measure success while also knowing whether they are aligned with the majority. We find that groups break deadlocks only if individuals more readily give up when they are going against the majority, corresponding to rule type 3 –such groups are “informed.” These behavioral rules succeed through positive and negative feedbacks that are implemented in our model via a single mechanism: individuals only need to measure the relative group sizes to make effective decisions. We also find that groups reach consensus more quickly if they have either a shared bias, high sensitivity to group behavior, or finely tuned persistence. Each of these is a potential adaptation for efficient cooperative transport. This flexibility makes the behavioral rules in the informed case relatively robust to deficiencies in the individuals’ capabilities. While inspired by ants, our results are generalizable to other collective decisions with deadlocks, and demonstrate that groups of behaviorally simple individuals with no memory and extremely limited information can break symmetry and reach a consensus in a decision between two equal options. PMID:27682983

  1. Group consensus of multi-agent systems in directed networks with noises and time delays

    NASA Astrophysics Data System (ADS)

    Shang, Yilun

    2015-10-01

    In this paper, group consensus problems in fixed directed networks of dynamic agents are investigated. Group consensus means that the agents in each group share a consistent value while there is no agreement between any two groups. Based on algebraic graph theory, sufficient conditions guaranteeing group consensus under the proposed control protocol in the presence of random noises and communication delays are derived. The analysis uses a stability result of Mao for stochastic differential delay equations, which ensures the consensus can be achieved almost surely and exponentially fast. Numerical examples are provided to demonstrate the availability of the obtained results as well as the effect of time delay/noise intensity.

  2. Group consensus control for heterogeneous multi-agent systems with fixed and switching topologies

    NASA Astrophysics Data System (ADS)

    Wen, Guoguang; Huang, Jun; Wang, Chunyan; Chen, Zhi; Peng, Zhaoxia

    2016-02-01

    In this paper, the group consensus problems of heterogeneous multi-agent systems with fixed and switching topologies are investigated. First, a class of distributed group consensus protocol is proposed for achieving the group consensus of heterogeneous multi-agent systems by using the neighbours' information. Then, some corresponding sufficient conditions are obtained to guarantee the achievement of group consensus. Rigorous proofs are given by using graph theory, matrix theory and Lyapunov theory. Finally, numerical simulations are also given to verify the theoretical analysis.

  3. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    PubMed

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-01-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  4. Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society.

    PubMed

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-03-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  5. Consensus group sessions: a useful method to reconcile stakeholders’ perspectives about network performance evaluation

    PubMed Central

    Lamontagne, Marie-Eve; Swaine, Bonnie R; Lavoie, André; Champagne, François; Marcotte, Anne-Claire

    2010-01-01

    Background Having a common vision among network stakeholders is an important ingredient to developing a performance evaluation process. Consensus methods may be a viable means to reconcile the perceptions of different stakeholders about the dimensions to include in a performance evaluation framework. Objectives To determine whether individual organizations within traumatic brain injury (TBI) networks differ in perceptions about the importance of performance dimensions for the evaluation of TBI networks and to explore the extent to which group consensus sessions could reconcile these perceptions. Methods We used TRIAGE, a consensus technique that combines an individual and a group data collection phase to explore the perceptions of network stakeholders and to reach a consensus within structured group discussions. Results One hundred and thirty-nine professionals from 43 organizations within eight TBI networks participated in the individual data collection; 62 professionals from these same organisations contributed to the group data collection. The extent of consensus based on questionnaire results (e.g. individual data collection) was low, however, 100% agreement was obtained for each network during the consensus group sessions. The median importance scores and mean ranks attributed to the dimensions by individuals compared to groups did not differ greatly. Group discussions were found useful in understanding the reasons motivating the scoring, for resolving differences among participants, and for harmonizing their values. Conclusion Group discussions, as part of a consensus technique, appear to be a useful process to reconcile diverging perceptions of network performance among stakeholders. PMID:21289996

  6. Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group.

    PubMed

    Gariepy, Cheryl E; Heyman, Melvin B; Lowe, Mark E; Pohl, John F; Werlin, Steven L; Wilschanski, Michael; Barth, Bradley; Fishman, Douglas S; Freedman, Steven D; Giefer, Matthew J; Gonska, Tanja; Himes, Ryan; Husain, Sohail Z; Morinville, Veronique D; Ooi, Chee Y; Schwarzenberg, Sarah J; Troendle, David M; Yen, Elizabeth; Uc, Aliye

    2017-01-01

    Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates during the past decade. As pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. The aim of the study was to review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. A systematic review of the literature was performed and scored for quality, followed by consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting.

  7. Consistency and consensus models for group decision-making with uncertain 2-tuple linguistic preference relations

    NASA Astrophysics Data System (ADS)

    Zhang, Zhen; Guo, Chonghui

    2016-08-01

    Due to the uncertainty of the decision environment and the lack of knowledge, decision-makers may use uncertain linguistic preference relations to express their preferences over alternatives and criteria. For group decision-making problems with preference relations, it is important to consider the individual consistency and the group consensus before aggregating the preference information. In this paper, consistency and consensus models for group decision-making with uncertain 2-tuple linguistic preference relations (U2TLPRs) are investigated. First of all, a formula which can construct a consistent U2TLPR from the original preference relation is presented. Based on the consistent preference relation, the individual consistency index for a U2TLPR is defined. An iterative algorithm is then developed to improve the individual consistency of a U2TLPR. To help decision-makers reach consensus in group decision-making under uncertain linguistic environment, the individual consensus and group consensus indices for group decision-making with U2TLPRs are defined. Based on the two indices, an algorithm for consensus reaching in group decision-making with U2TLPRs is also developed. Finally, two examples are provided to illustrate the effectiveness of the proposed algorithms.

  8. Implementing the distributed consensus-based estimation of environmental variables in unattended wireless sensor networks

    NASA Astrophysics Data System (ADS)

    Contreras, Rodrigo; Restrepo, Silvia E.; Pezoa, Jorge E.

    2014-10-01

    In this paper, the prototype implementation of a scalable, distributed protocol for calculating the global average of sensed environmental variables in unattended wireless sensor networks (WSNs) is presented. The design and implementation of the protocol introduces a communication scheme for discovering the WSN topology. Such scheme uses a synchronous flooding algorithm, which was implemented over an unreliable radiogram-based wireless channel. The topology discovery protocol has been synchronized with sampling time of the WSN and must be executed before the consensus-based estimation of the global averages. An average consensus algorithm, suited for clustered WSNs with static topologies, was selected from the literature. The algorithm was properly modified so that its implementation guarantees that the convergence time is bounded and less than the sampling time of the WSN. Moreover, to implement the consensus algorithm, a reliable packet-passing protocol was designed to exchange the weighting factors among the sensor nodes. Since the amount of data exchanged in each packet is bounded by the degree of the WSN, the scalability of the protocol is guaranteed to be linear. The proposed protocol was implemented in the Sun SPOT hardware/software platform using the Java programming language. All the radio communications were implemented over the IEEE 802.15.4 standard and the sensed environmental variables corresponded to the temperature and luminosity.

  9. Using Faculty Consensus to Develop and Implement a Medical Ethics Course.

    ERIC Educational Resources Information Center

    Ales, Kathy L.; And Others

    1992-01-01

    This report describes the development and implementation of a required course in medical ethics for second-year medical students at Cornell University Medical College (New York). The planning model stressed achieving faculty consensus. Evaluation indicated that faculty felt the planning sessions added greatly to their teaching and students were…

  10. Using Faculty Consensus to Develop and Implement a Medical Ethics Course.

    ERIC Educational Resources Information Center

    Ales, Kathy L.; And Others

    1992-01-01

    This report describes the development and implementation of a required course in medical ethics for second-year medical students at Cornell University Medical College (New York). The planning model stressed achieving faculty consensus. Evaluation indicated that faculty felt the planning sessions added greatly to their teaching and students were…

  11. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    PubMed

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-03-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  12. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    PubMed

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-01-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Scaled Group Consensus in Multiagent Systems With First/Second-Order Continuous Dynamics.

    PubMed

    Yu, Junyan; Shi, Yang

    2017-08-29

    We investigate scaled group consensus problems of multiagent systems with first/second-order linear continuous dynamics. For a complex network consisting of two subnetworks with different physical quantities or task distributions, it is concerned with this case that the agents' states in one subnetwork converge to a consistent value asymptotically, while the states in the other subnetwork approach another value with a ratio of the former. For the case of the information exchange being directed, novel consensus protocols are designed for both first-order and second-order dynamics to solve the scaled group consensus problems. By utilizing algebra theory, graph theory, and Lyapunov stability theory, several necessary and sufficient conditions are established to guarantee the agents' states reaching the scaled group consensus asymptotically. Finally, several simulation results are presented to demonstrate the effectiveness of the theoretical results.

  14. The group discussion effect: integrative processes and suggestions for implementation.

    PubMed

    Meleady, Rose; Hopthrow, Tim; Crisp, Richard J

    2013-02-01

    One of the most consistent findings in experimental social dilemmas research is the positive effect group discussion has on cooperative behavior. At a time when cooperation and consensus is critical to tackle global problems, ranging from debt to deforestation, understanding the dynamics of group discussion is a pressing need. Unfortunately, research investigating the underlying processes and implementation of the effect has been inconclusive. The authors present a critical review of existing explanations and integrate these perspectives into a single process model of group discussion, providing a more complete theoretical picture of how interrelated factors combine to facilitate discussion-induced cooperation. On the basis of this theoretical analysis, they consider complimentary approaches to the indirect and feasible implementation of group discussion. They argue that such strategies may overcome the barriers to direct discussion observed across a range of groups and organizations.

  15. Specifications and implementation of a new exchange format to support computerized consensus in pathology.

    PubMed

    Zapletal, Eric; Le Bozec, Christel; Degoulet, Patrice; Guinebretière, Jean-Marc; Jaulent, Marie-Christine

    2004-01-01

    In the pathology domain, consensus sessions around multi-headed microscopes enhance reproducibility and can reduce inter- and intra-observer variability. Computerized tools and Web technology could facilitate the organization of consensus sessions and assist pathologists to agree on features that are relevant to diagnosis. In the context of the IDEM project, whose aim is to achieve a computerized platform to allow pathologists to derive consensual diagnostic during Internet-based collaborative sessions, we propose a new extension of the existing TELESLIDE format. This new extended format enables the storage and the exchange of multi-experts descriptions that will be processed by the IDEM consensus engine to produce consensual descriptions. We describe this new format and its implementation in the IDEM teleconsensus platform.

  16. Consensus implementation of a groundwater remediation project at the Idaho National Engineering Laboratory

    SciTech Connect

    Hastings, K.R.; Carlson, D.S.

    1996-12-31

    Because of significant characterization uncertainties existing when the Record of Decision was signed and the unfavorable national reputation of groundwater pump and treat remediation projects, the Test Area North (TAN) groundwater ROD includes the evaluation of five emerging technologies that show potential for treating the organic contamination in situ or reducing the toxicity of contaminants above ground. Treatability studies will be conducted to ascertain whether any may be suitable for implementation at TAN to yield more timely or cost effective restoration of the aquifer. The implementation approach established for the TAN groundwater project is a consensus approach, maximizing a partnership relation with stakeholders in constant, iterative implementation decision making.

  17. Curriculum revision: reaching faculty consensus through the Nominal Group Technique.

    PubMed

    Davis, D C; Rhodes, R; Baker, A S

    1998-10-01

    A fundamental concept to initiate change in the curriculum revision process is to overcome resistance to change and the boundaries of self-interest. Curriculum change cannot occur without an "unfreezing" of faculty values and interests. The Nominal Group Technique (NGT) was used to facilitate faculty identification of areas needing change in the undergraduate nursing curriculum. The process led to the generation of numerous independent ideas in which all faculty participated. The revised curriculum which resulted from the NGT process has had full and enthusiastic support of the faculty.

  18. Planning for chemical incidents by implementing a Delphi based consensus study

    PubMed Central

    Crawford, I; Mackway-Jones, K; Russell, D; Carley, S

    2004-01-01

    This paper provides a practical approach to the difficulties surrounding planning for chemical incidents, based upon the results of a Delphi based consensus study. It is intended to offer advice, which can be implemented at regional and local prehospital and hospital level. The phases of the response that are covered include preparation, management of the incident, delivery of medical support during the incident, and recovery and support after the incident. PMID:14734368

  19. Collaborative Relevance Judgment: A Group Consensus Method for Evaluating User Search Performance.

    ERIC Educational Resources Information Center

    Zhang, Xiangmin

    2002-01-01

    Discusses relevance judgments in information retrieval; considers the collaborative nature of information retrieval in a group, organization, or societal context; and proposes a method that measures relevance based on group/peer consensus. Reports results of an experiment using this method to compare the search performance of different types of…

  20. The Effects of Assigned Role Versus Non-Assigned Role on Group Consensus.

    ERIC Educational Resources Information Center

    Gray, Philip A.

    1972-01-01

    Students in speech classes at Northern Illinois University participated in tests to determine what assumption of roles in discussion groups impairs participation and prohibits consensus. Students were randomly assigned to one of twelve discussion groups of five members each. The topic and materials for discussion were excerpted from the local…

  1. Food parenting measurement issues: working group consensus report.

    PubMed

    Hughes, Sheryl O; Frankel, Leslie A; Beltran, Alicia; Hodges, Eric; Hoerr, Sharon; Lumeng, Julie; Tovar, Alison; Kremers, Stef

    2013-08-01

    Childhood obesity is a growing problem. As more researchers become involved in the study of parenting influences on childhood obesity, there appears to be a lack of agreement regarding the most important parenting constructs of interest, definitions of those constructs, and measurement of those constructs in a consistent manner across studies. This article aims to summarize findings from a working group that convened specifically to discuss measurement issues related to parental influences on childhood obesity. Six subgroups were formed to address key measurement issues. The conceptualization subgroup proposed to define and distinguish constructs of general parenting styles, feeding styles, and food parenting practices with the goal of understanding interrelating levels of parental influence on child eating behaviors. The observational subgroup identified the need to map constructs for use in coding direct observations and create observational measures that can capture the bidirectional effects of parent-child interactions. The self-regulation subgroup proposed an operational definition of child self-regulation of energy intake and suggested future measures of self-regulation across different stages of development. The translational/community involvement subgroup proposed the involvement of community in the development of surveys so that measures adequately reflect cultural understanding and practices of the community. The qualitative methods subgroup proposed qualitative methods as a way to better understand the breadth of food parenting practices and motivations for the use of such practices. The longitudinal subgroup stressed the importance of food parenting measures sensitive to change for use in longitudinal studies. In the creation of new measures, it is important to consider cultural sensitivity and context-specific food parenting domains. Moderating variables such as child temperament and child food preferences should be considered in models.

  2. Food Parenting Measurement Issues: Working Group Consensus Report

    PubMed Central

    Frankel, Leslie A.; Beltran, Alicia; Hodges, Eric; Hoerr, Sharon; Lumeng, Julie; Tovar, Alison; Kremers, Stef

    2013-01-01

    Abstract Childhood obesity is a growing problem. As more researchers become involved in the study of parenting influences on childhood obesity, there appears to be a lack of agreement regarding the most important parenting constructs of interest, definitions of those constructs, and measurement of those constructs in a consistent manner across studies. This article aims to summarize findings from a working group that convened specifically to discuss measurement issues related to parental influences on childhood obesity. Six subgroups were formed to address key measurement issues. The conceptualization subgroup proposed to define and distinguish constructs of general parenting styles, feeding styles, and food parenting practices with the goal of understanding interrelating levels of parental influence on child eating behaviors. The observational subgroup identified the need to map constructs for use in coding direct observations and create observational measures that can capture the bidirectional effects of parent–child interactions. The self-regulation subgroup proposed an operational definition of child self-regulation of energy intake and suggested future measures of self-regulation across different stages of development. The translational/community involvement subgroup proposed the involvement of community in the development of surveys so that measures adequately reflect cultural understanding and practices of the community. The qualitative methods subgroup proposed qualitative methods as a way to better understand the breadth of food parenting practices and motivations for the use of such practices. The longitudinal subgroup stressed the importance of food parenting measures sensitive to change for use in longitudinal studies. In the creation of new measures, it is important to consider cultural sensitivity and context-specific food parenting domains. Moderating variables such as child temperament and child food preferences should be considered in models

  3. Definition of a COPD self-management intervention: International Expert Group consensus.

    PubMed

    Effing, Tanja W; Vercoulen, Jan H; Bourbeau, Jean; Trappenburg, Jaap; Lenferink, Anke; Cafarella, Paul; Coultas, David; Meek, Paula; van der Valk, Paul; Bischoff, Erik W M A; Bucknall, Christine; Dewan, Naresh A; Early, Frances; Fan, Vincent; Frith, Peter; Janssen, Daisy J A; Mitchell, Katy; Morgan, Mike; Nici, Linda; Patel, Irem; Walters, Haydn; Rice, Kathryn L; Singh, Sally; Zuwallack, Richard; Benzo, Roberto; Goldstein, Roger; Partridge, Martyn R; van der Palen, Job

    2016-07-01

    There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique features and an additional group meeting.In each consensus round the experts were asked to provide feedback on the proposed definition and to score their level of agreement (1=totally disagree; 5=totally agree). The information provided was used to modify the definition for the next consensus round. Thematic analysis was used for free text responses and descriptive statistics were used for agreement scores.In total, 28 experts participated. The consensus round response rate varied randomly over the five rounds (ranging from 48% (n=13) to 85% (n=23)), and mean definition agreement scores increased from 3.8 (round 1) to 4.8 (round 5) with an increasing percentage of experts allocating the highest score of 5 (round 1: 14% (n=3); round 5: 83% (n=19)).In this study we reached consensus regarding a conceptual definition of what should be a COPD self-management intervention, clarifying the requisites for such an intervention. Operationalisation of this conceptual definition in the near future will be an essential next step. The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2016.

  4. Evaluation of holistic sexuality education: A European expert group consensus agreement.

    PubMed

    Ketting, Evert; Friele, Minou; Michielsen, Kristien

    2016-01-01

    Holistic sexuality education (HSE) is a new concept in sexuality education (SE). Since it differs from other types of SE in a number of important respects, strategies developed for the evaluation of the latter are not necessarily applicable to HSE. In this paper the authors provide a basis for discussion on how to evaluate HSE. First, the international literature on evaluation of SE in general was reviewed in terms of its applicability to HSE. Second, the European Expert Group on Sexuality Education extensively discussed the requirements of its evaluation and suggested appropriate indicators and methods for evaluating HSE. The European experience in SE is scarcely represented in the general evaluation literature. The majority of the literature focuses on impact and neglects programme and implementation evaluations. Furthermore, the current literature demonstrates that evaluation criteria predominantly focus on the public health impact, while there is not yet a consensus on sexual well-being criteria and aspects of positive sexuality, which are crucial parts of HSE. Finally, experimental designs are still considered the gold standard, yet several of the conditions for their use are not fulfilled in HSE. Realising that a new evaluation framework for HSE is needed, the European expert group initiated its development and agreed upon a number of indicators that provide a starting point for further discussion. Aside from the health impact, the quality of SE programmes and their implementation also deserve attention and should be evaluated. To be applicable to HSE, the evaluation criteria need to cover more than the typical public health aspects. Since they do not register long-term and multi-component characteristics, evaluation methods such as randomised controlled trials are not sufficiently suitable for HSE. The evaluation design should rely on a number of different information sources from mixed methods that are complemented and triangulated to build a plausible case

  5. Consensus-Based Course Design and Implementation of Constructive Alignment Theory in a Power System Analysis Course

    ERIC Educational Resources Information Center

    Vanfretti, Luigi; Farrokhabadi, Mostafa

    2015-01-01

    This article presents the implementation of the constructive alignment theory (CAT) in a power system analysis course through a consensus-based course design process. The consensus-based design process involves both the instructor and graduate-level students and it aims to develop the CAT framework in a holistic manner with the goal of including…

  6. Consensus-Based Course Design and Implementation of Constructive Alignment Theory in a Power System Analysis Course

    ERIC Educational Resources Information Center

    Vanfretti, Luigi; Farrokhabadi, Mostafa

    2015-01-01

    This article presents the implementation of the constructive alignment theory (CAT) in a power system analysis course through a consensus-based course design process. The consensus-based design process involves both the instructor and graduate-level students and it aims to develop the CAT framework in a holistic manner with the goal of including…

  7. Study design and implementation for population pharmacokinetics of Chinese medicine: An expert consensus.

    PubMed

    Jiang, Jun-jie; Zhang, Wen; Xie, Yan-ming; Wang, Jian-nong; He, Fu-yuan; Xiong, Xin

    2016-02-01

    Although many population pharmacokinetics (PPK) researches have been conducted on chemical drugs, few have been in the field of Chinese medicine (CM). Each ingredient in CMs possesses different pharmacokinetic characteristics, therefore, it is important to develop methods of PPK studies on them to identify the differences in CM drug safety and efficacy among the population subgroups and to conduct quantitative studies on the determinants of CM drug concentrations. To develop an expert consensus on study design and implementation for PPK of CM, in August 2013, 6 experts in the field of PPK, CMs pharmacology, and statistics discussed problems on the PPK research protocol of CMs, and a consensus was reached. The medicines with toxicity and narrow therapeutic windows and with wide range of target population or with frequent adverse reactions were selected. The compositions with definite therapeutic effects were selected as indices, and specific time points and sample sizes were designed according to standard PPK design methods. Target components were tested through various chromatography methods. Total quantity statistical moment analysis was used to estimate PPK parameters of each component and PPK models reflecting the trend of CMs (which assists in reasonable adjustments on clinical dosage). This consensus specifies the study design and implementation process of PPK. It provides guidance for the following: post-marketing clinical studies, in vivo investigations related to the metabolism in different populations, and development and clinical adjustment of dosages of CMs.

  8. Convergence to consensus in heterogeneous groups and the emergence of informal leadership

    PubMed Central

    Gavrilets, Sergey; Auerbach, Jeremy; van Vugt, Mark

    2016-01-01

    When group cohesion is essential, groups must have efficient strategies in place for consensus decision-making. Recent theoretical work suggests that shared decision-making is often the most efficient way for dealing with both information uncertainty and individual variation in preferences. However, some animal and most human groups make collective decisions through particular individuals, leaders, that have a disproportionate influence on group decision-making. To address this discrepancy between theory and data, we study a simple, but general, model that explicitly focuses on the dynamics of consensus building in groups composed by individuals who are heterogeneous in preferences, certain personality traits (agreeability and persuasiveness), reputation, and social networks. We show that within-group heterogeneity can significantly delay democratic consensus building as well as give rise to the emergence of informal leaders, i.e. individuals with a disproportionately large impact on group decisions. Our results thus imply strong benefits of leadership particularly when groups experience time pressure and significant conflict of interest between members (due to various between-individual differences). Overall, our models shed light on why leadership and decision-making hierarchies are widespread, especially in human groups. PMID:27412692

  9. Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012

    PubMed Central

    2014-01-01

    Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors. PMID:24548745

  10. International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Hearing loss in the pediatric patient.

    PubMed

    Liming, Bryan J; Carter, John; Cheng, Alan; Choo, Daniel; Curotta, John; Carvalho, Daniela; Germiller, John A; Hone, Stephen; Kenna, Margaret A; Loundon, Natalie; Preciado, Diego; Schilder, Anne; Reilly, Brian J; Roman, Stephane; Strychowsky, Julie; Triglia, Jean-Michel; Young, Nancy; Smith, Richard J H

    2016-11-01

    To provide recommendations for the workup of hearing loss in the pediatric patient. Expert opinion by the members of the International Pediatric Otolaryngology Group. Consensus recommendations include initial screening and diagnosis as well as the workup of sensorineural, conductive and mixed hearing loss in children. The consensus statement discusses the role of genetic testing and imaging and provides algorithms to guide the workup of children with hearing loss. The workup of children with hearing loss can be guided by the recommendations provided herein. Published by Elsevier Ireland Ltd.

  11. How peer pressure shapes consensus, leadership, and innovations in social groups.

    PubMed

    Estrada, Ernesto; Vargas-Estrada, Eusebio

    2013-10-09

    What is the effect of the combined direct and indirect social influences--peer pressure (PP)--on a social group's collective decisions? We present a model that captures PP as a function of the socio-cultural distance between individuals in a social group. Using this model and empirical data from 15 real-world social networks we found that the PP level determines how fast a social group reaches consensus. More importantly, the levels of PP determine the leaders who can achieve full control of their social groups. PP can overcome barriers imposed upon a consensus by the existence of tightly connected communities with local leaders or the existence of leaders with poor cohesiveness of opinions. A moderate level of PP is also necessary to explain the rate at which innovations diffuse through a variety of social groups.

  12. How Peer Pressure Shapes Consensus, Leadership, and Innovations in Social Groups

    NASA Astrophysics Data System (ADS)

    Estrada, Ernesto; Vargas-Estrada, Eusebio

    2013-10-01

    What is the effect of the combined direct and indirect social influences--peer pressure (PP)--on a social group's collective decisions? We present a model that captures PP as a function of the socio-cultural distance between individuals in a social group. Using this model and empirical data from 15 real-world social networks we found that the PP level determines how fast a social group reaches consensus. More importantly, the levels of PP determine the leaders who can achieve full control of their social groups. PP can overcome barriers imposed upon a consensus by the existence of tightly connected communities with local leaders or the existence of leaders with poor cohesiveness of opinions. A moderate level of PP is also necessary to explain the rate at which innovations diffuse through a variety of social groups.

  13. How Peer Pressure Shapes Consensus, Leadership, and Innovations in Social Groups

    PubMed Central

    Estrada, Ernesto; Vargas-Estrada, Eusebio

    2013-01-01

    What is the effect of the combined direct and indirect social influences—peer pressure (PP)—on a social group's collective decisions? We present a model that captures PP as a function of the socio-cultural distance between individuals in a social group. Using this model and empirical data from 15 real-world social networks we found that the PP level determines how fast a social group reaches consensus. More importantly, the levels of PP determine the leaders who can achieve full control of their social groups. PP can overcome barriers imposed upon a consensus by the existence of tightly connected communities with local leaders or the existence of leaders with poor cohesiveness of opinions. A moderate level of PP is also necessary to explain the rate at which innovations diffuse through a variety of social groups. PMID:24104951

  14. In Pursuit of Consensus: Disagreement and legitimization during small-group argumentation

    NASA Astrophysics Data System (ADS)

    Berland, Leema K.; Lee, Victor R.

    2012-08-01

    In recent years, an emphasis on scientific argumentation in classrooms has brought into focus collaborative consensus-building as an instructional strategy. In these situations, students with differing and competing arguments are asked to work with one another in order to establish a shared perspective. However, the literature suggests that consensus-building can be challenging for students because their interpretations of the argumentative task and context may not enable their productive engagement with counter-arguments and evidence. In this paper, our goal is to explore the ways in which interactions of students support or inhibit their consensus-building. To that end, we examine and describe three cases that represent different ways in which initially dissenting students try to work towards a consensus with their peers. Through these cases, we demonstrate that legitimization of disparate or incorrect ideas can enable students whose arguments rely on incorrect ideas to feel that their ideas were heard and valued by the rest of their group. As such, we suggest that this legitimization is important because it can help students 'save face'. This enables students to move away from the competitive and persuasive aspects of argumentation towards interactions that align more closely with sensemaking and consensus-building.

  15. The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review.

    PubMed

    Humphrey-Murto, Susan; Varpio, Lara; Wood, Timothy J; Gonsalves, Carol; Ufholz, Lee-Anne; Mascioli, Kelly; Wang, Carol; Foth, Thomas

    2017-10-01

    Consensus group methods, such as the Delphi method and nominal group technique (NGT), are used to synthesize expert opinions when evidence is lacking. Despite their extensive use, these methods are inconsistently applied. Their use in medical education research has not been well studied. The authors set out to describe the use of consensus methods in medical education research and to assess the reporting quality of these methods and results. Using scoping review methods, the authors searched the Medline, Embase, PsycInfo, PubMed, Scopus, and ERIC databases for 2009-2016. Full-text articles that focused on medical education and the keywords Delphi, RAND, NGT, or other consensus group methods were included. A standardized extraction form was used to collect article demographic data and features reflecting methodological rigor. Of the articles reviewed, 257 met the inclusion criteria. The Modified Delphi (105/257; 40.8%), Delphi (91/257; 35.4%), and NGT (23/257; 8.9%) methods were most often used. The most common study purpose was curriculum development or reform (68/257; 26.5%), assessment tool development (55/257; 21.4%), and defining competencies (43/257; 16.7%). The reporting quality varied, with 70.0% (180/257) of articles reporting a literature review, 27.2% (70/257) reporting what background information was provided to participants, 66.1% (170/257) describing the number of participants, 40.1% (103/257) reporting if private decisions were collected, 37.7% (97/257) reporting if formal feedback of group ratings was shared, and 43.2% (111/257) defining consensus a priori. Consensus methods are poorly standardized and inconsistently used in medical education research. Improved criteria for reporting are needed.

  16. Standardizing terms for clinical pharmacogenetic test results: consensus terms from the Clinical Pharmacogenetics Implementation Consortium (CPIC)

    PubMed Central

    Caudle, Kelly E.; Dunnenberger, Henry M.; Freimuth, Robert R.; Peterson, Josh F.; Burlison, Jonathan D.; Whirl-Carrillo, Michelle; Scott, Stuart A.; Rehm, Heidi L.; Williams, Marc S.; Klein, Teri E.; Relling, Mary V.; Hoffman, James M.

    2017-01-01

    Introduction: Reporting and sharing pharmacogenetic test results across clinical laboratories and electronic health records is a crucial step toward the implementation of clinical pharmacogenetics, but allele function and phenotype terms are not standardized. Our goal was to develop terms that can be broadly applied to characterize pharmacogenetic allele function and inferred phenotypes. Materials and methods: Terms currently used by genetic testing laboratories and in the literature were identified. The Clinical Pharmacogenetics Implementation Consortium (CPIC) used the Delphi method to obtain a consensus and agree on uniform terms among pharmacogenetic experts. Results: Experts with diverse involvement in at least one area of pharmacogenetics (clinicians, researchers, genetic testing laboratorians, pharmacogenetics implementers, and clinical informaticians; n = 58) participated. After completion of five surveys, a consensus (>70%) was reached with 90% of experts agreeing to the final sets of pharmacogenetic terms. Discussion: The proposed standardized pharmacogenetic terms will improve the understanding and interpretation of pharmacogenetic tests and reduce confusion by maintaining consistent nomenclature. These standard terms can also facilitate pharmacogenetic data sharing across diverse electronic health care record systems with clinical decision support. Genet Med 19 2, 215–223. PMID:27441996

  17. International consensus for neuroblastoma molecular diagnostics: report from the International Neuroblastoma Risk Group (INRG) Biology Committee.

    PubMed

    Ambros, P F; Ambros, I M; Brodeur, G M; Haber, M; Khan, J; Nakagawara, A; Schleiermacher, G; Speleman, F; Spitz, R; London, W B; Cohn, S L; Pearson, A D J; Maris, J M

    2009-05-05

    Neuroblastoma serves as a paradigm for utilising tumour genomic data for determining patient prognosis and treatment allocation. However, before the establishment of the International Neuroblastoma Risk Group (INRG) Task Force in 2004, international consensus on markers, methodology, and data interpretation did not exist, compromising the reliability of decisive genetic markers and inhibiting translational research efforts. The objectives of the INRG Biology Committee were to identify highly prognostic genetic aberrations to be included in the new INRG risk classification schema and to develop precise definitions, decisive biomarkers, and technique standardisation. The review of the INRG database (n=8800 patients) by the INRG Task Force finally enabled the identification of the most significant neuroblastoma biomarkers. In addition, the Biology Committee compared the standard operating procedures of different cooperative groups to arrive at international consensus for methodology, nomenclature, and future directions. Consensus was reached to include MYCN status, 11q23 allelic status, and ploidy in the INRG classification system on the basis of an evidence-based review of the INRG database. Standardised operating procedures for analysing these genetic factors were adopted, and criteria for proper nomenclature were developed. Neuroblastoma treatment planning is highly dependant on tumour cell genomic features, and it is likely that a comprehensive panel of DNA-based biomarkers will be used in future risk assignment algorithms applying genome-wide techniques. Consensus on methodology and interpretation is essential for uniform INRG classification and will greatly facilitate international and cooperative clinical and translational research studies.

  18. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia.

    PubMed

    Chen, Liang-Kung; Liu, Li-Kuo; Woo, Jean; Assantachai, Prasert; Auyeung, Tung-Wai; Bahyah, Kamaruzzaman Shahrul; Chou, Ming-Yueh; Chen, Liang-Yu; Hsu, Pi-Shan; Krairit, Orapitchaya; Lee, Jenny S W; Lee, Wei-Ju; Lee, Yunhwan; Liang, Chih-Kuang; Limpawattana, Panita; Lin, Chu-Sheng; Peng, Li-Ning; Satake, Shosuke; Suzuki, Takao; Won, Chang Won; Wu, Chih-Hsing; Wu, Si-Nan; Zhang, Teimei; Zeng, Ping; Akishita, Masahiro; Arai, Hidenori

    2014-02-01

    Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m(2) for men and 5.4 kg/m(2) for women by using dual X-ray absorptiometry, and 7.0 kg/m(2) for men and 5.7 kg/m(2) for women by using bioimpedance analysis

  19. Expert and Advocacy Group Consensus Findings on the Horizon of Public Health Genetic Testing

    PubMed Central

    Modell, Stephen M.; Greendale, Karen; Citrin, Toby; Kardia, Sharon L. R.

    2016-01-01

    Description: Among the two leading causes of death in the United States, each responsible for one in every four deaths, heart disease costs Americans $300 billion, while cancer costs Americans $216 billion per year. They also rank among the top three causes of death in Europe and Asia. In 2012 the University of Michigan Center for Public Health and Community Genomics and Genetic Alliance, with the support of the Centers for Disease Control and Prevention Office of Public Health Genomics, hosted a conference in Atlanta, Georgia to consider related action strategies based on public health genomics. The aim of the conference was consensus building on recommendations to implement genetic screening for three major heritable contributors to these mortality and cost figures: hereditary breast and ovarian cancer (HBOC), familial hypercholesterolemia (FH), and Lynch syndrome (LS). Genetic applications for these three conditions are labeled with a “Tier 1” designation by the U.S. Centers for Disease Control and Prevention because they have been fully validated and clinical practice guidelines based on systematic review support them. Methodology: The conference followed a deliberative sequence starting with nationally recognized clinical and public health presenters for each condition, followed by a Patient and Community Perspectives Panel, working group sessions for each of the conditions, and a final plenary session. The 74 conference participants represented disease research and advocacy, public health, medicine and nursing, genetics, governmental health agencies, and industry. Participants drew on a public health framework interconnecting policy, clinical intervention, surveillance, and educational functions for their deliberations. Results: Participants emphasized the importance of collaboration between clinical, public health, and advocacy groups in implementing Tier 1 genetic screening. Advocacy groups could help with individual and institutional buy-in of Tier 1

  20. Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Canadian Consensus Working Group Update (2016).

    PubMed

    Mancini, G B John; Baker, Steven; Bergeron, Jean; Fitchett, David; Frohlich, Jiri; Genest, Jacques; Gupta, Milan; Hegele, Robert A; Ng, Dominic; Pearson, Glen J; Pope, Janet; Tashakkor, A Yashar

    2016-07-01

    The Canadian Consensus Working Group has updated its evaluation of the literature pertaining to statin intolerance and adverse effects. This overview introduces a pragmatic definition of statin intolerance (goal-inhibiting statin intolerance) that emphasizes the effects of symptoms on achieving nationally vetted goals in patients fulfilling indications for lipid-lowering therapy and cardiovascular risk reduction. The Canadian Consensus Working Group provides a structured framework for avoiding, evaluating and managing goal-inhibiting statin intolerance. Particularly difficult practice situations are reviewed, including management in young and elderly individuals, and in athletes and labourers. Finally, targeted at specialty practitioners, more detailed analyses of specific but more unusual adverse effects ascribed to statins are updated including evidence regarding new-onset diabetes, cognitive dysfunction, cataracts, and the rare but important immune-mediated necrotizing myopathy. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Members' attendance rates and outcomes of relationship education groups: A consensus-dispersion analysis.

    PubMed

    Kivlighan, D Martin; Owen, Jesse; Antle, Becky

    2017-04-01

    Relationship education programs (REPs) are an effective way to enhance relationship communication, prevent relational distress, and increase relationship quality. Most REPs are delivered in a group format; however, there is little known about the influence of group processes on outcomes for these programs, such as group members' attendance. Therefore, the current study applied a dispersion-consensus model to test the impact of attendance at the member and group levels on group members' REP outcomes. In a sample of 558 lower income, primarily African American participants, we examined whether individual and group attendance rates influenced posttreatment communication patterns and relationship quality. Results indicated that an individual group member's attendance was significantly and positively related to their posttreatment relationship quality, although this relationship is complex. Specifically, this relationship was stronger in groups with higher levels of attendance as well as groups with more attendance variability. In addition, results indicated that group members reported better posttreatment relationship quality in groups with less variability in members' attendance. However, we found a significant interaction between attendance consensus and variability, and an individual group member's posttreatment relationship quality, suggesting that group members report higher levels of relationship quality in groups where the attendance of the group as a whole is lower yet more consistent. No significant relationships were found for group member's posttreatment communication patterns. Our findings suggest that the rate and variability in the group's attendance, as well as an individual group member's own attendance significantly impacts their posttreatment relationship quality in complex ways. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  2. Gynecologic Cancer InterGroup (GCIG) consensus review for cervical adenocarcinoma.

    PubMed

    Fujiwara, Hiroyuki; Yokota, Harushige; Monk, Bradley; Treilleux, Isabelle; Devouassoux-Shisheboran, Mojgan; Davis, Alison; Kim, Jae-Weon; Mahner, Sven; Stany, Michael; Pignata, Sandro; Ray-Coquard, Isabelle; Fujiwara, Keiichi

    2014-11-01

    Cervical adenocarcinoma is known to be less common than squamous cell carcinoma of the cervix comprising approximately 25% of all cervical carcinomas. Differences in associated human papillomavirus types, patterns of spread, and prognosis call for treatments that are not always like those for squamous cancers. In this review, we report a consensus developed by the Gynecologic Cancer InterGroup surrounding cervical adenocarcinoma for epidemiology, pathology, treatment, and unanswered questions. Prospective clinical trials are needed to help develop treatment guidelines.

  3. Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation

    PubMed Central

    CAMILLERI, M.; DROSSMAN, D. A.; BECKER, G.; WEBSTER, L. R.; DAVIES, A. N.; MAWE, G. M.

    2015-01-01

    Background Opioids are effective for acute and chronic pain conditions, but their use is associated with often difficult-to-manage constipation and other gastrointestinal (GI) effects due to effects on peripheral μ-opioid receptors in the gut. The mechanism of opioid-induced constipation (OIC) differs from that of functional constipation (FC), and OIC may not respond as well to most first-line treatments for FC. The impact of OIC on quality of life (QoL) induces some patients to decrease or stop their opioid therapy to relieve or avoid constipation. Purpose At a roundtable meeting on OIC, a working group developed a consensus definition for OIC diagnosis across disciplines and reviewed current OIC treatments and the potential of treatments in development. By consensus, OIC is defined as follows: ‘A change when initiating opioid therapy from baseline bowel habits that is characterized by any of the following: reduced bowel movement frequency, development or worsening of straining to pass bowel movements, a sense of incomplete rectal evacuation, or harder stool consistency’. The working group noted the prior validation of a patient response outcome and end point for clinical trials and recommended future efforts to create treatment guidelines and QoL measures specific for OIC. Details from the working group’s discussion and consensus recommendations for patient care and research are presented in this article. PMID:25164154

  4. Mucoactive and antioxidant medicines for COPD: consensus of a group of Chinese pulmonary physicians

    PubMed Central

    Yan, Xixin; Song, Yuanlin; Shen, Ce; Xu, Wenbing; Chen, Liangan; Zhang, Jian; Liu, Huiguo; Huang, Mao; Lai, Guoxiang; Qian, Guishen; Wang, Jing; Ye, Xianwei; Zheng, Jinping; Bai, Chunxue

    2017-01-01

    Airway mucus hypersecretion is a frequent symptom associated with acute and chronic airway disease. Inhibition of mucus production or promotion of mucolysis not only relieved symptoms but also improved disease outcomes. There are numerous available mucoactive medicines for prescription, and how to select them properly for different diseases is important for clinical practice. So far, there is no one consensus or guideline reported. A group of Chinese pulmonary physicians worked together to complete this consensus based on literature review, summarized mechanism and usage of each classical mucoactive medicine. In general, antioxidant mucoactive medicines play an important role in chronic airway disease, including but not limited to airway mucus clearance, reduced acute exacerbation and improved pulmonary function. PMID:28405161

  5. [Therapeutic drug monitoring (TDM) of psychotropic drugs: a consensus guideline of the AGNP-TDM group].

    PubMed

    Baumann, P; Hiemke, C; Ulrich, S; Eckermann, G; Kuss, H L; Laux, G; Müller-Oerlingenhausen, B; Rao, M L; Riederer, P; Zernig, G

    2006-05-24

    In psychiatry, therapeutic drug monitoring (TDM) is an established procedure for most psychotropic drugs. However, as its use in everyday clinical practice is far from optimal, the AGNP-TDM group has worked out consensus guidelines to assist psychiatrists and laboratories involved in drug analysis. Based on a thorough analysis of available literature, 5 levels of recommendation were defined with regard to TDM of psychoactive drugs, from 1) (strongly recommended) to 5) (not recommended). A list of indications for TDM, alone or in combination with pharmacogenetic tests is presented. Instructions are given with regard to preparation of TDM, analytical procedures, reporting and interpretation of results and the use of information for patient treatment. Using the consensus guideline will help to ensure optimal clinical benefit of TDM.

  6. Consensus definitions and application guidelines for control groups in cerebrospinal fluid biomarker studies in multiple sclerosis.

    PubMed

    Teunissen, Charlotte; Menge, Til; Altintas, Ayse; Álvarez-Cermeño, José C; Bertolotto, Antonio; Berven, Frode S; Brundin, Lou; Comabella, Manuel; Degn, Matilde; Deisenhammer, Florian; Fazekas, Franz; Franciotta, Diego; Frederiksen, Jette L; Galimberti, Daniela; Gnanapavan, Sharmilee; Hegen, Harald; Hemmer, Bernhard; Hintzen, Rogier; Hughes, Steve; Iacobaeus, Ellen; Kroksveen, Ann C; Kuhle, Jens; Richert, John; Tumani, Hayrettin; Villar, Luisa M; Drulovic, Jelena; Dujmovic, Irena; Khalil, Michael; Bartos, Ales

    2013-11-01

    The choice of appropriate control group(s) is critical in cerebrospinal fluid (CSF) biomarker research in multiple sclerosis (MS). There is a lack of definitions and nomenclature of different control groups and a rationalized application of different control groups. We here propose consensus definitions and nomenclature for the following groups: healthy controls (HCs), spinal anesthesia subjects (SASs), inflammatory neurological disease controls (INDCs), peripheral inflammatory neurological disease controls (PINDCs), non-inflammatory neurological controls (NINDCs), symptomatic controls (SCs). Furthermore, we discuss the application of these control groups in specific study designs, such as for diagnostic biomarker studies, prognostic biomarker studies and therapeutic response studies. Application of these uniform definitions will lead to better comparability of biomarker studies and optimal use of available resources. This will lead to improved quality of CSF biomarker research in MS and related disorders.

  7. Toward standardization (Part 2): National nursing minimum data sets consensus building and implementation status.

    PubMed

    Moulton, Patricia L; Wiebusch, Pamela L; Cleary, Brenda L; Brunell, Mary Lou; Napier, Duane F; Bienemy, Cynthia; LeVasseur, Sandra A; Cimiotti, Jeannie P

    2012-08-01

    With the passage of the Affordable Care Act and the development of a National Workforce Commission, multiple entities have increased their interest in collecting standardized health care workforce data at the state and national levels. In a tight budget environment, developing data sets which collect the minimum needed information that is necessary for workforce planning and supply/demand projections has become critically needed. This article represents the second of a two part series describing the work that the Forum of State Nursing Workforce Centers has undertaken during the last 3 years toward standardizing nursing workforce data. Part I described the initial steps that informed the development of national nursing workforce minimum data sets. Part II describes the consensus model used to develop the minimum data sets as well as an update on the implementation of the minimum data sets in individual states including challenges and barriers encountered.

  8. A Consensus-Based Grouping Algorithm for Multi-agent Cooperative Task Allocation with Complex Requirements.

    PubMed

    Hunt, Simon; Meng, Qinggang; Hinde, Chris; Huang, Tingwen

    2014-01-01

    This paper looks at consensus algorithms for agent cooperation with unmanned aerial vehicles. The foundation is the consensus-based bundle algorithm, which is extended to allow multi-agent tasks requiring agents to cooperate in completing individual tasks. Inspiration is taken from the cognitive behaviours of eusocial animals for cooperation and improved assignments. Using the behaviours observed in bees and ants inspires decentralised algorithms for groups of agents to adapt to changing task demand. Further extensions are provided to improve task complexity handling by the agents with added equipment requirements and task dependencies. We address the problems of handling these challenges and improve the efficiency of the algorithm for these requirements, whilst decreasing the communication cost with a new data structure. The proposed algorithm converges to a conflict-free, feasible solution of which previous algorithms are unable to account for. Furthermore, the algorithm takes into account heterogeneous agents, deadlocking and a method to store assignments for a dynamical environment. Simulation results demonstrate reduced data usage and communication time to come to a consensus on multi-agent tasks.

  9. Measuring consensus

    SciTech Connect

    Kurstedt, H.A. Jr.; Brubaker, D.M.; Doss, A.R.; Koelling, C.P.

    1989-10-01

    For this paper, I wanted to compare mathematical techniques against group interaction in generating consensus for a ranking decision. I convened a group to come to consensus on ranking items needed for survival on the moon. I chose this problem because NASA has an approved solution. I solicited the group's individual rankings before and after discussion. I used Kendall's coefficient of concordance to measure the level of consensus before and after discussion and compared the results against individual qualitative responses to a questionnaire designed to also measure consensus. The approved solution allowed me to see if group felt more or less in agreement as they moved closer or farther from the approved solution. As background for this experiment, I researched the existing knowledge on measuring consensus. I make a distinction between consensus and successful consensus, define them, and operationalize them for the purposes of this study. I define different levels of consensus which can be reached regardless of the success of the consensus. In this experiment, I determined the interactive discussion produced consensus, but not successful consensus. The mathematical technique produced a ranking closer to the accepted answer than the group discussion did. 15 refs., 1 tab.

  10. Pelvic Normal Tissue Contouring Guidelines for Radiation Therapy: A Radiation Therapy Oncology Group Consensus Panel Atlas

    SciTech Connect

    Gay, Hiram A.; Barthold, H. Joseph; O'Meara, Elizabeth; Bosch, Walter R.; El Naqa, Issam; Al-Lozi, Rawan; Rosenthal, Seth A.; Lawton, Colleen; Lee, W. Robert; Sandler, Howard; Zietman, Anthony; Myerson, Robert; Dawson, Laura A.; Willett, Christopher; Kachnic, Lisa A.; Jhingran, Anuja; Portelance, Lorraine; Ryu, Janice; and others

    2012-07-01

    Purpose: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. Results: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa{sub R}, Adnexa{sub L}, Prostate, SeminalVesc, PenileBulb, Femur{sub R}, and Femur{sub L}. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. Conclusions: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.

  11. REAL-PANLAR Project for the Implementation and Accreditation of Centers of Excellence in Rheumatoid Arthritis Throughout Latin America: A Consensus Position Paper From REAL-PANLAR Group on Improvement of Rheumatoid Arthritis Care in Latin America Establishing Centers of Excellence.

    PubMed

    Santos-Moreno, Pedro; Galarza-Maldonado, Claudio; Caballero-Uribe, Carlo V; Cardiel, Mario H; Massardo, Loreto; Soriano, Enrique R; Olano, José Aguilar; Díaz Coto, José F; Durán Pozo, Gabriel R; da Silveira, Inês Guimarães; de Castrejón, Vianna J Khoury; Pérez, Leticia Lino; Méndez Justo, Carlos A; Montufar Guardado, Rubén A; Muños, Rafael; Elvir, Sergio Murillo; Paredes Domínguez, Ernesto R; Pons-Estel, Bernardo; Ríos Acosta, Carlos R; Sandino, Sayonara; Toro Gutiérrez, Carlos E; Villegas de Morales, Sol María; Pineda, Carlos

    2015-06-01

    A consensus meeting of representatives of 16 Latin American and Caribbean countries and the REAL-PANLAR group met in the city of Bogota to provide recommendations for improving quality of care of patients with rheumatoid arthritis (RA) in Latin America, defining a minimum standards of care and the concept of center of excellence in RA. Twenty-two rheumatologists from 16 Latin American countries with a special interest in quality of care in RA participated in the consensus meeting. Two RA Colombian patients and 2 health care excellence advisors were also invited to the meeting. A RAND-modified Delphi procedure of 5 steps was applied to define categories of centers of excellence. During a 1-day meeting, working groups were created in order to discuss and validate the minimum quality-of-care standards for the 3 proposed types of centers of excellence in RA. Positive votes from at least 60% of the attending leaders were required for the approval of each standard. Twenty-two opinion leaders from the PANLAR countries and the REAL-PANLAR group participated in the discussion and definition of the standards. One hundred percent of the participants agreed with setting up centers of excellence in RA throughout Latin America. Three types of centers of excellence and its criteria were defined, according to indicators of structure, processes, and outcomes: standard, optimal, and model. The standard level should have basic structure and process indicators, the intermediate or optimal level should accomplish more structure and process indicators, and model level should also fulfill outcome indicators and patient experience. This is the first Latin American effort to standardize and harmonize the treatment provided to RA patients and to establish centers of excellence that would offer to RA patients acceptable clinical results and high levels of safety.

  12. Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement.

    PubMed

    van Hest, N A; Aldridge, R W; de Vries, G; Sandgren, A; Hauer, B; Hayward, A; Arrazola de Oñate, W; Haas, W; Codecasa, L R; Caylà, J A; Story, A; Antoine, D; Gori, A; Quabeck, L; Jonsson, J; Wanlin, M; Orcau, Å; Rodes, A; Dedicoat, M; Antoun, F; van Deutekom, H; Keizer, St; Abubakar, I

    2014-03-06

    In low-incidence countries in the European Union (EU), tuberculosis (TB) is concentrated in big cities, especially among certain urban high-risk groups including immigrants from TB high-incidence countries, homeless people, and those with a history of drug and alcohol misuse. Elimination of TB in European big cities requires control measures focused on multiple layers of the urban population. The particular complexities of major EU metropolises, for example high population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions, not efficient in the general population, to be effective or cost effective. Lessons can be learnt from across the EU and this consensus statement on TB control in big cities and urban risk groups was prepared by a working group representing various EU big cities, brought together on the initiative of the European Centre for Disease Prevention and Control. The consensus statement describes general and specific social, educational, operational, organisational, legal and monitoring TB control interventions in EU big cities, as well as providing recommendations for big city TB control, based upon a conceptual TB transmission and control model.

  13. Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group

    PubMed Central

    Avet-Loiseau, Hervé; Lonial, Sagar; Usmani, Saad; Siegel, David; Anderson, Kenneth C.; Chng, Wee-Joo; Moreau, Philippe; Attal, Michel; Kyle, Robert A.; Caers, Jo; Hillengass, Jens; San Miguel, Jesús; van de Donk, Niels W. C. J.; Einsele, Hermann; Bladé, Joan; Durie, Brian G. M.; Goldschmidt, Hartmut; Mateos, María-Victoria; Palumbo, Antonio; Orlowski, Robert

    2016-01-01

    The International Myeloma Working Group consensus updates the definition for high-risk (HR) multiple myeloma based on cytogenetics Several cytogenetic abnormalities such as t(4;14), del(17/17p), t(14;16), t(14;20), nonhyperdiploidy, and gain(1q) were identified that confer poor prognosis. The prognosis of patients showing these abnormalities may vary with the choice of therapy. Treatment strategies have shown promise for HR cytogenetic diseases, such as proteasome inhibition in combination with lenalidomide/pomalidomide, double autologous stem cell transplant plus bortezomib, or combination of immunotherapy with lenalidomide or pomalidomide. Careful analysis of cytogenetic subgroups in trials comparing different treatments remains an important goal. Cross-trial comparisons may provide insight into the effect of new drugs in patients with cytogenetic abnormalities. However, to achieve this, consensus on definitions of analytical techniques, proportion of abnormal cells, and treatment regimens is needed. Based on data available today, bortezomib and carfilzomib treatment appear to improve complete response, progression-free survival, and overall survival in t(4;14) and del(17/17p), whereas lenalidomide may be associated with improved progression-free survival in t(4;14) and del(17/17p). Patients with multiple adverse cytogenetic abnormalities do not benefit from these agents. FISH data are implemented in the revised International Staging System for risk stratification. PMID:27002115

  14. Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer

    PubMed Central

    Ahmed, Hashim U.; Akin, Oguz; Coleman, Jonathan A.; Crane, Sarah; Emberton, Mark; Goldenberg, Larry; Hricak, Hedvig; Kattan, Mike W.; Kurhanewicz, John; Moore, Caroline M.; Parker, Chris; Polascik, Thomas J.; Scardino, Peter; van As, Nicholas; Villers, Arnauld

    2013-01-01

    OBJECTIVE To reach consensus on key issues for clinical practice and future research in active surveillance and focal therapy in managing localized prostate cancer. PATIENTS AND METHODS A group of expert urologists, oncologists, radiologists, pathologists and computer scientists from North America and Europe met to discuss issues in patient population, interventions, comparators and outcome measures to use in both tissue-preserving strategies of active surveillance and focal therapy. Break-out sessions were formed to provide agreement or highlight areas of disagreement on individual topics which were then collated by a writing group into statements that formed the basis of this report and agreed upon by the whole Transatlantic Consensus Group. RESULTS The Transatlantic group propose that emerging diagnostic tools such as precision imaging and transperineal prostate mapping biopsy can improve prostate cancer care. These tools should be integrated into prostate cancer management and research so that better risk stratification and more effective treatment allocation can be applied. The group envisaged a process of care in which active surveillance, focal therapy, and radical treatments lie on a continuum of complementary therapies for men with a range of disease grades and burdens, rather than being applied in the mutually exclusive and competitive way they are now. CONCLUSION The changing landscape of prostate cancer epidemiology requires the medical community to re-evaluate the entire prostate cancer diagnostic and treatment pathway in order to minimize harms resulting from over-diagnosis and over-treatment. Precise risk stratification at every point in this pathway is required alongside paradigm shifts in our thinking about what constitutes cancer in the prostate. PMID:22077593

  15. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS).

    PubMed

    Bockhorn, Maximilian; Uzunoglu, Faik G; Adham, Mustapha; Imrie, Clem; Milicevic, Miroslav; Sandberg, Aken A; Asbun, Horacio J; Bassi, Claudio; Büchler, Markus; Charnley, Richard M; Conlon, Kevin; Cruz, Laureano Fernandez; Dervenis, Christos; Fingerhutt, Abe; Friess, Helmut; Gouma, Dirk J; Hartwig, Werner; Lillemoe, Keith D; Montorsi, Marco; Neoptolemos, John P; Shrikhande, Shailesh V; Takaori, Kyoichi; Traverso, William; Vashist, Yogesh K; Vollmer, Charles; Yeo, Charles J; Izbicki, Jakob R

    2014-06-01

    This position statement was developed to expedite a consensus on definition and treatment for borderline resectable pancreatic ductal adenocarcinoma (BRPC) that would have worldwide acceptability. An international panel of pancreatic surgeons from well-established, high-volume centers collaborated on a literature review and development of consensus on issues related to borderline resectable pancreatic cancer. The International Study Group of Pancreatic Surgery (ISGPS) supports the National Comprehensive Cancer Network criteria for the definition of BRPC. Current evidence supports operative exploration and resection in the case of involvement of the mesentericoportal venous axis; in addition, a new classification of extrahepatic mesentericoportal venous resections is proposed by the ISGPS. Suspicion of arterial involvement should lead to exploration to confirm the imaging-based findings. Formal arterial resections are not recommended; however, in exceptional circumstances, individual therapeutic approaches may be evaluated under experimental protocols. The ISGPS endorses the recommendations for specimen examination and the definition of an R1 resection (tumor within 1 mm from the margin) used by the British Royal College of Pathologists. Standard preoperative diagnostics for BRPC may include: (1) serum levels of CA19-9, because CA19-9 levels predict survival in large retrospective series; and also (2) the modified Glasgow Prognostic Score and the neutrophil/lymphocyte ratio because of the prognostic relevance of the systemic inflammatory response. Various regimens of neoadjuvant therapy are recommended only in the setting of prospective trials at high-volume centers. Current evidence justifies portomesenteric venous resection in patients with BRPC. Basic definitions were identified, that are currently lacking but that are needed to obtain further evidence and improvement for this important patient subgroup. A consensus for each topic is given. Copyright © 2014

  16. From the office to the field: areas of tension and consensus in the implementation of the National Environmental Policy Act within the US Forest Service.

    PubMed

    Stern, Marc J; Predmore, S Andrew; Mortimer, Michael J; Seesholtz, David N

    2010-06-01

    We conducted an online survey (n = 3321) followed by five focus groups with Forest Service employees involved in compliance with the National Environmental Policy Act (NEPA) to explore agency views of how NEPA should be implemented within the agency. We filter these perceptions through the lenses of different functional groups within the agency, each with its own role in agency compliance with NEPA and its own suite of perceived accountabilities. In doing so, we uncover areas of consensus regarding valued practices as well as tensions between employees with different roles in NEPA compliance. General consensus exists regarding the importance of the effective functioning of interdisciplinary teams, but opinions about what constitutes an effective team vary. Findings suggest that NEPA serves as a playing field for competing accountabilities felt by line officers, disciplinary specialists, and advisory personnel within the agency, as each attempts to exert influence over NEPA processes and their outcomes. (c) 2010 Elsevier Ltd. All rights reserved.

  17. CTSA Consortium Consensus Scientific Review Committee (SRC) Working Group Report on the SRC Processes

    PubMed Central

    Buse, John B.; Califf, Robert M.; Carter, Robert; Cooper, Dan M.; Davis, Jonathan; Ford, Daniel E.; Galassetti, Pietro; Guay‐Woodford, Lisa; Huggins, Gordon S.; Kasper, Amanda; Kieburtz, Karl; Kirby, Aaron; Klein, Andreas K.; Kline, Joel; O’ Neill, Robert T.; Rape, Marie; Reichgott, Douglas J.; Rojevsky, Svetlana; Rosenthal, Gary E.; Rubinstein, Eric P.; Shepherd, Amy; Stacy, Mark; Terrin, Norma; Wallace, Mark; Welch, Lisa

    2015-01-01

    Abstract Human research projects must have a scientifically valid study design, analytic plan, and be operationally feasible in order to be successfully completed and thus to have translational impact. To ensure this, institutions that conduct clinical research should have a scientific review process prior to submission to the Institutional Review Committee (IRB). This paper reports the Clinical and Translational Science Award (CTSA) Consortium Scientific Review Committee (SRC) Consensus Working Group's proposed framework for a SRC process. Recommendations are provided for institutional support and roles of CTSAs, multisite research, criteria for selection of protocols that should be reviewed, roles of committee members, application process, and committee process. Additionally, to support the SCR process effectively, and to ensure efficiency, the Working Group recommends information technology infrastructures and evaluation metrics to determine outcomes are provided. PMID:26184433

  18. [Early viscoelasticity-based coagulation therapy for severely injured bleeding patients: Report of the consensus group on the consensus conference 2014 for formulation of S2k guidelines].

    PubMed

    Maegele, M; Inaba, K; Rizoli, S; Veigas, P; Callum, J; Davenport, R; Fröhlich, M; Hess, J

    2015-10-01

    Although there is increasing interest in the use of a viscoelastic test procedure (ROTEM/TEG) for diagnostics and therapy guidance of severely injured and bleeding patients, currently no uniformly accepted guidelines exist for how this technology should be integrated into clinical treatment. In September 2014 an international multidisciplinary group of opinion leaders in the field of trauma-induced coagulopathy and other disciplines involved in the treatment of severely injured patients were assembled for a 2-day consensus conference in Philadelphia (USA). This panel included trauma/accident surgeons, general/abdominal surgeons, vascular surgeons, emergency/intensive care surgeons, hematologists, transfusion specialists, anesthesiologists, laboratory physicians, pathobiologists/pathophysiologists and the lay public. A total of nine questions regarding the impact of viscoelastic testing in the early treatment of trauma patients were developed prior to the conference by a panel consensus. Early use was defined as baseline viscoelastic test result thresholds obtained within the first minutes of hospital arrival, when conventional laboratory results are not yet available. The available data for each question were then reviewed in person using standardized presentations by the expert panel. A consensus summary document was then developed and reviewed by the panel in an open forum. Finally, a 2-round Delphi poll was administered to the panel of experts regarding viscoelastic thresholds for triggering the initiation of specific treatments including fibrinogen (concentrates), platelet concentrates, blood plasma products and prothrombin complex concentrates (PCC). This report summarizes the findings and recommendations of this consensus conference, which correspond to a S2k guideline according to the system of the Association of the Scientific Medical Societies in Germany (AWMF) and taking formal consensus findings including Delphi methods into consideration.

  19. Recommendations of the Canadian Consensus Group on the Management of Chronic Myeloid Leukemia

    PubMed Central

    Laneuville, P.; Barnett, M.J.; Bélanger, R.; Couban, S.; Forrest, D.L.; Roy, D.C.; Lipton, J.H.

    2006-01-01

    Chronic myelogenous leukemia (cml) is a disease characterized by the expression of Bcr/Abl, an oncogenic protein tyrosine kinase, and by evolution over time from a relatively benign chronic phase to a rapidly fatal cml blast crisis. Until recently, the standard of care included potentially curative therapy with allogeneic stem cell transplantation, available only to a minority (about 10%) of patients, or medical therapy with interferon-α with or without cytarabine, which helped to prolong the chronic phase of the disease in a minority of patients. The availability of imatinib mesylate, a selective inhibitor of Bcr/Abl approved by Health Canada in 2001, has profoundly altered the clinical and laboratory management of cml. This change in practice has been reviewed by the Canadian Consensus Group on the Management of Chronic Myelogenous Leukemia and has resulted in a new set of recommendations for the optimal care of cml patients. PMID:22792021

  20. Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group.

    PubMed

    Palmes, Daniel; Brüwer, Matthias; Bader, Franz G; Betzler, Michael; Becker, Heinz; Bruch, Hans-Peter; Büchler, Markus; Buhr, Heinz; Ghadimi, Beta Michael; Hopt, Ulrich T; Konopke, Ralf; Ott, Katja; Post, Stefan; Ritz, Jörg-Peter; Ronellenfitsch, Ulrich; Saeger, Hans-Detlev; Senninger, Norbert

    2011-08-01

    Correct diagnosis, surgical treatment, and perioperative management of patients with esophageal carcinoma remain crucial for prognosis within multimodal treatment procedures. This study aims to achieve a consensus regarding current management strategies in esophageal cancer by questioning a panel of experts from the German Advanced Surgical Treatment Study (GAST) group, comprised of 9 centers specialized in esophageal surgery, with a combined total of >220 esophagectomies per year. The Delphi method, a systematic and interactive, evidence-based approach, was used to obtain consensus statements from the GAST group regarding ambiguities and disparities in diagnosis, patient selection, surgical technique, and perioperative management of patients with esophageal carcinoma. After four rounds of surveys, agreement was measured by Likert scales and defined as full (100% agreement), near (≥66.6% agreement), or no consensus (<66.6% agreement). Full or near consensus was obtained for essential aspects of esophageal cancer staging, proper surgical technique, perioperative management and indication for primary surgery, and neoadjuvant treatment or palliative treatment. No consensus was achieved regarding acceptability of minimally invasive technique and postoperative nutrition after esophagectomy. The GAST consensus statement represents a position paper for treatment of patients with esophageal carcinoma which both contributes to the development of clinical treatment guidelines and outlines topics in need of further clinical studies.

  1. Fracture-related infection: A consensus on definition from an international expert group.

    PubMed

    Metsemakers, W J; Morgenstern, M; McNally, M A; Moriarty, T F; McFadyen, I; Scarborough, M; Athanasou, N A; Ochsner, P E; Kuehl, R; Raschke, M; Borens, O; Xie, Z; Velkes, S; Hungerer, S; Kates, S L; Zalavras, C; Giannoudis, P V; Richards, R G; Verhofstad, M H J

    2017-08-24

    Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition. The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI. Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria. In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was

  2. The AGNP-TDM expert group consensus guidelines: therapeutic drug monitoring in psychiatry.

    PubMed

    Baumann, P; Hiemke, C; Ulrich, S; Eckermann, G; Gaertner, I; Gerlach, M; Kuss, H-J; Laux, G; Müller-Oerlinghausen, B; Rao, M L; Riederer, P; Zernig, G

    2004-11-01

    Therapeutic Drug Monitoring (TDM) is a valid tool to optimise pharmacotherapy. It enables the clinician to adjust the dosage of drugs according to the characteristics of the individual patient. In psychiatry, TDM is an established procedure for lithium, some antidepressants and antipsychotics. In spite of its obvious advantages, however, the use of TDM in everyday clinical practice is far from optimal. The interdisciplinary TDM group of the Arbeitsgemeinschaft fur Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) has therefore worked out consensus guidelines to assist psychiatrists and laboratories involved in psychotropic drug analysis to optimise the use of TDM of psychotropic drugs. Five research-based levels of recommendation were defined with regard to routine monitoring of plasma concentrations for dose titration of 65 psychoactive drugs: (1) strongly recommended, (2) recommended, (3) useful, (4) probably useful and (5) not recommended. A second approach defined indications to use TDM, e. g. control of compliance, lack of clinical response or adverse effects at recommended doses, drug interactions, pharmacovigilance programs, presence of a genetic particularity concerning the drug metabolism, children, adolescents and elderly patients. Indications for TDM are relevant for all drugs either with or without validated therapeutic ranges. When studies on therapeutic ranges are lacking, target ranges should be plasma concentrations that are normally observed at therapeutic doses of the drug. Therapeutic ranges of plasma concentrations that are considered to be optimal for treatment are proposed for those drugs, for which the evaluation of the literature demonstrated strong evidence. Moreover, situations are defined when pharmacogenetic (phenotyping or genotyping) tests are informative in addition to TDM. Finally, practical instructions are given how to use TDM. They consider preparation of TDM, analytical procedures, reporting and interpretation of results

  3. The AGNP-TDM Expert Group Consensus Guidelines: focus on therapeutic monitoring of antidepressants.

    PubMed

    Baumann, Pierre; Ulrich, Sven; Eckermann, Gabriel; Gerlach, Manfred; Kuss, Hans-Joachim; Laux, Gerd; Müller-Oerlinghausen, Bruno; Rao, Marie Luise; Riederer, Peter; Zernig, Gerald; Hiemke, Christoph

    2005-01-01

    Therapeutic drug monitoring (TDM) of psychotropic drugs such as antidepressants has been widely introduced for optimization of pharmacotherapy in psychiatric patients. The interdisciplinary TDM group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) has worked out consensus guidelines with the aim of providing psychiatrists and TDM laboratories with a tool to optimize the use of TDM. Five research-based levels of recommendation were defined with regard to routine monitoring of drug plasma concentrations: (i) strongly recommended; (ii) recommended; (iii) useful; (iv) probably useful; and (v) not recommended. In addition, a list of indications that justify the use of TDM is presented, eg, control of compliance, lack of clinical response or adverse effects at recommended doses, drug interactions, pharmacovigilance programs, presence of a genetic particularity concerning drug metabolism, and children, adolescents, and elderly patients. For some drugs, studies on therapeutic ranges are lacking, but target ranges for clinically relevant plasma concentrations are presented for most drugs, based on pharmacokinetic studies reported in the literature. For many antidepressants, a thorough analysis of the literature on studies dealing with the plasma concentration-clinical effectiveness relationship allowed inclusion of therapeutic ranges of plasma concentrations. In addition, recommendations are made with regard to the combination of pharmacogenetic (phenotyping or genotyping) tests with TDM. Finally, practical instructions are given for the laboratory practitioners and the treating physicians how to use TDM: preparation of TDM, drug analysis, reporting and interpretation of results, and adequate use of information for patient treatment TDM is a complex process that needs optimal interdisciplinary coordination of a procedure implicating patients, treating physicians, clinical pharmacologists, and clinical laboratory specialists. These

  4. The AGNP-TDM Expert Group Consensus Guidelines: focus on therapeutic monitoring of antidepressants

    PubMed Central

    Baumann, Pierre; Ulrich, Sven; Eckermann, Gabriel; Gerlach, Manfred; Kuss, Hans-Joachim; Laux, Gerd; Müller-Oerlinghausen, Bruno; Rao, Marie Luise; Riederer, Peter; Zernig, Gerald; Hiemke, Christoph

    2005-01-01

    Therapeutic drug monitoring (TDM) of psychotropic drugs such as antidepressants has been widely introduced for optimization of pharmacotherapy in psychiatric patients. The interdisciplinary TDM group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) has worked out consensus guidelines with the aim of providing psychiatrists and TDM laboratories with a tool to optimize the use of TDM. Five research-based levels of recommendation were defined with regard to routine monitoring of drug plasma concentrations: (i) strongly recommended; (ii) recommended; (iii) useful; (iv) probably useful; and (v) not recommended. In addition, a list of indications that justify the use of TDM is presented, eg, control of compliance, lack of clinical response or adverse effects at recommended doses, drug interactions, pharmacovigilance programs, presence of a genetic particularity concerning drug metabolism, and children, adolescents, and elderly patients. For some drugs, studies on therapeutic ranges are lacking, but target ranges for clinically relevant plasma concentrations are presented for most drugs, based on pharmacokinetic studies reported in the literature. For many antidepressants, a thorough analysis of the literature on studies dealing with the plasma concentration–clinical effectiveness relationship allowed inclusion of therapeutic ranges of plasma concentrations. In addition, recommendations are made with regard to the combination of pharmacogenetic (phenotyping or genotyping) tests with TDM, Finally, practical instructions are given for the laboratory practitioners and the treating physicians how to use TDM: preparation of TDM, drug analysis, reporting and interpretation of results, and adequate use of information for patient treatment. TDM is a complex process that needs optimal interdisciplinary coordination of a procedure implicating patients, treating physicians, clinical pharmacologists, and clinical laboratory specialists. These

  5. [Isolated primary nocturnal enuresis: international evidence based management. Consensus recommendations by French expert group].

    PubMed

    Aubert, D; Berard, E; Blanc, J-P; Lenoir, G; Liard, F; Lottmann, H

    2010-05-01

    The causes and treatment of isolated primary nocturnal enuresis (PNE) are the subject of ongoing controversy. We are proposing consensus practical recommendations, based on a formalised analysis of the literature and validated by a large panel of experts. A task force of six experts based its work on the guide for literature analysis and recommendations and recommendation grading of the French Haute Autorité de Santé (formalized consensus process methodological guidelines) to evaluate the level of scientific proof (grade of 1 to 4) and the strength of the recommendations (grade A, B, C) of the publications on PNE. As a result of this, 223 articles from 2003 on were identified, of which only 127 (57 %) have an evaluable level of proof. This evaluation was then reviewed by a 19-member rating group. Several recommendations, poorly defined by the literature, had to be proposed by a professional agreement resulting from a consultation between the members of the task force and those of the rating group. For its final validation, the document was submitted to a reading group of 21 members working in a wide range of specialist areas and practices but all involved in PNE. The definition of PNE is very specific: intermittent incontinence during sleep, from the age of 5, with no continuous period of continence longer than 6 months, with no other associated symptom, particularly during the day. Its diagnosis is clinical by the exclusion of all other urinary pathologies. Two factors must be identified during the consultation: nocturnal polyuria promoted by excessive fluid intake, inverse secretion of vasopressin, snoring and sleep apnoea. It is sensitive to desmopressin; small bladder capacity evaluated according to a voiding diary and the ICCS formula. It may be associated with diurnal hyperactivity of the detrusor (30 %). It is resistant to desmopressin. Problems associated with PNE are: abnormal arousal threshold, attention deficit hyperactivity disorder (ADHD) (10 %), low

  6. Development of a standardised training curriculum for robotic surgery: a consensus statement from an international multidisciplinary group of experts.

    PubMed

    Ahmed, Kamran; Khan, Reenam; Mottrie, Alexandre; Lovegrove, Catherine; Abaza, Ronny; Ahlawat, Rajesh; Ahlering, Thomas; Ahlgren, Goran; Artibani, Walter; Barret, Eric; Cathelineau, Xavier; Challacombe, Ben; Coloby, Patrick; Khan, Muhammad S; Hubert, Jacques; Michel, Maurice Stephan; Montorsi, Francesco; Murphy, Declan; Palou, Joan; Patel, Vipul; Piechaud, Pierre-Thierry; Van Poppel, Hendrik; Rischmann, Pascal; Sanchez-Salas, Rafael; Siemer, Stefan; Stoeckle, Michael; Stolzenburg, Jens-Uwe; Terrier, Jean-Etienne; Thüroff, Joachim W; Vaessen, Christophe; Van Der Poel, Henk G; Van Cleynenbreugel, Ben; Volpe, Alessandro; Wagner, Christian; Wiklund, Peter; Wilson, Timothy; Wirth, Manfred; Witt, Jörn; Dasgupta, Prokar

    2015-07-01

    To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement κ 0.89) and they included: need for a training curriculum (inter-rater agreement κ 0.85); identification of learning needs (κ 0.83); development of the curriculum contents (κ 0.81); an overview of available curricula (κ 0.79); settings for robotic surgery training ((κ 0.89); assessment and training of trainers (κ 0.92); requirements for certification and patient safety (κ 0.83); and need for a universally standardised curriculum (κ 0.78). A training curriculum was proposed based on the above discussions. This group proposes a multi-step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  7. The Alcohol Hangover Research Group Consensus Statement on Best Practice in Alcohol Hangover Research

    PubMed Central

    Verster, Joris C.; Stephens, Richard; Penning, Renske; Rohsenow, Damaris; McGeary, John; Levy, Dan; McKinney, Adele; Finnigan, Frances; Piasecki, Thomas M.; Adan, Ana; Batty, G. David; Fliervoet, Lies A.L.; Heffernan, Thomas; Howland, Jonathan; Kim, Dai-Jin; Kruisselbrink, L. Darren; Ling, Jonathan; McGregor, Neil; Murphy, René J.L.; van Nuland, Merel; Oudelaar, Marieke; Parkes, Andrew; Prat, Gemma; Reed, Nick; Slutske, Wendy S.; Smith, Gordon; Young, Mark

    2013-01-01

    Alcohol-induced hangover, defined by a series of symptoms, is the most commonly reported consequence of excessive alcohol consumption. Alcohol hangovers contribute to workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and may compromise potentially dangerous daily activities such as driving a car or operating heavy machinery. These socioeconomic consequences and health risks of alcohol hangover are much higher when compared to various common diseases and other health risk factors. Nevertheless, unlike alcohol intoxication the hangover has received very little scientific attention and studies have often yielded inconclusive results. Systematic research is important to increase our knowledge on alcohol hangover and its consequences. This consensus paper of the Alcohol Hangover Research Group discusses methodological issues that should be taken into account when performing future alcohol hangover research. Future research should aim to (1) further determine the pathology of alcohol hangover, (2) examine the role of genetics, (3) determine the economic costs of alcohol hangover, (4) examine sex and age differences, (5) develop common research tools and methodologies to study hangover effects, (6) focus on factor that aggravate hangover severity (e.g., congeners), and (7) develop effective hangover remedies. PMID:20712593

  8. Diagnosis, prevention, and management of statin adverse effects and intolerance: Canadian Working Group Consensus update.

    PubMed

    Mancini, G B John; Tashakkor, A Yashar; Baker, Steven; Bergeron, Jean; Fitchett, David; Frohlich, Jiri; Genest, Jacques; Gupta, Milan; Hegele, Robert A; Ng, Dominic S; Pearson, Glen J; Pope, Janet

    2013-12-01

    The Proceedings of a Canadian Working Group Consensus Conference, first published in 2011, provided a summary of statin-associated adverse effects and intolerance and management suggestions. In this update, new clinical studies identified since then that provide further insight into effects on muscle, cognition, cataracts, diabetes, kidney disease, and cancer are discussed. Of these, the arenas of greatest controversy pertain to purported effects on cognition and the emergence of diabetes during long-term therapy. Regarding cognition, the available evidence is not strongly supportive of a major adverse effect of statins. In contrast, the linkage between statin therapy and incident diabetes is more firm. However, this risk is more strongly associated with traditional risk factors for new-onset diabetes than with statin itself and any possible negative effect of new-onset diabetes during statin treatment is far outweighed by the cardiovascular risk reduction benefits. Additional studies are also discussed, which support the principle that systematic statin rechallenge, and lower or intermittent statin dosing strategies are the main methods for dealing with suspected statin intolerance at this time.

  9. TOPSIS-based consensus model for group decision-making with incomplete interval fuzzy preference relations.

    PubMed

    Liu, Fang; Zhang, Wei-Guo

    2014-08-01

    Due to the vagueness of real-world environments and the subjective nature of human judgments, it is natural for experts to estimate their judgements by using incomplete interval fuzzy preference relations. In this paper, based on the technique for order preference by similarity to ideal solution method, we present a consensus model for group decision-making (GDM) with incomplete interval fuzzy preference relations. To do this, we first define a new consistency measure for incomplete interval fuzzy preference relations. Second, a goal programming model is proposed to estimate the missing interval preference values and it is guided by the consistency property. Third, an ideal interval fuzzy preference relation is constructed by using the induced ordered weighted averaging operator, where the associated weights of characterizing the operator are based on the defined consistency measure. Fourth, a similarity degree between complete interval fuzzy preference relations and the ideal one is defined. The similarity degree is related to the associated weights, and used to aggregate the experts' preference relations in such a way that more importance is given to ones with the higher similarity degree. Finally, a new algorithm is given to solve the GDM problem with incomplete interval fuzzy preference relations, which is further applied to partnership selection in formation of virtual enterprises.

  10. Eliciting Neutralizing Antibodies with gp120 Outer Domain Constructs Based on M-Group Consensus Sequence

    PubMed Central

    Qin, Yali; Banasik, Marisa; Kim, SoonJeung; Penn-Nicholson, Adam; Habte, Habtom H; Labranche, Celia; Montefiori, David C; Wang, Chong; Cho, Michael W

    2014-01-01

    One strategy being evaluated for HIV-1 vaccine development is focusing immune responses towards neutralizing epitopes on the gp120 outer domain (OD) by removing the immunodominant, but non-neutralizing, inner domain. Previous OD constructs have not elicited strong neutralizing antibodies (nAbs). We constructed two immunogens, a monomeric gp120-OD and a trimeric gp120-OD×3, based on an M group consensus sequence (MCON6). Their biochemical and immunological properties were compared with intact gp120. Results indicated better preservation of critical neutralizing epitopes on gp120-OD×3. In contrast to previous studies, our immunogens induced potent, cross-reactive nAbs in rabbits. Although nAbs primarily targeted Tier 1 viruses, they exhibited significant breadth. Epitope mapping analyses indicated that nAbs primarily targeted conserved V3 loop elements. Although the potency and breadth of nAbs were similar for all three immunogens, nAb induction kinetics indicated that gp120-OD×3 was superior to gp120-OD, suggesting that gp120-OD×3 is a promising prototype for further gp120 OD-based immunogen development. PMID:25046154

  11. The alcohol hangover research group consensus statement on best practice in alcohol hangover research.

    PubMed

    Verster, Joris C; Stephens, Richard; Penning, Renske; Rohsenow, Damaris; McGeary, John; Levy, Dan; McKinney, Adele; Finnigan, Frances; Piasecki, Thomas M; Adan, Ana; Batty, G David; Fliervoet, Lies A L; Heffernan, Thomas; Howland, Jonathan; Kim, Dai-Jin; Kruisselbrink, L Darren; Ling, Jonathan; McGregor, Neil; Murphy, René J L; van Nuland, Merel; Oudelaar, Marieke; Parkes, Andrew; Prat, Gemma; Reed, Nick; Slutske, Wendy S; Smith, Gordon; Young, Mark

    2010-06-01

    Alcohol-induced hangover, defined by a series of symptoms, is the most commonly reported consequence of excessive alcohol consumption. Alcohol hangovers contribute to workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and may compromise potentially dangerous daily activities such as driving a car or operating heavy machinery. These socioeconomic consequences and health risks of alcohol hangover are much higher when compared to various common diseases and other health risk factors. Nevertheless, unlike alcohol intoxication the hangover has received very little scientific attention and studies have often yielded inconclusive results. Systematic research is important to increase our knowledge on alcohol hangover and its consequences. This consensus paper of the Alcohol Hangover Research Group discusses methodological issues that should be taken into account when performing future alcohol hangover research. Future research should aim to (1) further determine the pathology of alcohol hangover, (2) examine the role of genetics, (3) determine the economic costs of alcohol hangover, (4) examine sex and age differences, (5) develop common research tools and methodologies to study hangover effects, (6) focus on factor that aggravate hangover severity (e.g., congeners), and (7) develop effective hangover remedies.

  12. Two-species-coagulation approach to consensus by group level interactions

    NASA Astrophysics Data System (ADS)

    Escudero, Carlos; Macià, Fabricio; Velázquez, Juan J. L.

    2010-07-01

    We explore the self-organization dynamics of a set of entities by considering the interactions that affect the different subgroups conforming the whole. To this end, we employ the widespread example of coagulation kinetics, and characterize which interaction types lead to consensus formation and which do not, as well as the corresponding different macroscopic patterns. The crucial technical point is extending the usual one species coagulation dynamics to the two species one. This is achieved by means of introducing explicitly solvable kernels which have a clear physical meaning. The corresponding solutions are calculated in the long time limit, in which consensus may or may not be reached. The lack of consensus is characterized by means of scaling limits of the solutions. The possible applications of our results to some topics in which consensus reaching is fundamental, such as collective animal motion and opinion spreading dynamics, are also outlined.

  13. Two-species-coagulation approach to consensus by group level interactions

    SciTech Connect

    Escudero, Carlos; Macia, Fabricio

    2010-07-15

    We explore the self-organization dynamics of a set of entities by considering the interactions that affect the different subgroups conforming the whole. To this end, we employ the widespread example of coagulation kinetics, and characterize which interaction types lead to consensus formation and which do not, as well as the corresponding different macroscopic patterns. The crucial technical point is extending the usual one species coagulation dynamics to the two species one. This is achieved by means of introducing explicitly solvable kernels which have a clear physical meaning. The corresponding solutions are calculated in the long time limit, in which consensus may or may not be reached. The lack of consensus is characterized by means of scaling limits of the solutions. The possible applications of our results to some topics in which consensus reaching is fundamental, such as collective animal motion and opinion spreading dynamics, are also outlined.

  14. Consensus views on implementation and measurement of enhanced recovery after surgery in England: Delphi study

    PubMed Central

    Knott, Amy; Pathak, Samir; McGrath, John S; Kennedy, Robin; Horgan, Alan; Mythen, Monty; Carter, Fiona; Francis, Nader K

    2012-01-01

    Objective The Department of Health's Enhanced Recovery Partnership Programme (ERPP) started a spread and adoption scheme of Enhanced Recovery After Surgery (ERAS) throughout England. In preparation for widespread adoption the ERPP wished to obtain expert consensus on appropriate outcome measures for ERAS, emerging techniques being widely adopted and proposed methods for the continued development and sustainability of ERAS in the National Health Service. The aim of this study was to interrogate expert opinion and define areas of consensus on these issues. Design A Delphi technique using three rounds of reiterative questionnaires was used to obtain consensus. Participants Experts were chosen from teams with experience of delivering a successful ERAS programme across different surgical specialties and across various disciplines. Setting The first two rounds of the questionnaire were completed online and a final, third round was undertaken in a meeting using interactive voting. Results 86 experts took part in this study. Consensus statements agreed that patient experience data should be recorded, analysed and reviewed at regular ERAS meetings. Recent developments in regional analgesia, the increased use of intraoperative monitoring for fluid management and cardio-pulmonary exercise testing were the main emerging techniques identified. National standards for those outcome measures would be welcomed. To sustain success in ERAS, the experts highlighted clinical champions and the presence of a dedicated ERAS facilitator as essential elements. For future networking, a unanimous agreement was achieved on the formation a national network to facilitate spread and adoption of ERAS and to promote research and education across surgery. Conclusions Consensus was achieved on regular measurement and review of patient experience in ERAS. Agreement was reached on the role of regional analgesia and the use of oesophageal Doppler for intraoperative goal-directed fluid therapy. In order

  15. A Multi-Peer Assessment Platform for Programming Language Learning: Considering Group Non-Consensus and Personal Radicalness

    ERIC Educational Resources Information Center

    Wang, Yanqing; Liang, Yaowen; Liu, Luning; Liu, Ying

    2016-01-01

    Multi-peer assessment has often been used by teachers to reduce personal bias and make the assessment more reliable. This study reviews the design and development of multi-peer assessment systems that detect and solve two common issues in such systems: non-consensus among group members and personal radicalness in some assessments. A multi-peer…

  16. Physician executive promotes process for managing change. Building consensus for group plan is key to successful transitions.

    PubMed

    Carrigan, V M

    2001-01-01

    Thrust into a leadership position after years in solo practice demanded quick thinking for one physician executive. Faced with a need for change, he developed his own process for turning an individual's idea into a plan of action for an entire group. Learn the steps he took to build consensus and ease resistance to change.

  17. A Multi-Peer Assessment Platform for Programming Language Learning: Considering Group Non-Consensus and Personal Radicalness

    ERIC Educational Resources Information Center

    Wang, Yanqing; Liang, Yaowen; Liu, Luning; Liu, Ying

    2016-01-01

    Multi-peer assessment has often been used by teachers to reduce personal bias and make the assessment more reliable. This study reviews the design and development of multi-peer assessment systems that detect and solve two common issues in such systems: non-consensus among group members and personal radicalness in some assessments. A multi-peer…

  18. Elective Clinical Target Volumes for Conformal Therapy in Anorectal Cancer: A Radiation Therapy Oncology Group Consensus Panel Contouring Atlas

    SciTech Connect

    Myerson, Robert J. Garofalo, Michael C.; El Naqa, Issam; Abrams, Ross A.; Apte, Aditya; Bosch, Walter R.; Das, Prajnan; Gunderson, Leonard L.; Hong, Theodore S.; Kim, J.J. John; Willett, Christopher G.; Kachnic, Lisa A.

    2009-07-01

    Purpose: To develop a Radiation Therapy Oncology Group (RTOG) atlas of the elective clinical target volume (CTV) definitions to be used for planning pelvic intensity-modulated radiotherapy (IMRT) for anal and rectal cancers. Methods and Materials: The Gastrointestinal Committee of the RTOG established a task group (the nine physician co-authors) to develop this atlas. They responded to a questionnaire concerning three elective CTVs (CTVA: internal iliac, presacral, and perirectal nodal regions for both anal and rectal case planning; CTVB: external iliac nodal region for anal case planning and for selected rectal cases; CTVC: inguinal nodal region for anal case planning and for select rectal cases), and to outline these areas on individual computed tomographic images. The imaging files were shared via the Advanced Technology Consortium. A program developed by one of the co-authors (I.E.N.) used binomial maximum-likelihood estimates to generate a 95% group consensus contour. The computer-estimated consensus contours were then reviewed by the group and modified to provide a final contouring consensus atlas. Results: The panel achieved consensus CTV definitions to be used as guidelines for the adjuvant therapy of rectal cancer and definitive therapy for anal cancer. The most important difference from similar atlases for gynecologic or genitourinary cancer is mesorectal coverage. Detailed target volume contouring guidelines and images are discussed. Conclusion: This report serves as a template for the definition of the elective CTVs to be used in IMRT planning for anal and rectal cancers, as part of prospective RTOG trials.

  19. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology.

    PubMed

    Howes, Oliver D; McCutcheon, Rob; Agid, Ofer; de Bartolomeis, Andrea; van Beveren, Nico J M; Birnbaum, Michael L; Bloomfield, Michael A P; Bressan, Rodrigo A; Buchanan, Robert W; Carpenter, William T; Castle, David J; Citrome, Leslie; Daskalakis, Zafiris J; Davidson, Michael; Drake, Richard J; Dursun, Serdar; Ebdrup, Bjørn H; Elkis, Helio; Falkai, Peter; Fleischacker, W Wolfgang; Gadelha, Ary; Gaughran, Fiona; Glenthøj, Birte Y; Graff-Guerrero, Ariel; Hallak, Jaime E C; Honer, William G; Kennedy, James; Kinon, Bruce J; Lawrie, Stephen M; Lee, Jimmy; Leweke, F Markus; MacCabe, James H; McNabb, Carolyn B; Meltzer, Herbert; Möller, Hans-Jürgen; Nakajima, Shinchiro; Pantelis, Christos; Reis Marques, Tiago; Remington, Gary; Rossell, Susan L; Russell, Bruce R; Siu, Cynthia O; Suzuki, Takefumi; Sommer, Iris E; Taylor, David; Thomas, Neil; Üçok, Alp; Umbricht, Daniel; Walters, James T R; Kane, John; Correll, Christoph U

    2017-03-01

    Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients. There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.

  20. Antigone: Implementing Policy in Secure Group Communication

    DTIC Science & Technology

    2000-01-01

    identification of a highly fault-tolerant key distribution scheme . Process group semantics are used to facilitate secure communication. A single session key...the group views1 constructed through membership protocols. The security context is not changed through shared session keys, but through the secure...is a secret key shared shared between the session leader and a single member. Once the group has been established, each member knows all the keys

  1. In Pursuit of Consensus: Disagreement and Legitimization during Small-Group Argumentation

    ERIC Educational Resources Information Center

    Berland, Leema K.; Lee, Victor R.

    2012-01-01

    In recent years, an emphasis on scientific argumentation in classrooms has brought into focus collaborative consensus-building as an instructional strategy. In these situations, students with differing and competing arguments are asked to work with one another in order to establish a shared perspective. However, the literature suggests that…

  2. Consensus-based course design and implementation of constructive alignment theory in a power system analysis course

    NASA Astrophysics Data System (ADS)

    Vanfretti, Luigi; Farrokhabadi, Mostafa

    2015-03-01

    This article presents the implementation of the constructive alignment theory (CAT) in a power system analysis course through a consensus-based course design process. The consensus-based design process involves both the instructor and graduate-level students and it aims to develop the CAT framework in a holistic manner with the goal of including different perceptions. The considerations required to implement this approach are described in detail. To examine the effect of this approach, three different course evaluations were conducted by querying the students during different stages of the course. These evaluations show that most of the students find a benefit for their learning in the implementation of CAT within the new course design. These observations are supported by a comparison of the students' performance in the new course and the previous one. Finally, the revised two-factor study process questionnaire (R-SPQ-2F) is utilised to identify the students' learning approach towards the course. The aim is to correlate the students' approach with their final grade to assess if students adopting a deep learning approach are rewarded with higher marks and vice versa, that is, to check if the CAT implementation was successful. Meanwhile, some of the R-SPQ-2F limitations, which affect the quality of the results, are identified and discussed. Additionally, to facilitate the practical usage of R-SPQ-2F, an algorithm was developed by the authors to rank the students' approach towards the course. The results of the new ranking algorithm demonstrate positive correlation with the students' final grade, which is an indication of the effective CAT implementation.

  3. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes.

    PubMed

    Berney, Daniel M; Wheeler, Thomas M; Grignon, David J; Epstein, Jonathan I; Griffiths, David F; Humphrey, Peter A; van der Kwast, Theo; Montironi, Rodolfo; Delahunt, Brett; Egevad, Lars; Srigley, John R

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coordinated by working group 4. There was a consensus that complete blocking of the seminal vesicles was not necessary, although sampling of the junction of the seminal vesicles and prostate was mandatory. There was consensus that sampling of the vas deferens margins was not obligatory. There was also consensus that muscular wall invasion of the extraprostatic seminal vesicle only should be regarded as seminal vesicle invasion. Categorization into types of seminal vesicle spread was agreed by consensus to be not necessary. For examination of lymph nodes, there was consensus that special techniques such as frozen sectioning were of use only in high-risk cases. There was no consensus on the optimal sampling method for pelvic lymph node dissection specimens, although there was consensus that all lymph nodes should be completely blocked as a minimum. There was also a consensus that a count of the number of lymph nodes harvested should be attempted. In view of recent evidence, there was consensus that the diameter of the largest lymph node metastasis should be measured. These consensus decisions will hopefully clarify the difficult areas of pathological assessment in radical prostatectomy evaluation and improve the concordance of research series to allow more accurate assessment of patient prognosis.

  4. European Expert Consensus Paper on the implementation of Article 14 of the WHO Framework Convention on Tobacco Control.

    PubMed

    Clancy, Luke

    2016-11-01

    On 24 November 2015, under the auspices of the European Policy Roundtable on Smoking Cessation, 15 experts on tobacco control and dependence from across the European Union, chaired by Professor Luke Clancy, met in Oslo, Norway, to discuss the implementation of the Tobacco Products Directive and the WHO Framework Convention on Tobacco Control, namely Article 14. On the occasion of the 10th anniversary of the Framework Convention on Tobacco Control, this paper reports the consensus reached by all Roundtable participants on the need to further advance the availability and access to services to support cessation of tobacco use. The implementation of services to support cessation of tobacco use in line with Article 14 can and should be significantly improved to protect the health of European citizens. The meeting was initiated and funded by Pfizer.

  5. The use, publication and future directions of immunocytochemistry in veterinary medicine: a consensus of the Oncology-Pathology Working Group.

    PubMed

    Priest, H L; Hume, K R; Killick, D; Kozicki, A; Rizzo, V L; Seelig, D; Snyder, L A; Springer, N L; Wright, Z M; Robat, C

    2017-09-01

    One of the primary objectives of the Oncology Pathology Working Group (OPWG), a joint initiative of the Veterinary Cancer Society and the American College of Veterinary Pathologists, is for oncologists and pathologists to collaboratively generate consensus documents to standardize aspects of and provide guidelines for oncologic pathology. Consensus is established through review of relevant peer-reviewed literature relative to a subgroup's particular focus. In this document, the authors provide descriptions of the literature reviewed, the review process, and a summary of the information gathered on immunocytochemistry. The intent of this publication is to help educate practitioners and pathologists on the process of immunocytochemistry and to provide a guide for the use of this technique in veterinary medicine. This document represents the opinions of the working group and the authors and does not constitute a formal endorsement by the American College of Veterinary Pathologists or the Veterinary Cancer Society. © 2016 John Wiley & Sons Ltd.

  6. Efficient implementation of the time renormalization group

    NASA Astrophysics Data System (ADS)

    Vollmer, Adrian; Amendola, Luca; Catena, Riccardo

    2016-02-01

    The time renormalization group (TRG) is an effective method for accurate calculations of the matter power spectrum at the scale of the first baryonic acoustic oscillations. By using a particular variable transformation in the TRG formalism, we can reduce the 2D integral in the source term of the equations of motion for the power spectrum into a series of 1D integrals. The shape of the integrand allows us to precompute only 13 antiderivatives numerically, which can then be reused when evaluating the outer integral. While this introduces a few challenges to keep numerical noise under control, we find that the computation time for nonlinear corrections to the matter power spectrum decreases by a factor of 50. This opens up the possibility to use TRG for mass production as in Markov chain Monte Carlo methods. A fortran code demonstrating this new algorithm is publicly available.

  7. The role of the pathologist in tissue banking: European Consensus Expert Group Report.

    PubMed

    Bevilacqua, Generoso; Bosman, Fred; Dassesse, Thibaut; Höfler, Heinz; Janin, Anne; Langer, Rupert; Larsimont, Denis; Morente, Manuel M; Riegman, Peter; Schirmacher, Peter; Stanta, Giorgio; Zatloukal, Kurt; Caboux, Elodie; Hainaut, Pierre

    2010-04-01

    Human tissue biobanking encompasses a wide range of activities and study designs and is critical for application of a wide range of new technologies (-"omics") to the discovery of molecular patterns of disease and for implementation of novel biomarkers into clinical trials. Pathology is the cornerstone of hospital-based tissue biobanking. Pathologists not only provide essential information identifying the specimen but also make decisions on what should be biobanked, making sure that the timing of all operations is consistent with both the requirements of clinical diagnosis and the optimal preservation of biological products. This document summarizes the conclusions of a Pathology Expert Group Meeting within the European Biological and Biomolecular Research Infrastructure (BBMRI) Program. These recommendations are aimed at providing guidance for pathologists as well as for institutions hosting biobanks on how to better integrate and support pathological activities within the framework of biobanks that fulfill international standards.

  8. Recommendations for reporting economic evaluations of haemophilia prophylaxis: a nominal groups consensus statement on behalf of the Economics Expert Working Group of The International Prophylaxis Study Group.

    PubMed

    Nicholson, A; Berger, K; Bohn, R; Carcao, M; Fischer, K; Gringeri, A; Hoots, K; Mantovani, L; Schramm, W; van Hout, B A; Willan, A R; Feldman, B M

    2008-01-01

    The need for clearly reported studies evaluating the cost of prophylaxis and its overall outcomes has been recommended from previous literature. To establish minimal ''core standards'' that can be followed when conducting and reporting economic evaluations of hemophilia prophylaxis. Ten members of the IPSG Economic Analysis Working Group participated in a consensus process using the Nominal Groups Technique (NGT). The following topics relating to the economic analysis of prophylaxis studies were addressed; Whose perspective should be taken? Which is the best methodological approach? Is micro- or macro-costing the best costing strategy? What information must be presented about costs and outcomes in order to facilitate local and international interpretation? The group suggests studies on the economic impact of prophylaxis should be viewed from a societal perspective and be reported using a Cost Utility Analysis (CUA) (with consideration of also reporting Cost Benefit Analysis [CBA]). All costs that exceed $500 should be used to measure the costs of prophylaxis (macro strategy) including items such as clotting factor costs, hospitalizations, surgical procedures, productivity loss and number of days lost from school or work. Generic and disease specific quality of lífe and utility measures should be used to report the outcomes of the study. The IPSG has suggested minimal core standards to be applied to the reporting of economic evaluations of hemophilia prophylaxis. Standardized reporting will facilitate the comparison of studies and will allow for more rational policy decisions and treatment choices.

  9. Practice guidelines for the management of low back pain. Consensus Group of Practice Parameters to Manage Low Back Pain.

    PubMed

    Guevara-López, Uría; Covarrubias-Gómez, Alfredo; Elías-Dib, Jorge; Reyes-Sánchez, Alejandro; Rodríguez-Reyna, Tatiana Sofía

    2011-01-01

    It has been documented that pain in its diverse modalities is the most common cause of medical attention. In Mexico, an increase in its frequency has promoted its consideration in several health programs. On the other hand, inadequate pain management will cause severe physical, psychoaffective, and socioeconomic repercussions for patients, families, and public health services. Despite this panorama, there has not been an agreement to establish better diagnostic and therapeutic methods for the management of chronic pain. A consensus group was reunited and was integrated by medical experts from private and public institutions and from various states of the Mexican Republic. To assure the development of these practice guidelines, these experts had experience in the assessment and treatment of conditions causing pain. With the guidelines used by other consensus groups, meetings were held to analyze and discuss published literary evidence for the management of low back pain. The recommendations were classified according to their methodological strength. As a result of this meeting, consensus recommendations were based on evidence and operational conclusions of such proactive educational plans, institutional policies and diagnostic recommendations for pharmacological and nonpharmacological treatment in order for Mexican physicians to provide a better therapeutic approach to low back pain.

  10. Response evaluation criteria for solid tumours in dogs (v1.0): a Veterinary Cooperative Oncology Group (VCOG) consensus document.

    PubMed

    Nguyen, S M; Thamm, D H; Vail, D M; London, C A

    2015-09-01

    In veterinary medical oncology, there is currently no standardized protocol for assessing response to therapy in solid tumours. The lack of such a formalized guideline makes it challenging to critically compare outcome measures across various treatment protocols. The Veterinary Cooperative Oncology Group (VCOG) membership consensus document presented here is based on the recommendations of a subcommittee of American College of Veterinary Internal Medicine (ACVIM) board-certified veterinary oncologists. This consensus paper has used the human response evaluation criteria in solid tumours (RECIST v1.1) as a framework to establish standard procedures for response assessment in canine solid tumours that is meant to be easy to use, repeatable and applicable across a variety of clinical trial structures in veterinary oncology. It is hoped that this new canine RECIST (cRECIST v1.0) will be adopted within the veterinary oncology community and thereby facilitate the comparison of current and future treatment protocols used for companion animals with cancer.

  11. The 1st Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2016. Summary and Consensus Statements: Group II - Peri-Implantitis Diagnostics and Decision Tree

    PubMed Central

    Dursun, Erhan; Galindo-Moreno, Pablo; Juodzbalys, Gintaras; López-Martínez, Jesús; O'Valle, Francisco; Padial-Molina, Miguel; Ramanauskaite, Ausra

    2016-01-01

    ABSTRACT Introduction The task of Group 2 was to review and update the existing data concerning clinical and genetic methods of diagnostics of peri-implantitis. Special interest was paid to the peri-implant crevicular fluid (PICF) overview including analysis of enzymes and biomarkers and microbial profiles from implants. Material and Methods The main areas of interest were as follows: effect of smoking and history of periodontitis, prosthetic treatment mistakes, excess cement, overloading, general diseases influence on peri-implantitis development. The systematic review and/or meta-analysis were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was searched and reported using the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. The method of preparation of systematic reviews of the literature based on comprehensive search strategies was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic review and/or meta-analysis is presented in Preface chapter. Results The results and conclusions of the review process are presented in the respective papers. The group′s general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article. PMID:27833736

  12. The 1st Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2016. Summary and Consensus Statements: Group III - Peri-Implantitis Treatment

    PubMed Central

    Faria e Almeida, Ricardo; Cicciù, Marco; Daugela, Povilas; Ramanauskaite, Ausra; Saulacic, Nikola; Tervonen, Tellervo; Wang, Hom-Lay; Yu, Shan-Huey

    2016-01-01

    ABSTRACT Introduction The task of Group 3 was to review and update the existing data concerning non-surgical, surgical non-regenerative and surgical regenerative treatment of peri-implantitis. Special interest was paid to the preventive and supporting therapy in case of peri-implantitis. Material and Methods The main areas of interest were as follows: effect of smoking and history of periodontitis, prosthetic treatment mistakes, excess cement, overloading, general diseases influence on peri-implantitis development. The systematic review and/or meta-analysis were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was searched and reported using the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. The method of preparation of systematic reviews of the literature based on comprehensive search strategies was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic review and/or meta-analysis is presented in Preface chapter. Results The results and conclusions of the review process are presented in the respective papers. The group′s general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article. PMID:27833741

  13. Nurse intention to implement creative group activities among psychiatric patients.

    PubMed

    Drori, Tal; Guetta, Hava; Ben Natan, Merav; Polakevich, Yaakov

    2014-10-01

    This study examined the factors that affect nurse intention to implement creative group activities among psychiatric patients. The study used a cross-sectional design. One hundred psychiatric nurses completed a questionnaire based on the theory of reasoned action. The findings indicate that the theory predicts nurse intention to implement these activities, and the most significant factors for this intention are their previous implementation and the effect of nursing managers. Nursing managers should support nurses to implement creative group activities among psychiatric patients, and provide appropriate training. © 2014 Wiley Periodicals, Inc.

  14. Guidelines for the diagnosis and management of neuropathic pain: consensus of a group of Latin American experts.

    PubMed

    Acevedo, Juan Carlos; Amaya, Abraham; Casasola, Oscar de León; Chinchilla, Nelson; De Giorgis, Marcelo; Florez, Sandra; Genis, Miguel Angel; Gomez-Barrios, Juan Vicente; Hernández, John Jairo; Ibarra, Eduardo; Moreno, Carlos; Orrillo, Enrique; Pasternak, Danilo; Romero, Sabina; Vallejo, Mariana; Velasco, Maritza; Villalobos, Alberto

    2009-01-01

    These consensus guidelines have been developed by a group of Latin American experts in pain management, to point out patterns and make practical recommendations to guide the diagnosis, identify warning signs (yellow and red flags), and establish comprehensive medical management (pharmacologic and nonpharmacologic treatment) and monitoring plans for patients enduring neuropathic pain. From the viewpoint of pharmacologic management, drugs are classified into groups according to efficacy, availability/accessibility, and safety criteria. Drugs are recommended for use depending on the disease and particular circumstances of each patient, with an approach that favors multimodal treatment while taking into consideration the idiosyncrasies of medical practice in Latin America.

  15. Academic requirements for Certificate of Completion of Training in surgical training: Consensus recommendations from the Association of Surgeons in Training/National Research Collaborative Consensus Group.

    PubMed

    Lee, Mathew J; Bhangu, A; Blencowe, Natalie S; Nepogodiev, D; Gokani, Vimal J; Harries, Rhiannon L; Akinfala, M; Ali, O; Allum, W; Bosanquet, D C; Boyce, K; Bradburn, M; Chapman, S J; Christopher, E; Coulter, I; Dean, B J F; Dickfos, M; El Boghdady, M; Elmasry, M; Fleming, S; Glasbey, J; Healy, C; Kasivisvanathan, V; Khan, K S; Kolias, A G; Lee, S M; Morton, D; O'Beirne, J; Sinclair, P; Sutton, P A

    2016-11-01

    Surgical trainees are expected to demonstrate academic achievement in order to obtain their certificate of completion of training (CCT). These standards are set by the Joint Committee on Surgical Training (JCST) and specialty advisory committees (SAC). The standards are not equivalent across all surgical specialties and recognise different achievements as evidence. They do not recognise changes in models of research and focus on outcomes rather than process. The Association of Surgeons in Training (ASiT) and National Research Collaborative (NRC) set out to develop progressive, consistent and flexible evidence set for academic requirements at CCT. A modified-Delphi approach was used. An expert group consisting of representatives from the ASiT and the NRC undertook iterative review of a document proposing changes to requirements. This was circulated amongst wider stakeholders. After ten iterations, an open meeting was held to discuss these proposals. Voting on statements was performed using a 5-point Likert Scale. Each statement was voted on twice, with ≥80% of votes in agreement meaning the statement was approved. The results of this vote were used to propose core and optional academic requirements for CCT. Online discussion concluded after ten rounds. At the consensus meeting, statements were voted on by 25 delegates from across surgical specialties and training-grades. The group strongly favoured acquisition of 'Good Clinical Practice' training and research methodology training as CCT requirements. The group agreed that higher degrees, publications in any author position (including collaborative authorship), recruiting patients to a study or multicentre audit and presentation at a national or international meeting could be used as evidence for the purpose of CCT. The group agreed on two essential 'core' requirements (GCP and methodology training) and two of a menu of four 'additional' requirements (publication with any authorship position, presentation

  16. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group.

    PubMed

    Ma, Irene W Y; Arishenkoff, Shane; Wiseman, Jeffrey; Desy, Janeve; Ailon, Jonathan; Martin, Leslie; Otremba, Mirek; Halman, Samantha; Willemot, Patrick; Blouw, Marcus

    2017-05-11

    Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

  17. Designing, Implementing, and Evaluating a Group Therapy for Underserved Populations

    ERIC Educational Resources Information Center

    Waltman, Scott H.; Hetrick, Holly; Tasker, Tamara E.

    2012-01-01

    This article presents the case of a mindfulness-based group therapy that was implemented in a residential treatment facility. The case presented comprised a group of adolescent males with disruptive behavior disorders. The group was designed to be appropriate for the unique demographics of the clients, with the intent to help the clients enhance…

  18. Designing, Implementing, and Evaluating a Group Therapy for Underserved Populations

    ERIC Educational Resources Information Center

    Waltman, Scott H.; Hetrick, Holly; Tasker, Tamara E.

    2012-01-01

    This article presents the case of a mindfulness-based group therapy that was implemented in a residential treatment facility. The case presented comprised a group of adolescent males with disruptive behavior disorders. The group was designed to be appropriate for the unique demographics of the clients, with the intent to help the clients enhance…

  19. Focus Groups among Latino Farmworker Populations: Recommendations for Implementation.

    ERIC Educational Resources Information Center

    Perez, Miguel A.; Pinzon, Helda L.; Luquis, Raffy R.

    1998-01-01

    Presents suggestions for the implementation of focus groups among Latino farmworkers in the United States. Recommendations are based on a study of risk factors for HIV and AIDS among Latino farmworkers. They center on group membership, facilitation, and the focus group process. (SLD)

  20. Context matters: measuring implementation climate among individuals and groups

    PubMed Central

    2014-01-01

    Background It has been noted that implementation climate is positively associated with implementation effectiveness. However, issues surrounding the measurement of implementation climate, or the extent to which organizational members perceive that innovation use is expected, supported and rewarded by their organization remain. Specifically, it is unclear whether implementation climate can be measured as a global construct, whether individual or group-referenced items should be used, and whether implementation climate can be assessed at the group or organizational level. Methods This research includes two cross-sectional studies with data collected via surveys at the individual level. The first study assessed the implementation climate perceptions of physicians participating in the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP), and the second study assessed the perceptions of children’s behavioral health clinicians implementing a treatment innovation. To address if implementation climate is a global construct, we used confirmatory factor analysis. To address how implementation climate should be measured and at what level, we followed a five-step framework outlined by van Mierlo and colleagues. This framework includes exploratory factor analysis and correlations to assess differences between individual and group-referenced items and intraclass correlations, interrater agreements, and exploratory factor analysis to determine if implementation climate can be assessed at the organizational level. Results The confirmatory factor analysis demonstrated that implementation climate is a global construct consisting of items related to expectations, support and rewards. There are mixed results, however, as to whether implementation climate should be measured using individual or group-referenced items. In our first study, where physicians were geographically dispersed and practice independently, there were no differences based on the type of

  1. Context matters: measuring implementation climate among individuals and groups.

    PubMed

    Jacobs, Sara R; Weiner, Bryan J; Bunger, Alicia C

    2014-04-17

    It has been noted that implementation climate is positively associated with implementation effectiveness. However, issues surrounding the measurement of implementation climate, or the extent to which organizational members perceive that innovation use is expected, supported and rewarded by their organization remain. Specifically, it is unclear whether implementation climate can be measured as a global construct, whether individual or group-referenced items should be used, and whether implementation climate can be assessed at the group or organizational level. This research includes two cross-sectional studies with data collected via surveys at the individual level. The first study assessed the implementation climate perceptions of physicians participating in the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP), and the second study assessed the perceptions of children's behavioral health clinicians implementing a treatment innovation. To address if implementation climate is a global construct, we used confirmatory factor analysis. To address how implementation climate should be measured and at what level, we followed a five-step framework outlined by van Mierlo and colleagues. This framework includes exploratory factor analysis and correlations to assess differences between individual and group-referenced items and intraclass correlations, interrater agreements, and exploratory factor analysis to determine if implementation climate can be assessed at the organizational level. The confirmatory factor analysis demonstrated that implementation climate is a global construct consisting of items related to expectations, support and rewards. There are mixed results, however, as to whether implementation climate should be measured using individual or group-referenced items. In our first study, where physicians were geographically dispersed and practice independently, there were no differences based on the type of items used, and implementation

  2. [Therapy and prevention of coronary heart diseases through lowering of the serum cholesterol levels; third consensus 'Cholesterol'. Consensus Working Group, CBO].

    PubMed

    Simoons, M L; Casparie, A F

    1998-09-19

    For the second time the consensus text for lipid lowering therapy is revised. In angiographic studies it was shown that a decrease in the total cholesterol as well as the low-density lipoprotein cholesterol level results in a reduction of the progression of vascular disease. Furthermore, intervention trials demonstrated that therapy with cholesterol synthesis inhibitors reduces not only both the cardiovascular and total mortality, but also other manifestations of coronary heart disease (CHD). Hypercholesterolaemia is treated with a low-fat diet and normalisation of the weight. For individuals, this might result in a reduction of the risk for myocardial infarction or death and for the population in a decrease of the mean serum cholesterol concentration and the incidence of CHD. The indication for drug therapy is founded on the expected effectiveness to reduce the incidence of (new manifestations of) CHD, which is related to the level of the absolute risk of vascular disease. In persons without known vascular diseases this risk is calculated from the total and high-density lipoprotein cholesterol ratio, age, sex, blood pressure, diabetes mellitus, and smoking. Treatment with cholesterol synthesis inhibitors must be considered in (a) patients with familial hypercholesterolaemia, (b) all patients with a history of myocardial infarction or other symptomatic vascular disease with a total cholesterol concentration above 5.0 mmol/l and a life expectancy of at least five years; (c) persons with a combination of diabetes mellitus, hypertension, hypercholesterolaemia and high risk for development of CHD, rising from 25% per 10 years at the age of 40 years to 35-40% per 10 years at the age of 70 years, with a life expectancy of at least five years. If these guidelines are followed, the upper limit of the calculated cost-effectiveness is about Dfl. 40,000 per life year gained. The working group judges this reasonable in comparison with other therapeutic interventions in the

  3. Consensus Statement on medication use in multiple sclerosis by the Spanish Society of Neurology's study group for demyelinating diseases.

    PubMed

    García-Merino, A; Fernández, O; Montalbán, X; de Andrés, C; Oreja-Guevara, C; Rodríguez-Antigüedad, A; Arbizu, T

    2013-01-01

    Treatments for multiple sclerosis therapy are rapidly evolving. It is believed that new drugs will be approved in the near future, thereby changing current indications for treatment. In this context, the Spanish Society of Neurology's study group on demyelinating diseases, which evaluates medication use in MS, has decided to draw up a consensus statement on the current indications and guidelines for multiple sclerosis treatment. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  4. Group visits for chronic illness management: implementation challenges and recommendations.

    PubMed

    Jones, Katherine R; Kaewluang, Napatsawan; Lekhak, Nirmala

    2014-01-01

    The group visit approach to improve chronic illness self-management appears promising in terms of selected outcomes, but little information is available about best ways to organize and implement group visits. This literature review of 84 articles identified group visit implementation challenges, including lack of a group visit billing code, inadequate administrative support and resources, difficult participant recruitment and retention, and logistical issues such as space and scheduling. Recommendations for future implementation initiatives were also abstracted from the literature. Patients and providers can benefit from well-planned and well-conducted group visits. These benefits include greater patient and provider satisfaction, reduced overall utilization, improved clinical outcomes, and greater provider efficiency and productivity.

  5. A consensus reaching model for 2-tuple linguistic multiple attribute group decision making with incomplete weight information

    NASA Astrophysics Data System (ADS)

    Zhang, Wancheng; Xu, Yejun; Wang, Huimin

    2016-01-01

    The aim of this paper is to put forward a consensus reaching method for multi-attribute group decision-making (MAGDM) problems with linguistic information, in which the weight information of experts and attributes is unknown. First, some basic concepts and operational laws of 2-tuple linguistic label are introduced. Then, a grey relational analysis method and a maximising deviation method are proposed to calculate the incomplete weight information of experts and attributes respectively. To eliminate the conflict in the group, a weight-updating model is employed to derive the weights of experts based on their contribution to the consensus reaching process. After conflict elimination, the final group preference can be obtained which will give the ranking of the alternatives. The model can effectively avoid information distortion which is occurred regularly in the linguistic information processing. Finally, an illustrative example is given to illustrate the application of the proposed method and comparative analysis with the existing methods are offered to show the advantages of the proposed method.

  6. Teacher Educators' Design and Implementation of Group Learning Activities

    ERIC Educational Resources Information Center

    De Hei, Miranda S. A.; Sjoer, Ellen; Admiraal, Wilfried; Strijbos, Jan-Willem

    2016-01-01

    The aim of this study was to describe how teacher educators design and implement group learning activities (GLAs). We used the Group Learning Activities Instructional Design (GLAID) framework to analyse their descriptions. The GLAID framework includes eight components: (1) interaction, (2) learning objectives and outcomes, (3) assessment, (4) task…

  7. The Empowerment Dynamic: Planning and Implementing a Support Group Network.

    ERIC Educational Resources Information Center

    Stephens, Robin; Haley, Pat

    This handbook describes how to plan and implement a support group for disabled youth in transition from school to work. It was developed from the experiences of a 3-year model program entitled Employability Support Network of Disabled Youth (ESN) which used support groups to accomplish its primary goal of creating "employability readiness" for…

  8. Teacher Educators' Design and Implementation of Group Learning Activities

    ERIC Educational Resources Information Center

    De Hei, Miranda S. A.; Sjoer, Ellen; Admiraal, Wilfried; Strijbos, Jan-Willem

    2016-01-01

    The aim of this study was to describe how teacher educators design and implement group learning activities (GLAs). We used the Group Learning Activities Instructional Design (GLAID) framework to analyse their descriptions. The GLAID framework includes eight components: (1) interaction, (2) learning objectives and outcomes, (3) assessment, (4) task…

  9. Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015.

    PubMed

    Zagari, Rocco Maurizio; Romano, Marco; Ojetti, Veronica; Stockbrugger, Reinhold; Gullini, Sergio; Annibale, Bruno; Farinati, Fabio; Ierardi, Enzo; Maconi, Giovanni; Rugge, Massimo; Calabrese, Carlo; Di Mario, Francesco; Luzza, Francesco; Pretolani, Stefano; Savio, Antonella; Gasbarrini, Giovanni; Caselli, Michele

    2015-11-01

    Knowledge on the role of Helicobacter pylori (HP) infection is continually evolving, and treatment is becoming more challenging due to increasing bacterial resistance. Since the management of HP infection is changing, an update of the national Italian guidelines delivered in 2007 was needed. In the III Working Group Consensus Report 2015, a panel of 17 experts from several Italian regions reviewed current evidence on different topics relating to HP infection. Four working groups examined the following topics: (1) "open questions" on HP diagnosis and treatment (focusing on dyspepsia, gastro-oesophageal reflux disease, non-steroidal anti-inflammatory drugs or aspirin use and extra-gastric diseases); (2) non-invasive and invasive diagnostic tests; (3) treatment of HP infection; (4) role of HP in the prevention of gastric cancer. Statements and recommendations were discussed and a consensus reached in a final plenary session held in February 2015 in Bologna. Recommendations are based on the best current evidence to help physicians manage HP infection in Italy. The guidelines have been endorsed by the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy.

  10. Phenotyping animal models of diabetic neuropathy: a consensus statement of the diabetic neuropathy study group of the EASD (Neurodiab)

    PubMed Central

    Biessels, G.J.; Bril, V.; Calcutt, N.A.; Cameron, N.E.; Cotter, M.A.; Dobrowsky, R.; Feldman, E.L.; Fernyhough, P.; Jakobsen, J.; Malik, R.A.; Mizisin, A.P.; Oates, P.J.; Obrosova, I.G.; Pop-Busui, R.; Russell, J.W.; Sima, A.A.; Stevens, M.J.; Schmidt, R.E.; Tesfaye, S.; Veves, A.; Vinik, A.I.; Wright, D.E.; Yagihashi, S.; Yorek, M.A.; Ziegler, D.; Zochodne, D.W.

    2015-01-01

    NIDDK, JDRF, and the Diabetic Neuropathy Study Group of EASD sponsored a meeting to explore the current status of animal models of diabetic peripheral neuropathy. The goal of the workshop was to develop a set of consensus criteria for the phenotyping of rodent models of diabetic neuropathy. The discussion was divided into five areas: (1) status of commonly used rodent models of diabetes, (2) nerve structure, (3) electrophysiological assessments of nerve function, (4) behavioral assessments of nerve function, and (5) the role of biomarkers in disease phenotyping. Participants discussed the current understanding of each area, gold standards (if applicable) for assessments of function, improvements of existing techniques, and utility of known and exploratory biomarkers. The research opportunities in each area were outlined, providing a possible roadmap for future studies. The meeting concluded with a discussion on the merits and limitations of a unified approach to phenotyping rodent models of diabetic neuropathy and a consensus formed on the definition of the minimum criteria required for establishing the presence of the disease. A neuropathy phenotype in rodents was defined as the presence of statistically different values between diabetic and control animals in 2 of 3 assessments (nocifensive behavior, nerve conduction velocities, or nerve structure). The participants propose that this framework would allow different research groups to compare and share data, with an emphasis on data targeted toward the therapeutic efficacy of drug interventions. PMID:24934510

  11. [Therapeutic Residential Care for Children and Youth: A Consensus Statement of the International Work Group on Therapeutic Residential Care].

    PubMed

    Whittaker, James K; Holmes, Lisa; Del Valle, Jorge F; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erick; Lausten, Mette; Lyons, John; Martin, Eduardo; McDermid, Samantha; McNamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat

    2017-08-01

    Therapeutic Residential Care for Children and Youth: A Consensus Statement of the International Work Group on Therapeutic Residential Care. In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC was leading: “Therapeutic residential care involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support, and protection to children and youth with identified mental health or behavioral needs in partnership with their families and in collaboration with a full spectrum of community based formal and informal helping resources”. The meeting was characterised by exchange of information and evidence, and by preparing an international research agenda. In addition, the outlines of a consensus statement on TRC were discussed. This statement, originally published in English and now reproduced in a Spanish translation, comprises inter alia five basic principles of care that according to the Work Group on Therapeutic Residental Care should be guiding for residential youth care provided at any time.

  12. Phenotyping animal models of diabetic neuropathy: a consensus statement of the diabetic neuropathy study group of the EASD (Neurodiab).

    PubMed

    Biessels, G J; Bril, V; Calcutt, N A; Cameron, N E; Cotter, M A; Dobrowsky, R; Feldman, E L; Fernyhough, P; Jakobsen, J; Malik, R A; Mizisin, A P; Oates, P J; Obrosova, I G; Pop-Busui, R; Russell, J W; Sima, A A; Stevens, M J; Schmidt, R E; Tesfaye, S; Veves, A; Vinik, A I; Wright, D E; Yagihashi, S; Yorek, M A; Ziegler, D; Zochodne, D W

    2014-06-01

    NIDDK, JDRF, and the Diabetic Neuropathy Study Group of EASD sponsored a meeting to explore the current status of animal models of diabetic peripheral neuropathy. The goal of the workshop was to develop a set of consensus criteria for the phenotyping of rodent models of diabetic neuropathy. The discussion was divided into five areas: (1) status of commonly used rodent models of diabetes, (2) nerve structure, (3) electrophysiological assessments of nerve function, (4) behavioral assessments of nerve function, and (5) the role of biomarkers in disease phenotyping. Participants discussed the current understanding of each area, gold standards (if applicable) for assessments of function, improvements of existing techniques, and utility of known and exploratory biomarkers. The research opportunities in each area were outlined, providing a possible roadmap for future studies. The meeting concluded with a discussion on the merits and limitations of a unified approach to phenotyping rodent models of diabetic neuropathy and a consensus formed on the definition of the minimum criteria required for establishing the presence of the disease. A neuropathy phenotype in rodents was defined as the presence of statistically different values between diabetic and control animals in 2 of 3 assessments (nocifensive behavior, nerve conduction velocities, or nerve structure). The participants propose that this framework would allow different research groups to compare and share data, with an emphasis on data targeted toward the therapeutic efficacy of drug interventions.

  13. Consensus best practice pathway of the UK Systemic Sclerosis Study group: management of cardiac disease in systemic sclerosis.

    PubMed

    Bissell, Lesley-Anne; Anderson, Marina; Burgess, Malcolm; Chakravarty, Kuntal; Coghlan, Gerry; Dumitru, Raluca B; Graham, Lee; Ong, Voon; Pauling, John D; Plein, Sven; Schlosshan, Dominik; Woolfson, Peter; Buch, Maya H

    2017-06-01

    Cardiac disease in SSc can manifest in various ways and is associated with a poor prognosis. There is little evidence on how best to detect and manage cardiac disease in SSc. Our objective was to produce an expert consensus best practice pathway for the management of cardiac disease in SSc. The UK Systemic Sclerosis Study Group set up several working groups to develop a number of consensus best practice pathways for the management of SSc-specific complications, including cardiac disease. A multidisciplinary task force was convened. The guidelines were partly informed by a comprehensive literature review. A best practice pathway for cardiac disease (with a focus on primary cardiac disease) in SSc is presented, including approaches for early detection and standard pharmacological and device therapies. Due to the benefits, shared care and a multidisciplinary approach are recommended. A future research agenda has been formulated in response to the relative lack of understanding of the natural history of primary cardiac disease that was highlighted by the initiative. The physician should be alert to the possibility of cardiac disease in SSc; it is best managed within a multidisciplinary team including both rheumatologists and cardiologists. This pathway provides a reference for all physicians managing patients with SSc.

  14. Defining a roadmap for harmonizing quality indicators in Laboratory Medicine: a consensus statement on behalf of the IFCC Working Group "Laboratory Error and Patient Safety" and EFLM Task and Finish Group "Performance specifications for the extra-analytical phases".

    PubMed

    Sciacovelli, Laura; Panteghini, Mauro; Lippi, Giuseppe; Sumarac, Zorica; Cadamuro, Janne; Galoro, César Alex De Olivera; Pino Castro, Isabel Garcia Del; Shcolnik, Wilson; Plebani, Mario

    2017-08-28

    The improving quality of laboratory testing requires a deep understanding of the many vulnerable steps involved in the total examination process (TEP), along with the identification of a hierarchy of risks and challenges that need to be addressed. From this perspective, the Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) is focusing its activity on implementation of an efficient tool for obtaining meaningful information on the risk of errors developing throughout the TEP, and for establishing reliable information about error frequencies and their distribution. More recently, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has created the Task and Finish Group "Performance specifications for the extra-analytical phases" (TFG-PSEP) for defining performance specifications for extra-analytical phases. Both the IFCC and EFLM groups are working to provide laboratories with a system to evaluate their performances and recognize the critical aspects where improvement actions are needed. A Consensus Conference was organized in Padova, Italy, in 2016 in order to bring together all the experts and interested parties to achieve a consensus for effective harmonization of quality indicators (QIs). A general agreement was achieved and the main outcomes have been the release of a new version of model of quality indicators (MQI), the approval of a criterion for establishing performance specifications and the definition of the type of information that should be provided within the report to the clinical laboratories participating to the QIs project.

  15. Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View.

    PubMed

    Collins, Justin W; Patel, Hiten; Adding, Christofer; Annerstedt, Magnus; Dasgupta, Prokar; Khan, Shamim M; Artibani, Walter; Gaston, Richard; Piechaud, Thierry; Catto, James W; Koupparis, Anthony; Rowe, Edward; Perry, Matthew; Issa, Rami; McGrath, John; Kelly, John; Schumacher, Martin; Wijburg, Carl; Canda, Abdullah E; Balbay, Meviana D; Decaestecker, Karel; Schwentner, Christian; Stenzl, Arnulf; Edeling, Sebastian; Pokupić, Sasa; Stockle, Michael; Siemer, Stefan; Sanchez-Salas, Rafael; Cathelineau, Xavier; Weston, Robin; Johnson, Mark; D'Hondt, Fredrik; Mottrie, Alexander; Hosseini, Abolfazl; Wiklund, Peter N

    2016-10-01

    Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials. To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients. The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee. Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation. This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs. There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We

  16. How consensus standards are utilized and implemented in the United Kingdom

    SciTech Connect

    Bhanot, K.E.

    1996-12-31

    Within the United Kingdom, the Health and Safety Executive (HSE) regulates nuclear activities by issuing a nuclear site license to nuclear plant operators. The requirements laid out in the license are not prescriptive but rather stipulate objectives that the site operator must meet in order to satisfy the regulator. It is the responsibility of each licensee to develop and implement detailed arrangements to demonstrate compliance with its site license. As a consequence of this approach, the mechanics of compliance with the site license varies throughout the U.K. nuclear industry. It is therefore essential to have a means of discussing, defining, and disseminating {open_quotes}good practice{close_quotes} throughout the industry. The principal way that such discussion is achieved is through the Working Party on Criticality (WPC), the terms of reference of which include `a body for producing industrywide standards and guidance` and `a focal point for determining the U.K. input into international undertakings, e.g., standards of the American Nuclear Society and the International Organization for Standardization.` The latter is achieved by appointing individuals to various bodies, and the WPC is the means to distribute draft documents, discuss comments, and press for desirable changes. This enables both the regulator and industry to keep abreast of international developments.

  17. Gaps, conflicts, and consensus in the ethics statements of professional associations, medical groups, and health plans

    PubMed Central

    Berkman, N; Wynia, M; Churchill, L

    2004-01-01

    Background: Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines. Method: We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998–99 policies of 38 organisations—18 medical associations (associations), nine physician group practices (groups), and 12 health plans (plans)—selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item health care ethics taxonomy; a reconciled abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society. Results: A majority in all three groups mention "fiduciary obligations" of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians' obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations. Conclusions: With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery. PMID:15289536

  18. Spread of consensus in self-organized groups of individuals: Hydrodynamics matters

    NASA Astrophysics Data System (ADS)

    De Rosis, A.; Lévêque, E.; Ubertini, S.; Succi, S.

    2016-01-01

    Nature routinely presents us with spectacular demonstrations of organization and orchestrated motion in living species. Efficient information transfer among the individuals is known to be instrumental to the emergence of spatial patterns (e.g. V-shaped formations for birds or diamond-like shapes for fishes), responding to a specific functional goal such as predatory avoidance or energy savings. Such functional patterns materialize whenever individuals appoint one of them as a leader with the task of guiding the group towards a prescribed target destination. It is here shown that, under specific conditions, the surrounding hydrodynamics plays a critical role in shaping up a successful group dynamics to reach the desired target.

  19. Composition of a Vision Screen for Servicemembers With Traumatic Brain Injury: Consensus Using a Modified Nominal Group Technique

    PubMed Central

    Finkelstein, Marsha; Llanos, Imelda; Scheiman, Mitchell; Wagener, Sharon Gowdy

    2014-01-01

    Vision impairment is common in the first year after traumatic brain injury (TBI), including among service members whose brain injuries occurred during deployment in Iraq and Afghanistan. Occupational therapy practitioners provide routine vision screening to inform treatment planning and referral to vision specialists, but existing methods are lacking because many tests were developed for children and do not screen for vision dysfunction typical of TBI. An expert panel was charged with specifying the composition of a vision screening protocol for servicemembers with TBI. A modified nominal group technique fostered discussion and objective determinations of consensus. After considering 29 vision tests, the panel recommended a nine-test vision screening that examines functional performance, self-reported problems, far–near acuity, reading, accommodation, convergence, eye alignment and binocular vision, saccades, pursuits, and visual fields. Research is needed to develop reliable, valid, and clinically feasible vision screening protocols to identify TBI-related vision disorders in adults. PMID:25005505

  20. Pathology as the cornerstone of human tissue banking: European consensus expert group report.

    PubMed

    Hainaut, Pierre; Caboux, Elodie; Bevilacqua, Generoso; Bosman, Fref; Dassesse, Thibaut; Hoefler, Heinz; Janin, Anne; Langer, Rupert; Larsimont, Denis; Morente, Manuel; Riegman, Peter; Schirmacher, Peter; Stanta, Giorgio; Zatloukal, Kurt

    2009-09-01

    Aside from ethical considerations, the primary requirement for usage of human tissues in basic or translational research is the thorough characterization of tissues. The second, but equally essential, requirement is that tissues be collected, processed, annotated, and preserved in optimal conditions. These requirements put the pathologist at the center of tissue banking activities and of research aimed at discovering new biomarkers. Pathologists not only provide information identifying the specimen but also make decisions on what materials should be biobanked, on the preservation conditions, and on the timeline of events that precede preservation and storage. This central position calls for increased recognition of the role of the pathologist by the biomolecular community and places new demands on the pathologist's workload and scope of scientific activities. These questions were addressed by an Expert Group Meeting of the European Biological and Biomolecular Research Infrastructure (BBMRI). While detailed recommendations are published elsewhere (Bevilacqua et al., Virchows Archivs, 2010, in press), this article outlines the strategic and technological issues identified by the Expert Group and identifies ways forward for better integration of pathology in the current thrust for development of biomarker-based "personalized medicine."

  1. Minimal requirements in prostate cancer irradiation: a consensus document by the AIRO Lombardia Cooperative Group.

    PubMed

    Valdagni, R; Bertoni, F; Bossi, A; Caraffini, B; Corbella, F; Italia, C; Källi, M; Leoni, M; Nava, S; Sarti, E; Vavassori, V; Villa, S

    1999-01-01

    With the aim of establishing clinical and technical criteria to homogenize radiotherapy practice, a working group of AIRO-Lombardia (Associazione Italiana di Radioterapia Oncologica--Gruppo regionale della Lombardia) has tried to define minimal requirements for radical and postoperative irradiation in prostate cancer. The document has been structured in such a way as to be also of interest to the urological and medical oncology communities. The working group, composed of representatives of most of the regional radiotherapy departments in the Lombardy region, had monthly meetings during 1996 and 1997. The document on minimal requirements has been derived from the participants' combined experience and knowledge, from review of the literature, and from a 1995 regional survey on current practice of prostate irradiation. Minimal requirements for radical and postoperative irradiation of prostate cancer have been defined with respect to treatment strategies, pre-treatment diagnostic evaluation and staging, treatment prescription, preparation and execution, and quality assurance procedures. Standards of reference for minimal requirements in prostate cancer irradiation adapted to the regional structures and resources have been defined.

  2. Report: Stem cell applications in neurological practice, an expert group consensus appraisal

    PubMed Central

    Devi, M. Gourie; Sharma, Alka; Mohanty, Sujata; Jain, Neeraj; Verma, Kusum; Padma, M. Vasantha; Pal, Pramod; Chabbra, H. S.; Khadilkar, Satish; Prabhakar, Sudesh; Singh, Gagandeep

    2016-01-01

    Introduction: Neurologists in their clinical practice are faced with inquiries about the suitability of stem cell approaches by patients with a variety of acute and chronic (namely neurodegenerative) disorders. The challenge is to provide these patients with accurate information about the scope of stem cell use as well as at the same time, empowering patients with the capacity to make an autonomous decision regarding the use of stem cells. Methods: The Indian Academy of Neurology commissioned an Expert Group Meeting to formulate an advisory to practicing neurologists to counsel patients seeking information and advice about stem cell approaches. Results and Conclusions: In the course of such counselling, it should be emphasized that the information provided by many lay websites might be unsubstantiated. Besides, standard recommendations for the stem cell research, in particular, the application of several layers of oversight should be strictly adhered in order to ensure safety and ethical use of stem cells in neurological disorders. PMID:27570390

  3. Flexible implementations of group sequential stopping rules using constrained boundaries.

    PubMed

    Burington, Bart E; Emerson, Scott S

    2003-12-01

    Group sequential stopping rules are often used during the conduct of clinical trials in order to attain more ethical treatment of patients and to better address efficiency concerns. Because the use of such stopping rules materially affects the frequentist operating characteristics of the hypothesis test, it is necessary to choose an appropriate stopping rule during the planning of the study. It is often the case, however, that the number and timing of interim analyses are not precisely known at the time of trial design, and thus the implementation of a particular stopping rule must allow for flexible determination of the schedule of interim analyses. In this article, we consider the use of constrained stopping boundaries in the implementation of stopping rules. We compare this approach when used on various scales for the test statistic. When implemented on the scale of boundary crossing probabilities, this approach is identical to the error spending function approach of Lan and DeMets (1983).

  4. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia.

    PubMed

    Fielding, Roger A; Vellas, Bruno; Evans, William J; Bhasin, Shalender; Morley, John E; Newman, Anne B; Abellan van Kan, Gabor; Andrieu, Sandrine; Bauer, Juergen; Breuille, Denis; Cederholm, Tommy; Chandler, Julie; De Meynard, Capucine; Donini, Lorenzo; Harris, Tamara; Kannt, Aimo; Keime Guibert, Florence; Onder, Graziano; Papanicolaou, Dimitris; Rolland, Yves; Rooks, Daniel; Sieber, Cornel; Souhami, Elisabeth; Verlaan, Sjors; Zamboni, Mauro

    2011-05-01

    Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1 m/s(-1). Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m·s(-1) and an objectively measured low muscle mass (eg, appendicular mass relative to ht(2) that is ≤ 7.23 kg/m(2) in men and ≤ 5.67 kg/m(2) in women). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization, and death.

  5. Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. European Helicobacter Pylori Study Group.

    PubMed Central

    1997-01-01

    There is considerable confusion over the management of Helicobacter pylori infection, particularly among primary care physicians, and numerous European countries lack national guidelines in this rapidly growing area of medicine. The European Helicobacter Pylori Study Group therefore organised a meeting in Maastricht of H pylori experts, primary care physicians and representatives of National Societies of Gastroenterology from Europe to establish consensus guidelines on the management of H pylori at the primary care and specialist levels, and to consider general health care issues associated with the infection. As in previous guidelines, eradication therapy was recommended in all H pylori positive patients with peptic ulcer disease. Additionally, at the primary care level in dyspeptic patients < 45 years old and with no alarm symptoms, diagnosis is recommended by non-invasive means (13C urea breath test, serology) and if H pylori positive the patient should be treated. Moreover, at the specialist level the indications for eradication of H pylori were also broadened to include H pylori positive patients with functional dyspepsia in whom no other possible causes of symptoms are identified by the specialist (after a full investigation including endoscopy, ultrasound and other necessary investigations), patients with low grade gastric mucosa associated lymphoid tissue (MALT) lymphoma (managed in specialised centres) and those with gastritis with severe macro- or microscopic abnormalities. There was consensus that treatment regimens should be simple, well tolerated and achieve an eradication rate of over 80% on an intention to treat basis. It was strongly recommended, therefore, that eradication treatment should be with proton pump inhibitor based triple therapy for seven days, using a proton pump inhibitor and two of the following: clarithromycin, a nitroimidazole (metronidazole or tinidazole) and amoxycillin. PMID:9274464

  6. International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017).

    PubMed

    Younes, A; Hilden, P; Coiffier, B; Hagenbeek, A; Salles, G; Wilson, W; Seymour, J F; Kelly, K; Gribben, J; Pfreunschuh, M; Morschhauser, F; Schoder, H; Zelenetz, A D; Rademaker, J; Advani, R; Valente, N; Fortpied, C; Witzig, T E; Sehn, L H; Engert, A; Fisher, R I; Zinzani, P-L; Federico, M; Hutchings, M; Bollard, C; Trneny, M; Elsayed, Y A; Tobinai, K; Abramson, J S; Fowler, N; Goy, A; Smith, M; Ansell, S; Kuruvilla, J; Dreyling, M; Thieblemont, C; Little, R F; Aurer, I; Van Oers, M H J; Takeshita, K; Gopal, A; Rule, S; de Vos, S; Kloos, I; Kaminski, M S; Meignan, M; Schwartz, L H; Leonard, J P; Schuster, S J; Seshan, V E

    2017-04-03

    In recent years, the number of approved and investigational agents that can be safely administered for the treatment of lymphoma patients for a prolonged period of time has substantially increased. Many of these novel agents are evaluated in early-phase clinical trials in patients with a wide range of malignancies, including solid tumors and lymphoma. Furthermore, with the advances in genome sequencing, new "basket" clinical trial designs have emerged that select patients based on the presence of specific genetic alterations across different types of solid tumors and lymphoma. The standard response criteria currently in use for lymphoma are the Lugano Criteria which are based on 18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) or bidimensional tumor measurements on computerized tomography (CT) scans. These differ from the RECIST criteria used in solid tumors, which use unidimensional measurements. The RECIL group hypothesized that single dimension measurement could be used to assess response to therapy in lymphoma patients, producing results similar to the standard criteria. We tested this hypothesis by analyzing 47,828 imaging measurements from 2983 individual adult and pediatric lymphoma patients enrolled on 10 multicenter clinical trials, and developed new lymphoma response criteria (RECIL 2017). We demonstrate that assessment of tumor burden in lymphoma clinical trials can use the sum of longest diameters of a maximum of three target lesions. Furthermore, we introduced a new provisional category of a minor response. We also clarified response assessment in patients receiving novel immune therapy and targeted agents that generate unique imaging situations.

  7. Interprofessional Perspectives on ABCDE Bundle Implementation: A Focus Group Study.

    PubMed

    Boehm, Leanne M; Vasilevskis, Eduard E; Mion, Lorraine C

    The ABCDE bundle is a multifaceted, interprofessional intervention that is associated with reduced ventilator and delirium days as well as increased likelihood of mobility in intensive care. The aim of this study is to describe organizational domains that contribute to variation in ABCDE bundle implementation as reported by intensive care unit providers and to examine the capability of a conceptual framework for identifying variation in ABCDE bundle implementation. We conducted 2 separate focus groups that included nurses, respiratory therapists, occupational and physical therapists (N = 16) from the surgical and medical intensive care units at 1 academic medical center. All participants had experience performing ABCDE bundle activities. Variation in how the ABCDE bundle was interpreted and executed within and across disciplines was noted. Organizational facets, the physical environment, labor quantity and quality, task burden, provider attitudes, and patient characteristics were noted to influence ABCDE bundle execution. The difficulty coordinating and implementing early mobility was emphasized. The number of disciplines required to perform an activity and individual component complexity was reported to influence ABCDE bundle implementation. Nurses repeatedly described challenges with coordinating care across disciplines. Small tests of change, adequate staffing, interprofessional training and protocol development efforts, and role modeling may be effective methods for successful ABCDE bundle implementation.

  8. Assessing the Utility of the Nominal Group Technique as a Consensus-Building Tool in Extension-Led Avian Influenza Response Planning

    ERIC Educational Resources Information Center

    Kline, Terence R.

    2013-01-01

    The intent of the project described was to apply the Nominal Group Technique (NGT) to achieve a consensus on Avian Influenza (AI) planning in Northeastern Ohio. Nominal Group Technique is a process first developed by Delbecq, Vande Ven, and Gustafsen (1975) to allow all participants to have an equal say in an open forum setting. A very diverse…

  9. Assessing the Utility of the Nominal Group Technique as a Consensus-Building Tool in Extension-Led Avian Influenza Response Planning

    ERIC Educational Resources Information Center

    Kline, Terence R.

    2013-01-01

    The intent of the project described was to apply the Nominal Group Technique (NGT) to achieve a consensus on Avian Influenza (AI) planning in Northeastern Ohio. Nominal Group Technique is a process first developed by Delbecq, Vande Ven, and Gustafsen (1975) to allow all participants to have an equal say in an open forum setting. A very diverse…

  10. Design and Implementation of a Group Membership Protocol

    DTIC Science & Technology

    1992-09-01

    AD’-A257 442 NAVAL POSTfGRADUATE SCHOOL 09 Monterey, California DTICJ~SELECTE f NOV23 199213 A ’ THESIS DESIGN AND IMPLEMENTATION OF A GROUP...MEMBERSHIP PROTOCOL by DEVALLA RAGHURAM September, 1992 Thesis Advisor: Shridhar B. Shukia Second Reader: Douglas J. Fouts Approved for public release...Year. Month, Day) 15. PAGE COUNT Master’s Thesis FROM 09/90 TO 09/92 . September 1992 127 16. SUPPLEMENTARY NOTATION The views expressed in this

  11. Obtaining consensus about patient-centred professionalism in community nursing: nominal group work activity with professionals and the public.

    PubMed

    Hutchings, Hayley; Rapport, Frances; Wright, Sarah; Doel, Marcus; Jones, Aled

    2012-11-01

      To report on the development of a ranked thematic list encompassing the positive and challenging exemplars of patient-centred professionalism in community nursing.   There has been little research exploring what 'patient-centred professionalism' means to those working within the healthcare settings. Consensus methods, such as those developed through Nominal Group Work, can help establish the extent of agreement on a particular issue whilst overcoming some of the problems associated with group decision-making.   Mixed methods studying through consultation workshops.   The study took place in South-west Wales, UK between October 2009-September 2010. Thirty-four participants consisting of community nurses (9), newly qualifying nurses (13), nursing stakeholders (6) and members of the public (6) took part in the study. An adapted Nominal Group Work approach was used in five individual consultation workshops: two with community nurses, one with newly qualifying nurses, one with stakeholders and one with members of the public followed by a mixed-group Forum event.   Each of the five workshops resulted in the production of approximately ten positive and ten challenging exemplars of patient-centred professionalism. The thematization of these exemplars allowed the development of eight broad themes. The Forum event then provided a mechanism for ranking the importance of these themes. The patient, community nurse as a person and nursing ethos were ranked as the most important themes by study participants.   The adapted Nominal Group Work approach was a useful method to allow the development of a ranked thematic list that illustrated the important positive and challenging exemplars of patient-centred professionalism in community nursing. © 2012 Blackwell Publishing Ltd.

  12. Standard operating procedures for serum and plasma collection: early detection research network consensus statement standard operating procedure integration working group.

    PubMed

    Tuck, Melissa K; Chan, Daniel W; Chia, David; Godwin, Andrew K; Grizzle, William E; Krueger, Karl E; Rom, William; Sanda, Martin; Sorbara, Lynn; Stass, Sanford; Wang, Wendy; Brenner, Dean E

    2009-01-01

    Specimen collection is an integral component of clinical research. Specimens from subjects with various stages of cancers or other conditions, as well as those without disease, are critical tools in the hunt for biomarkers, predictors, or tests that will detect serious diseases earlier or more readily than currently possible. Analytic methodologies evolve quickly. Access to high-quality specimens, collected and handled in standardized ways that minimize potential bias or confounding factors, is key to the "bench to bedside" aim of translational research. It is essential that standard operating procedures, "the how" of creating the repositories, be defined prospectively when designing clinical trials. Small differences in the processing or handling of a specimen can have dramatic effects in analytical reliability and reproducibility, especially when multiplex methods are used. A representative working group, Standard Operating Procedures Internal Working Group (SOPIWG), comprised of members from across Early Detection Research Network (EDRN) was formed to develop standard operating procedures (SOPs) for various types of specimens collected and managed for our biomarker discovery and validation work. This report presents our consensus on SOPs for the collection, processing, handling, and storage of serum and plasma for biomarker discovery and validation.

  13. Planning and Performance in Small Groups: Collective Implementation Intentions Enhance Group Goal Striving

    PubMed Central

    Thürmer, J. Lukas; Wieber, Frank; Gollwitzer, Peter M.

    2017-01-01

    There are two key motivators to perform well in a group: making a contribution that (a) is crucial for the group (indispensability) and that (b) the other group members recognize (identifiability). We argue that indispensability promotes setting collective (“We”) goals whereas identifiability induces individual (“I”) goals. Although both goals may enhance performance, they should align with different strategies. Whereas pursuing collective goals should involve more cooperation, pursuing individual goals should involve less cooperation. Two experiments support this reasoning and show that planning out collective goals with collective implementation intentions (cIIs or “We-plans”) relies on cooperation but planning out individual goals with individual implementation intentions (IIs or “I-plans”) does not. In Experiment 1, three-member groups first formed a collective or an individual goal and then performed a first round of a physical persistence task. Groups then either formed a respective implementation intention (cII or II) or a control plan and then performed a second round of the task. Although groups with cIIs and IIs performed better on a physical persistence task than respective control groups, only cII groups interacted more cooperatively during task performance. To confirm the causal role of these interaction processes, Experiment 2 used the same persistence task and manipulated whether groups could communicate: When communication was hindered, groups with cIIs but not groups with IIs performed worse. Communication thus qualifies as a process making cIIs effective. The present research offers a psychology of action account to small group performance. PMID:28469592

  14. Lignes directrices pour le suivi des cardiostimulateurs au canada : consensus du groupe de travail canadien sur la cardiostimulation

    PubMed

    D Fraser JD; M Gillis AM; Irwin; Nishimura; Tyers; Philippon

    2000-03-01

    Un sondage sur les pratiques de cardiostimulation au Canada effectue en 1997 a revele un profond desir pour des lignes directrices nationales sur le suivi des cardiostimulateurs. Ces lignes directrices sur le suivi des cardiostimulateurs representent une declaration de consensus du Groupe de travail canadien sur la cardiostimulation. Le suivi des patients en personne plutot que par moyens transtelephoniques est preferable. Les patients devraient etre examines au minimum dans les 72 heures suivant l'implantation, 2 a 12 semaines et 6 mois apres l'implantation, et annuellement par la suite. Des examens plus frequents peuvent etre requis pour certains patients. Ceci dependra des problemes cardiovasculaires associes et des appareils en particulier. Une visite de suivi typique devrait comprendre un examen cardiovasculaire oriente, l'interrogation du systeme de cardiostimulation et une revue des donnees de telemetrie, un examen du rythme sous-jacent, un examen des seuils de stimulation et de detection et une reprogrammation adequate des parametres pour optimaliser le fonctionnement et la longevite de l'appareil.

  15. Myeloproliferative neoplasms working group consensus recommendations for diagnosis and management of primary myelofibrosis, polycythemia vera, and essential thrombocythemia

    PubMed Central

    Agarwal, M. B.; Malhotra, Hemant; Chakrabarti, Prantar; Varma, Neelam; Mathews, Vikram; Bhattacharyya, Jina; Seth, Tulika; Gayathri, K.; Menon, Hari; Subramanian, P. G.; Sharma, Ajay; Bhattacharyya, Maitreyee; Mehta, Jay; Vaid, A. K.; Shah, Sandeep; Aggarwal, Shyam; Gogoi, P. K.; Nair, Reena; Agarwal, Usha; Varma, Subhash; Prasad, S. V. S. S.; Manipadam, Marie Therese

    2015-01-01

    According to the 2008 revision of the World Health Organization (WHO) classification of myeloid malignancies, philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) include clonal, hematologic disorders such as polycythemia vera, primary myelofibrosis, and essential thrombocythemia.Recent years have witnessed major advances in the understanding of the molecular pathophysiology of these rare subgroups of chronic, myeloproliferative disorders. Identification of somatic mutations in genes associated with pathogenesis and evolution of these myeloproliferative conditions (Janus Kinase 2; myeloproliferative leukemia virus gene; calreticulin) led to substantial changes in the international guidelines for diagnosis and treatment of Ph-negative MPN during the last few years.The MPN-Working Group (MPN-WG), a panel of hematologists with expertise in MPN diagnosis and treatment from various parts of India, examined applicability of this latest clinical and scientific evidence in the context of hematology practice in India.This manuscript summarizes the consensus recommendations formulated by the MPN-WG that can be followed as a guideline for management of patients with Ph-negative MPN in the context of clinical practice in India. PMID:25810569

  16. Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom.

    PubMed

    Sharrock, A E; Gokani, V J; Harries, R L; Pearce, L; Smith, S R; Ali, O; Chu, H; Dubois, A; Ferguson, H; Humm, G; Marsden, M; Nepogodiev, D; Venn, M; Singh, S; Swain, C; Kirkby-Bott, J

    2015-01-01

    The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

  17. Intrathecal Baclofen therapy in Germany: Proceedings of the IAB-Interdisciplinary Working Group for Movement Disorders Consensus Meeting.

    PubMed

    Dressler, D; Berweck, S; Chatzikalfas, A; Ebke, M; Frank, B; Hesse, S; Huber, M; Krauss, J K; Mücke, K-H; Nolte, A; Oelmann, H-D; Schönle, P W; Schmutzler, M; Pickenbrock, H; Van der Ven, C; Veelken, N; Vogel, M; Vogt, T; Saberi, F Adib

    2015-11-01

    Continuous intrathecal Baclofen application (ITB) through an intracorporeal pump system is widely used in adults and children with spasticity of spinal and supraspinal origin. Currently, about 1200 new ITB pump systems are implanted in Germany each year. ITB is based on an interdisciplinary approach with neurologists, rehabilitation specialists, paediatricians and neurosurgeons. We are presenting the proceedings of a consensus meeting organised by IAB-Interdisciplinary Working Group for Movement Disorders. The ITB pump system consists of the implantable pump with its drug reservoir, the refill port, an additional side port and a flexible catheter. Non-programmable pumps drive the Baclofen flow by the reservoir pressure. Programmable pumps additionally contain a radiofrequency control unit, an electrical pump and a battery. They have major advantages during the dose-finding phase. ITB doses vary widely between 10 and 2000 μg/day. For spinal spasticity, they are typically in the order of 100-300 μg/day. Hereditary spastic paraplegia seems to require particularly low doses, while dystonia and brain injury require particularly high ones. Best effects are documented for tonic paraspasticity of spinal origin and the least effects for phasic muscle hyperactivity disorders of supraspinal origin. Oral antispastics are mainly effective in mild spasticity. Botulinum toxin is most effective in focal spasticity. Myotomies and denervation operations are restricted to selected cases of focal spasticity. Due to its wide-spread distribution within the cerebrospinal fluid, ITB can tackle wide-spread and severe spasticity.

  18. Composition of a vision screen for servicemembers with traumatic brain injury: consensus using a modified nominal group technique.

    PubMed

    Radomski, Mary Vining; Finkelstein, Marsha; Llanos, Imelda; Scheiman, Mitchell; Wagener, Sharon Gowdy

    2014-01-01

    Vision impairment is common in the first year after traumatic brain injury (TBI), including among service members whose brain injuries occurred during deployment in Iraq and Afghanistan. Occupational therapy practitioners provide routine vision screening to inform treatment planning and referral to vision specialists, but existing methods are lacking because many tests were developed for children and do not screen for vision dysfunction typical of TBI. An expert panel was charged with specifying the composition of a vision screening protocol for servicemembers with TBI. A modified nominal group technique fostered discussion and objective determinations of consensus. After considering 29 vision tests, the panel recommended a nine-test vision screening that examines functional performance, self-reported problems, far-near acuity, reading, accommodation, convergence, eye alignment and binocular vision, saccades, pursuits, and visual fields. Research is needed to develop reliable, valid, and clinically feasible vision screening protocols to identify TBI-related vision disorders in adults. Copyright © 2014 by the American Occupational Therapy Association, Inc.

  19. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG).

    PubMed

    Schmoll, H J; Souchon, R; Krege, S; Albers, P; Beyer, J; Kollmannsberger, C; Fossa, S D; Skakkebaek, N E; de Wit, R; Fizazi, K; Droz, J P; Pizzocaro, G; Daugaard, G; de Mulder, P H M; Horwich, A; Oliver, T; Huddart, R; Rosti, G; Paz Ares, L; Pont, O; Hartmann, J T; Aass, N; Algaba, F; Bamberg, M; Bodrogi, I; Bokemeyer, C; Classen, J; Clemm, S; Culine, S; de Wit, M; Derigs, H G; Dieckmann, K P; Flasshove, M; Garcia del Muro, X; Gerl, A; Germa-Lluch, J R; Hartmann, M; Heidenreich, A; Hoeltl, W; Joffe, J; Jones, W; Kaiser, G; Klepp, O; Kliesch, S; Kisbenedek, L; Koehrmann, K U; Kuczyk, M; Laguna, M P; Leiva, O; Loy, V; Mason, M D; Mead, G M; Mueller, R P; Nicolai, N; Oosterhof, G O N; Pottek, T; Rick, O; Schmidberger, H; Sedlmayer, F; Siegert, W; Studer, U; Tjulandin, S; von der Maase, H; Walz, P; Weinknecht, S; Weissbach, L; Winter, E; Wittekind, C

    2004-09-01

    Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception.

  20. Preventing the Complications Associated with the Use of Dermal Fillers in Facial Aesthetic Procedures: An Expert Group Consensus Report.

    PubMed

    Urdiales-Gálvez, Fernando; Delgado, Nuria Escoda; Figueiredo, Vitor; Lajo-Plaza, José V; Mira, Mar; Ortíz-Martí, Francisco; Del Rio-Reyes, Rosa; Romero-Álvarez, Nazaret; Del Cueto, Sofía Ruiz; Segurado, María A; Rebenaque, Cristina Villanueva

    2017-06-01

    The use of dermal fillers in minimally invasive facial aesthetic procedures has become increasingly popular of late, yet as the indications and the number of procedures performed increase, the number of complications is also likely to increase. Paying special attention to specific patient characteristics and to the technique used can do much to avoid these complications. Indeed, a well-trained physician can also minimize the impact of such problems when they do occur. A multidisciplinary group of experts in aesthetic treatments reviewed the main factors associated with the complications that arise when using dermal fillers. A search of English, French and Spanish language articles in PubMed was performed using the terms "complications" OR "soft filler complications" OR "injectable complications" AND "dermal fillers". An initial document was drafted that reflected the complications identified and recommendations as to how they should be handled. This document was then reviewed and modified by the expert panel, until a final text was agreed upon and validated. The panel addressed consensus recommendations about the preparation, the procedure and the post-procedural care. The panel considered it crucial to obtain an accurate medical history to prevent potential complications. An additional clinical assessment, including standardized photography, is also crucial to evaluate the outcomes and prevent potential complications. Furthermore, the state of the operating theatre, the patient's health status and the preparation of the skin are critical to prevent superficial soft tissue infections. Finally, selecting the appropriate technique, based on the physician's experience, as well as the characteristics of the patient and filler, helps to ensure successful outcomes and limits the complications. This consensus document provides key elements to help clinicians who are starting to use dermal fillers to employ standard procedures and to understand how best to prevent

  1. Standardized reporting of bleeding complications for clinical investigations in acute coronary syndromes: a proposal from the academic bleeding consensus (ABC) multidisciplinary working group.

    PubMed

    Rao, Sunil V; Eikelboom, John; Steg, Ph Gabriel; Lincoff, A Michael; Weintraub, William S; Bassand, Jean-Pierre; Rao, A Koneti; Gibson, C Michael; Petersen, John L; Mehran, Roxana; Manoukian, Steven V; Charnigo, Richard; Lee, Kerry L; Moscucci, Mauro; Harrington, Robert A

    2009-12-01

    Clinical trials of antithrombotic agents for the treatment of ACS routinely assess bleeding as a safety endpoint, but variation in bleeding definitions makes comparison of the relative safety of these agents difficult. The ABC Multidisciplinary Working Group, an informal working group comprising clinical researchers and representatives from the US Food and Drug Administration, the National Institutes of Health, and the pharmaceutical industry, sought to develop a consensus approach to measuring the incidence and severity of bleeding complications during clinical trials of acute coronary syndromes (ACS). A meeting of the ABC was convened in April 2008 in Washington, DC, with the goal of developing a consensus approach to measuring the incidence and severity of hemorrhagic complications during clinical trials of ACS. Relevant literature on bleeding was reviewed through a series of short lectures and intensive group discussion. Using existing evidence on bleeding and outcomes as well as clinical judgment, criteria for the assessment of bleeding were developed through expert consensus. This consensus statement divides bleeding-related data elements into three categories: essential, recommended, and optional. The ABC Group recommendations for collection and reporting of bleeding complications provide a framework for consistency in the collection of information on hemorrhagic complications in trials of ACS. Widespread adoption of the statement recommendations will facilitate understanding of the mechanisms of adverse outcomes after bleeding and comparisons of the relative safety of antithrombotic agents, as well as the interpretation of safety results from future studies.

  2. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People.

    PubMed

    Cruz-Jentoft, Alfonso J; Baeyens, Jean Pierre; Bauer, Jürgen M; Boirie, Yves; Cederholm, Tommy; Landi, Francesco; Martin, Finbarr C; Michel, Jean-Pierre; Rolland, Yves; Schneider, Stéphane M; Topinková, Eva; Vandewoude, Maurits; Zamboni, Mauro

    2010-07-01

    The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

  3. Consensus recommendations for common data elements for operational stress research and surveillance: report of a federal interagency working group.

    PubMed

    Nash, William P; Vasterling, Jennifer; Ewing-Cobbs, Linda; Horn, Sarah; Gaskin, Thomas; Golden, John; Riley, William T; Bowles, Stephen V; Favret, James; Lester, Patricia; Koffman, Robert; Farnsworth, Laura C; Baker, Dewleen G

    2010-11-01

    Empirical studies and surveillance projects increasingly assess and address potentially adverse psychological health outcomes from the stress of military operations, but no standards yet exist for common concept definitions, variable categories, and measures. This article reports the consensus recommendations of the federal interagency Operational Stress Working Group for common data elements to be used in future operational stress research and surveillance with the goal of improving comparability across studies. Operational stress encompasses more than just combat; it occurs everywhere service members and their families live and work. Posttraumatic stress is not the only adverse mental or behavioral health outcome of importance. The Operational Stress Working Group contends that a primary goal of operational stress research and surveillance is to promote prevention of adverse mental and behavioral outcomes, especially by recognizing the preclinical and subclinical states of distress and dysfunction that portend a risk for failure of role performance or future mental disorders. Recommendations for data elements are divided into 3 tiers: core, supplemental, and emerging, including variable domains and specific measures for assessing operational stressor exposures, stress outcomes, moderating factors, and mediating processes. Attention is drawn to the emerging construct of stress injury as a generic term for subclinical operational stress, and to emerging data elements addressing biological, psychological, and spiritual mediators of risk. Methodologies are needed for identifying preclinical and subclinical states of distress or dysfunction that are markers of risk for failure of role performance and future clinical mental disorders, so that targeted prevention interventions can be developed and evaluated. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling.

    PubMed

    Samaratunga, Hemamali; Montironi, Rodolfo; True, Lawrence; Epstein, Jonathan I; Griffiths, David F; Humphrey, Peter A; van der Kwast, Theo; Wheeler, Thomas M; Srigley, John R; Delahunt, Brett; Egevad, Lars

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the handling and processing of radical prostatectomy specimens were coordinated by working group 1. Most uropathologists followed similar procedures for fixation of radical prostatectomy specimens, with 51% of respondents transporting tissue in formalin. There was also consensus that the prostate weight without the seminal vesicles should be recorded. There was consensus that the surface of the prostate should be painted. It was agreed that both the prostate apex and base should be examined by the cone method with sagittal sectioning of the tissue sample. There was consensus that the gland should be fully fixed before sectioning. Both partial and complete embedding of prostates was considered to be acceptable as long as the method of partial embedding is stated. No consensus was determined regarding the necessity of weighing and measuring the length of the seminal vesicles, the preparation of whole mounts rather than standardized blocks and the methodology for sampling of fresh tissue for research purposes, and it was agreed that these should be left to the discretion of the working pathologist.

  5. Implementation intention and planning interventions in Health Psychology: Recommendations from the Synergy Expert Group for research and practice.

    PubMed

    Hagger, Martin S; Luszczynska, Aleksandra; de Wit, John; Benyamini, Yael; Burkert, Silke; Chamberland, Pier-Eric; Chater, Angel; Dombrowski, Stephan U; van Dongen, Anne; French, David P; Gauchet, Aurelie; Hankonen, Nelli; Karekla, Maria; Kinney, Anita Y; Kwasnicka, Dominika; Hing Lo, Siu; López-Roig, Sofía; Meslot, Carine; Marques, Marta Moreira; Neter, Efrat; Plass, Anne Marie; Potthoff, Sebastian; Rennie, Laura; Scholz, Urte; Stadler, Gertraud; Stolte, Elske; Ten Hoor, Gill; Verhoeven, Aukje; Wagner, Monika; Oettingen, Gabriele; Sheeran, Paschal; Gollwitzer, Peter M

    2016-07-01

    The current article details a position statement and recommendations for future research and practice on planning and implementation intentions in health contexts endorsed by the Synergy Expert Group. The group comprised world-leading researchers in health and social psychology and behavioural medicine who convened to discuss priority issues in planning interventions in health contexts and develop a set of recommendations for future research and practice. The expert group adopted a nominal groups approach and voting system to elicit and structure priority issues in planning interventions and implementation intentions research. Forty-two priority issues identified in initial discussions were further condensed to 18 key issues, including definitions of planning and implementation intentions and 17 priority research areas. Each issue was subjected to voting for consensus among group members and formed the basis of the position statement and recommendations. Specifically, the expert group endorsed statements and recommendations in the following areas: generic definition of planning and specific definition of implementation intentions, recommendations for better testing of mechanisms, guidance on testing the effects of moderators of planning interventions, recommendations on the social aspects of planning interventions, identification of the preconditions that moderate effectiveness of planning interventions and recommendations for research on how people use plans.

  6. Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis.

    PubMed

    Iwashyna, Theodore J; Odden, Andrew; Rohde, Jeffrey; Bonham, Catherine; Kuhn, Latoya; Malani, Preeti; Chen, Lena; Flanders, Scott

    2014-06-01

    Severe sepsis is a common and costly problem. Although consistently defined clinically by consensus conference since 1991, there have been several different implementations of the severe sepsis definition using ICD-9-CM codes for research. We conducted a single center, patient-level validation of 1 common implementation of the severe sepsis definition, the so-called "Angus" implementation. Administrative claims for all hospitalizations for patients initially admitted to general medical services from an academic medical center in 2009-2010 were reviewed. On the basis of ICD-9-CM codes, hospitalizations were sampled for review by 3 internal medicine-trained hospitalists. Chart reviews were conducted with a structured instrument, and the gold standard was the hospitalists' summary clinical judgment on whether the patient had severe sepsis. Three thousand one hundred forty-six (13.5%) hospitalizations met ICD-9-CM criteria for severe sepsis by the Angus implementation (Angus-positive) and 20,142 (86.5%) were Angus-negative. Chart reviews were performed for 92 randomly selected Angus-positive and 19 randomly-selected Angus-negative hospitalizations. Reviewers had a κ of 0.70. The Angus implementation's positive predictive value was 70.7% [95% confidence interval (CI): 51.2%, 90.5%]. The negative predictive value was 91.5% (95% CI: 79.0%, 100%). The sensitivity was 50.4% (95% CI: 14.8%, 85.7%). Specificity was 96.3% (95% CI: 92.4%, 100%). Two alternative ICD-9-CM implementations had high positive predictive values but sensitivities of <20%. The Angus implementation of the international consensus conference definition of severe sepsis offers a reasonable but imperfect approach to identifying patients with severe sepsis when compared with a gold standard of structured review of the medical chart by trained hospitalists.

  7. [Nutritional status assessment in Geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology NutritionWork Group].

    PubMed

    Camina-Martín, María Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, José Antonio; Redondo-Del-Río, María Paz

    2016-01-01

    Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. Copyright © 2015 SEGG. Published by Elsevier

  8. Nutritional status assessment in geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology Nutrition Work Group.

    PubMed

    Camina-Martín, M Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, J Antonio; Redondo-del-Río, M Paz

    2015-07-01

    Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, because elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología, SEGG) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories seeks to aid in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment associated to laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is to further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics.

  9. Design and implementation of a mechanically heterogeneous robot group

    NASA Astrophysics Data System (ADS)

    Sukhatme, Gaurav S.; Montgomery, James F.; Mataric, Maja J.

    1999-08-01

    This paper describes the design and construction of a cooperative, heterogeneous robot group comprised of one semi-autonomous aerial robot and two autonomous ground robots. The robots are designed to perform automated surveillance and reconnaissance of an urban outdoor area using onboard sensing. The ground vehicles have GPS, sonar for obstacle detection and avoidance, and a simple color- based vision system. Navigation is performed using an optimal mixture of odometry and GPS. The helicopter is equipped with a GPS/INS system, a camera, and a framegrabber. Each robot has an embedded 486 PC/104 processor running the QNX real-time operating system. Individual robot controllers are behavior-based and decentralized. We describe a control strategy and architecture that coordinates the robots with minimal top- down planning. The overall system is controlled at high level by a single human operator using a specially designed control unit. The operator is able to task the group with a mission using a minimal amount of training. The group can re-task itself based on sensor inputs and can also be re- tasked by the operator. We describe a particular reconnaissance mission that the robots have been tested with, and lessons learned during the design and implementation. Our initial results with these experiments are encouraging given the challenging mechanics of the aerial robot. We conclude the paper with a discussion of ongoing and future work.

  10. Patient resources in the therapeutic education of haemophiliacs in France: their skills and roles as defined by consensus of a working group.

    PubMed

    Wintz, L; Sannié, T; Ayçaguer, S; Guerois, C; Bernhard, J-P; Valluet, D; Borel-Derlon, A; Guillon, P; Fondanesche, C; Lambert, T; Meunier, S; Alliaume, N; Gagnayre, R

    2010-05-01

    The activities of 'expert patients' or 'patient tutors', who help educate their peers, are gaining recognition in the health care system. This study investigates the role played by such patients in therapeutic education programmes organized by caregivers to validate the role of patients in implementing the therapeutic education of haemophilic patients and to define the skills required for such activities. This study employs the consensus methodology recommended by France's National Authority for Health. The working group includes seven caregivers from Hemophiliac Treatment Centers (HTCs) and three patients from the French Association of Hemophiliacs (FAH). The role of patients in haemophilia education is recognized. Patients participating in the education of their peers are referred to as 'patient resources'. A patient resource should be an adult, a volunteer and live in the same region as his peers. Candidates are chosen by the FAH and the HTCs to serve based on their motivation to facilitate the education of other patients as well as on their psychological and pedagogical aptitudes. A patient resource participates in the conception and administration of therapeutic education programmes. He also mediates between the caregivers and the patients. He ensures that the patients understand the material and are able to apply their knowledge in daily life. His activities are governed by professional ethics. Seven categories of skills were defined, permitting the group to determine precisely which skills are required to function as a patient resource. Supervision of the patients is planned to reinforce reflexive practices in the patients. Evolution of the health care system has led patients to become involved in therapeutic education. This phenomenon calls for a framework to be developed and an evaluation of its eventual effects.

  11. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group.

    PubMed

    Kolte, A M; Bernardi, L A; Christiansen, O B; Quenby, S; Farquharson, R G; Goddijn, M; Stephenson, M D

    2015-03-01

    Pregnancy loss prior to viability is common and research in the field is extensive. Unfortunately, terminology in the literature is inconsistent. The lack of consensus regarding nomenclature and classification of pregnancy loss prior to viability makes it difficult to compare study results from different centres. In our opinion, terminology and definitions should be based on clinical findings, and when possible, transvaginal ultrasound. With this Early Pregnancy Consensus Statement, it is our goal to provide clear and consistent terminology for pregnancy loss prior to viability.

  12. Development and implementation of a balanced scorecard in an academic hospitalist group.

    PubMed

    Hwa, Michael; Sharpe, Bradley A; Wachter, Robert M

    2013-03-01

    Academic hospitalist groups (AHGs) are often expected to excel in multiple domains: quality improvement, patient safety, education, research, administration, and clinical care. To be successful, AHGs must develop strategies to balance their energies, resources, and performance. The balanced scorecard (BSC) is a strategic management system that enables organizations to translate their mission and vision into specific objectives and metrics across multiple domains. To date, no hospitalist group has reported on BSC implementation. We set out to develop a BSC as part of a strategic planning initiative. Based on a needs assessment of the University of California, San Francisco, Division of Hospital Medicine, mission and vision statements were developed. We engaged representative faculty to develop strategic objectives and determine performance metrics across 4 BSC perspectives. There were 41 metrics identified, and 16 were chosen for the initial BSC. It allowed us to achieve several goals: 1) present a broad view of performance, 2) create transparency and accountability, 3) communicate goals and engage faculty, and 4) ensure we use data to guide strategic decisions. Several lessons were learned, including the need to build faculty consensus, establish metrics with reliable measureable data, and the power of the BSC to drive goals across the division. We successfully developed and implemented a BSC in an AHG as part of a strategic planning initiative. The BSC has been instrumental in allowing us to achieve balanced success in multiple domains. Academic groups should consider employing the BSC as it allows for a data-driven strategic planning and assessment process. Copyright © 2013 Society of Hospital Medicine.

  13. Consensus document on the evaluation and treatment of moderate-to-severe psoriasis: Psoriasis Group of the Spanish Academy of Dermatology and Venereology.

    PubMed

    Daudén, E; Puig, L; Ferrándiz, C; Sánchez-Carazo, J L; Hernanz-Hermosa, J M

    2016-03-01

    Psoriasis is a highly prevalent disease with a major impact on quality of life; therefore, appropriate patient management is mandatory. Given that many issues in psoriasis are controversial and not clearly defined by evidence-based medicine, management of psoriasis is very variable. Expert consensus can generate practical guidelines for optimization of patient care. Much has changed since 2009, when the Consensus Document on the Evaluation and Treatment of Moderate to Severe Psoriasis was published by the Spanish Psoriasis Group (GEP) of the Spanish Academy of Dermatology and Venereology (AEDV). The objective of the present consensus document is to provide the dermatologist with updated recommendations for the evaluation and treatment of patients with moderate-to-severe plaque psoriasis. All active members of the GEP of the AEDV were invited to participate in the survey. The final group comprised 46 members from various areas of Spain and with substantial experience in managing psoriasis. A 3-round Delphi process was used to reach consensus. Consistent agreement and consistent disagreement (consensus) required the achievement of at least two of the following three criteria: Criterion 1, which was based on the position occupied by the mean on a scale of 1-9 and an SD <2; Criterion 2, which was based on the median and interquartile range (IQR) on a scale of 1-9; Criterion 3, which considered the percentage of the voting experts on a scale of 1-9. The items studied were definition of severity, therapeutic objectives, indications for systemic treatment and biologic therapy, induction and maintenance periods, therapeutic failure, loss of response, relapse and rebound, continuous and intermittent therapy, screening of patients before treatment, adherence to therapy, follow-up of treatment outcome, combination of drugs, transitioning and associated comorbidities. Consistent agreement or disagreement (consensus) was achieved for 198 items (agreement, 3 criteria 146 items

  14. Interobserver Variability in Target Definition for Hepatocellular Carcinoma With and Without Portal Vein Thrombus: Radiation Therapy Oncology Group Consensus Guidelines

    SciTech Connect

    Hong, Theodore S.; Bosch, Walter R.; Krishnan, Sunil; Kim, Tae K.; Mamon, Harvey J.; Ben-Josef, Edgar; Seong, Jinsil; Haddock, Michael G.; Cheng, Jason C.; Feng, Mary U.; Stephans, Kevin L.; Roberge, David; and others

    2014-07-15

    Purpose: Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Methods and Materials: Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. Results: Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). Conclusions: In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning

  15. Dose calculation formalisms and consensus dosimetry parameters for intravascular brachytherapy dosimetry: Recommendations of the AAPM Therapy Physics Committee Task Group No. 149

    SciTech Connect

    Chiu-Tsao, Sou-Tung; Schaart, Dennis R.; Soares, Christopher G.; Nath, Ravinder

    2007-11-15

    Since the publication of AAPM Task Group 60 report in 1999, a considerable amount of dosimetry data for the three coronary brachytherapy systems in use in the United States has been reported. A subgroup, Task Group 149, of the AAPM working group on Special Brachytherapy Modalities (Bruce Thomadsen, Chair) was charged to develop recommendations for dose calculation formalisms and the related consensus dosimetry parameters. The recommendations of this group are presented here. For the Cordis {sup 192}Ir and Novoste {sup 90}Sr/{sup 90}Y systems, the original TG-43 formalism in spherical coordinates should be used along with the consensus values of the dose rate constant, geometry function, radial dose function, and anisotropy function for the single seeds. Contributions from the single seeds should be added linearly for the calculation of dose distributions from a source train. For the Guidant {sup 32}P wire system, the modified TG-43 formalism in cylindrical coordinates along with the recommended data for the 20 and 27 mm wires should be used. Data tables for the 6, 10, 14, 18, and 22 seed trains of the Cordis system, 30, 40, and 60 mm seed trains of the Novoste system, and the 20 and 27 mm wires of the Guidant system are presented along with our rationale and methodology for selecting the consensus data. Briefly, all available datasets were compared with each other and the consensus dataset was either an average of available data or the one obtained from the most densely populated study; in most cases this was a Monte Carlo calculation.

  16. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

    PubMed Central

    Frerichs, Inéz; Amato, Marcelo B P; van Kaam, Anton H; Tingay, David G; Zhao, Zhanqi; Grychtol, Bartłomiej; Bodenstein, Marc; Gagnon, Hervé; Böhm, Stephan H; Teschner, Eckhard; Stenqvist, Ola; Mauri, Tommaso; Torsani, Vinicius; Camporota, Luigi; Schibler, Andreas; Wolf, Gerhard K; Gommers, Diederik; Leonhardt, Steffen; Adler, Andy

    2017-01-01

    Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology. PMID:27596161

  17. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group.

    PubMed

    Frerichs, Inéz; Amato, Marcelo B P; van Kaam, Anton H; Tingay, David G; Zhao, Zhanqi; Grychtol, Bartłomiej; Bodenstein, Marc; Gagnon, Hervé; Böhm, Stephan H; Teschner, Eckhard; Stenqvist, Ola; Mauri, Tommaso; Torsani, Vinicius; Camporota, Luigi; Schibler, Andreas; Wolf, Gerhard K; Gommers, Diederik; Leonhardt, Steffen; Adler, Andy

    2017-01-01

    Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology.

  18. Service versus education: finding the right balance: a consensus statement from the Council Of Emergency Medicine Residency Directors 2009 Academic Assembly "Question 19" working group.

    PubMed

    Quinn, Antonia; Brunett, Patrick

    2009-12-01

    Many emergency medicine (EM) residency programs have recently received citations for their residents' responses to Question 19 of the Accreditation Council on Graduate Medical Education annual survey, which asks residents to rate their program's emphasis on clinical education over service obligations. To the best of our knowledge, no prior investigations or consensus statements exist that specifically address the appropriate balance between educational activity and clinical service in EM residency training. The objective of this project was to create a consensus statement based on the shared insights of academic faculty and educators in EM, with specific recommendations to improve the integration of education with clinical service in EM residency training programs. More than 80 EM program directors (PDs), associate and assistant PDs, and other academic EM faculty attending an annual conference of EM educators met to address this issue in a discussion session and working group. Participants examined the current literature on resident service and education and shared with the conference at large their collective insight and experience and possible solutions to this challenge. A consensus statement of specific recommendations and effective educational techniques aimed at balancing service and education requirements was created, based on the contributions of a diverse group of academic emergency physicians. Recommendations included identifying the teachable moment in all clinical service; promoting resident understanding of program goals and expectations from the beginning; educating residents about the ACGME resident survey; and engaging hospitals, institutional graduate medical education departments, and residents in finding solutions. (c) 2009 by the Society for Academic Emergency Medicine.

  19. Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria.

    PubMed

    Segal, Brahm H; Herbrecht, Raoul; Stevens, David A; Ostrosky-Zeichner, Luis; Sobel, Jack; Viscoli, Claudio; Walsh, Thomas J; Maertens, Johan; Patterson, Thomas F; Perfect, John R; Dupont, Bertrand; Wingard, John R; Calandra, Thierry; Kauffman, Carol A; Graybill, John R; Baden, Lindsey R; Pappas, Peter G; Bennett, John E; Kontoyiannis, Dimitrios P; Cordonnier, Catherine; Viviani, Maria Anna; Bille, Jacques; Almyroudis, Nikolaos G; Wheat, L Joseph; Graninger, Wolfgang; Bow, Eric J; Holland, Steven M; Kullberg, Bart-Jan; Dismukes, William E; De Pauw, Ben E

    2008-09-01

    Invasive fungal diseases (IFDs) have become major causes of morbidity and mortality among highly immunocompromised patients. Authoritative consensus criteria to diagnose IFD have been useful in establishing eligibility criteria for antifungal trials. There is an important need for generation of consensus definitions of outcomes of IFD that will form a standard for evaluating treatment success and failure in clinical trials. Therefore, an expert international panel consisting of the Mycoses Study Group and the European Organization for Research and Treatment of Cancer was convened to propose guidelines for assessing treatment responses in clinical trials of IFDs and for defining study outcomes. Major fungal diseases that are discussed include invasive disease due to Candida species, Aspergillus species and other molds, Cryptococcus neoformans, Histoplasma capsulatum, and Coccidioides immitis. We also discuss potential pitfalls in assessing outcome, such as conflicting clinical, radiological, and/or mycological data and gaps in knowledge.

  20. End points for phase II trials in intensive care: recommendations from the Australian and New Zealand Clinical Trials Group consensus panel meeting.

    PubMed

    Young, Paul; Hodgson, Carol; Dulhunty, Joel; Saxena, Manoj; Bailey, Michael; Bellomo, Rinaldo; Davies, Andrew; Finfer, Simon; Kruger, Peter; Lipman, Jeffrey; Myburgh, John; Peake, Sandra; Seppelt, Ian; Streat, Stephen; Tate, Rhiannon; Webb, Steven

    2012-09-01

    There is uncertainty about which end points should be used for Phase II trials in critically ill patients. To systematically evaluate potential end points for Phase II trials in critically ill patients. A report outlining a process of literature review and recommendations from a consensus meeting conducted on behalf of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) in October 2011. The consensus panel concluded that there are no adequately validated end points for Phase II trials in critically ill patients. However, the following were identified as potential Phase II end points: hospital-free days to Day 90, ICU-free days to Day 28, ventilator-free days to Day 28, cardiovascular support-free days to Day 28, and renal replacement therapy-free days to Day 28. We recommend that these end points be evaluated further.

  1. Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps.

    PubMed

    Greenwald, Jeffrey L; Halasyamani, Lakshmi; Greene, Jan; LaCivita, Cynthia; Stucky, Erin; Benjamin, Bona; Reid, William; Griffin, Frances A; Vaida, Allen J; Williams, Mark V

    2010-10-01

    what constitutes a medication and what processes are encompassed by reconciliation. Clarifying these terms is critical to ensuring more uniform impact of medication reconciliation. 2 The varying roles of the multidisciplinary participants in the reconciliation process must be clearly defined. These role definitions should include those of the patient and family/caregiver and must occur locally, taking into account the need for flexibility in design given the varying structures and resources at healthcare sites. 3 Measures of the reconciliation processes must be clinically meaningful (i.e., of defined benefit to the patient) and derived through consultation with stakeholder groups. Those measures to be reported for national benchmarking and accreditation should be limited in number and clinically meaningful. 4 While a comprehensive reconciliation system is needed across the continuum of care, a phased approach to implementation, allowing it to start slowly and be tailored to local organizational structures and work flows, will increase the chances of successful organizational uptake. 5 Developing mechanisms for prospectively and proactively identifying patients at risk for medication-related adverse events and failed reconciliation is needed. Such an alert system would help maintain vigilance toward these patient safety issues and help focus additional resources on high risk patients. 6 Given the diversity in medication reconciliation practices, research aimed at identifying effective processes is important and should be funded with national resources. Funding should include varying sites of care (e.g., urban and rural, academic and nonacademic, etc.). 7 Strategies for medication reconciliation-both successes and key lessons learned from unsuccessful efforts-should be widely disseminated. 8 A personal health record that is integrated and easily transferable between sites of care is needed to facilitate successful medication reconciliation. 9 Partnerships between

  2. Achieving consensus in environmental programs

    SciTech Connect

    Kurstedt, Jr., H. A.; Jones, R. M.; Walker, J. A.; Middleman, L. I.

    1989-01-01

    In this paper, we describe a new research effort on consensus tied to the Environmental Restoration Program (ERP) within the US Department of Energy's Office of Defense Waste and Transportation Management (DWTM). We define consensus and explain why consensus decisions are not merely desirable but necessary in furthering ERP activities. As examples of our planned applied research, we first discuss Nominal Group Technique as a representative consensus-generating tool, and we conclude by describing the consensus-related mission of the Waste Management Review Group, established at Virginia Tech to conduct independent, third-party review of DWTM/ERP plans and activities. 10 refs.

  3. Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

    PubMed Central

    Wissig, Stephanie; van Maasakkers, Lisa; Stowell, Caleb; Ackerman, Ilana; Ayers, David; Barber, Thomas; Benzakour, Thami; Bozic, Kevin; Budhiparama, Nicolaas; Caillouette, James; Conaghan, Philip G.; Dahlberg, Leif; Dunn, Jennifer; Grady‐Benson, John; Ibrahim, Said A.; Lewis, Sally; Malchau, Henrik; Manzary, Mojieb; March, Lyn; Nassif, Nader; Nelissen, Rob; Smith, Noel; Franklin, Patricia D.

    2016-01-01

    Objective To define a minimum Standard Set of outcome measures and case‐mix factors for monitoring, comparing, and improving health care for patients with clinically diagnosed hip or knee osteoarthritis (OA), with a focus on defining the outcomes that matter most to patients. Methods An international working group of patients, arthroplasty register experts, orthopedic surgeons, primary care physicians, rheumatologists, and physiotherapists representing 10 countries was assembled to review existing literature and practices for assessing outcomes of pharmacologic and nonpharmacologic OA therapies, including surgery. A series of 8 teleconferences, incorporating a modified Delphi process, were held to reach consensus. Results The working group reached consensus on a concise set of outcome measures to evaluate patients’ joint pain, physical functioning, health‐related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were defined. Annual outcome measurement is recommended for all patients. Conclusion We have defined a Standard Set of outcome measures for monitoring the care of people with clinically diagnosed hip or knee OA that is appropriate for use across all treatment and care settings. We believe this Standard Set provides meaningful, comparable, and easy to interpret measures ready to implement in clinics and/or registries globally. We view this set as an initial step that, when combined with cost data, will facilitate value‐based health care improvements in the treatment of hip and knee OA. PMID:26881821

  4. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease.

    PubMed

    Magi-Galluzzi, Cristina; Evans, Andrew J; Delahunt, Brett; Epstein, Jonathan I; Griffiths, David F; van der Kwast, Theo H; Montironi, Rodolfo; Wheeler, Thomas M; Srigley, John R; Egevad, Lars L; Humphrey, Peter A

    2011-01-01

    The International Society of Urological Pathology Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to extraprostatic extension (pT3a disease), bladder neck invasion, lymphovascular invasion and the definition of pT4 were coordinated by working group 3. It was agreed that prostate cancer can be categorized as pT3a in the absence of adipose tissue involvement when cancer bulges beyond the contour of the gland or beyond the condensed smooth muscle of the prostate at posterior and posterolateral sites. Extraprostatic extension can also be identified anteriorly. It was agreed that the location of extraprostatic extension should be reported. Although there was consensus that the amount of extraprostatic extension should be quantitated, there was no agreement as to which method of quantitation should be employed. There was overwhelming consensus that microscopic urinary bladder neck invasion by carcinoma should be reported as stage pT3a and that lymphovascular invasion by carcinoma should be reported. It is recommended that these elements are considered in the development of practice guidelines and in the daily practice of urological surgical pathology.

  5. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    PubMed

    Tan, Puay Hoon; Cheng, Liang; Srigley, John R; Griffiths, David; Humphrey, Peter A; van der Kwast, Theodore H; Montironi, Rodolfo; Wheeler, Thomas M; Delahunt, Brett; Egevad, Lars; Epstein, Jonathan I

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

  6. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume.

    PubMed

    van der Kwast, Theo H; Amin, Mahul B; Billis, Athanase; Epstein, Jonathan I; Griffiths, David; Humphrey, Peter A; Montironi, Rodolfo; Wheeler, Thomas M; Srigley, John R; Egevad, Lars; Delahunt, Brett

    2011-01-01

    The 2009 International Society of Urological Pathology consensus conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the substaging of pT2 prostate cancers according to the TNM 2002/2010 system, reporting of tumor size/volume and zonal location of prostate cancers were coordinated by working group 2. A survey circulated before the consensus conference demonstrated that 74% of the 157 participants considered pT2 substaging of prostate cancer to be of clinical and/or academic relevance. The survey also revealed a considerable variation in the frequency of reporting of pT2b substage prostate cancer, which was likely a consequence of the variable methodologies used to distinguish pT2a from pT2b tumors. Overview of the literature indicates that current pT2 substaging criteria lack clinical relevance and the majority (65.5%) of conference attendees wished to discontinue pT2 substaging. Therefore, the consensus was that reporting of pT2 substages should, at present, be optional. Several studies have shown that prostate cancer volume is significantly correlated with other clinicopathological features, including Gleason score and extraprostatic extension of tumor; however, most studies fail to demonstrate this to have prognostic significance on multivariate analysis. Consensus was reached with regard to the reporting of some quantitative measure of the volume of tumor in a prostatectomy specimen, without prescribing a specific methodology. Incorporation of the zonal and/or anterior location of the dominant/index tumor in the pathology report was accepted by most participants, but a formal definition of the identifying features of the dominant/index tumor remained undecided.

  7. Qualitative Research in Group Work: Status, Synergies, and Implementation

    ERIC Educational Resources Information Center

    Rubel, Deborah; Okech, Jane E. Atieno

    2017-01-01

    The article aims to advance the use of qualitative research methods to understand group work. The first part of this article situates the use of qualitative research methods in relationship to group work research. The second part examines recent qualitative group work research using a framework informed by scoping and systematic review methods and…

  8. Qualitative Research in Group Work: Status, Synergies, and Implementation

    ERIC Educational Resources Information Center

    Rubel, Deborah; Okech, Jane E. Atieno

    2017-01-01

    The article aims to advance the use of qualitative research methods to understand group work. The first part of this article situates the use of qualitative research methods in relationship to group work research. The second part examines recent qualitative group work research using a framework informed by scoping and systematic review methods and…

  9. Contemporary Gleason Grading of Prostatic Carcinoma: An Update With Discussion on Practical Issues to Implement the 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma.

    PubMed

    Epstein, Jonathan I; Amin, Mahul B; Reuter, Victor E; Humphrey, Peter A

    2017-02-07

    The primary proceedings of the 2014 International Society of Urological Pathology Grading Conference were published promptly in 2015 and dealt with: (1) definition of various grading patterns of usual acinar carcinoma, (2) grading of intraductal carcinoma; and (3) support for the previously proposed new Grade Groups. The current manuscript in addition to highlighting practical issues to implement the 2014 recommendations, provides an updated perspective based on numerous studies published after the 2014 meeting. A major new recommendation that came from the 2014 Consensus Conference was to report percent pattern 4 with Gleason score 7 in both needle biopsies and radical prostatectomy (RP) specimens. This manuscript gives the options how to record percentage pattern 4 and under which situations recording this information may not be necessary. Another consensus from the 2014 meeting was to replace the term tertiary-grade pattern with minor high-grade pattern. Minor high-grade indicates that the term tertiary should not merely be just the third most common pattern but that it should be minor or limited in extent. Although a specific cutoff of 5% was not voted on in the 2014 Consensus meeting, the only quantification of minor high-grade pattern that has been used in the literature with evidence-based data correlating with outcome has been the 5% cutoff. At the 2014 Consensus Conference, there was agreement that the grading rule proposed in the 2005 Consensus Conference on needle biopsies be followed, that tertiary be not used, and that the most common and highest grade patterns be summed together as the Gleason score. Therefore, the term tertiary or minor high-grade pattern should only be used in RP specimens when there are 3 grade patterns, such as with 3+4=7 or 4+3=7 with <5% Gleason pattern 5. It was recommended at the 2014 Conference that for the foreseeable future, the new Grade Groups would be reported along with the Gleason system. The minor high-grade patterns

  10. [Narrowband UV-B, monochromatic excimer laser, and photodynamic therapy in psoriasis: a consensus statement of the Spanish Psoriasis Group].

    PubMed

    Carrascosa, J M; López-Estebaranz, J L; Carretero, G; Daudén, E; Ferrándiz, C; Vidal, D; Belinchón, I; Sánchez-Regaña, M; Puig, L

    2011-04-01

    Novel treatment strategies and new information concerning the management of moderate to severe psoriasis justify a reassessment of the role of the classic therapies in this setting. This consensus statement evaluates narrowband UV-B therapy, which is currently considered the phototherapy option of choice in psoriasis because of its risk-to-benefit ratio. The role of excimer laser and photodynamic therapies are also discussed. These targeted therapies are still only available in a small number of centers in Spain and are used principally in the treatment of localized and recalcitrant forms of psoriasis. We discuss the efficacy and safety of phototherapy as well as treatment regimens, combination therapy, and clinical considerations relating to the characteristics of the patient or the disease. Copyright © 2010 Elsevier España, S.L. y AEDV. All rights reserved.

  11. Classification, diagnosis, and approach to treatment for angioedema: consensus report from the Hereditary Angioedema International Working Group.

    PubMed

    Cicardi, M; Aberer, W; Banerji, A; Bas, M; Bernstein, J A; Bork, K; Caballero, T; Farkas, H; Grumach, A; Kaplan, A P; Riedl, M A; Triggiani, M; Zanichelli, A; Zuraw, B

    2014-05-01

    Angioedema is defined as localized and self-limiting edema of the subcutaneous and submucosal tissue, due to a temporary increase in vascular permeability caused by the release of vasoactive mediator(s). When angioedema recurs without significant wheals, the patient should be diagnosed to have angioedema as a distinct disease. In the absence of accepted classification, different types of angioedema are not uniquely identified. For this reason, the European Academy of Allergy and Clinical Immunology gave its patronage to a consensus conference aimed at classifying angioedema. Four types of acquired and three types of hereditary angioedema were identified as separate forms from the analysis of the literature and were presented in detail at the meeting. Here, we summarize the analysis of the data and the resulting classification of angioedema.

  12. [Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document].

    PubMed

    Alós Cortés, Juan Ignacio; Andreu Domingo, Antonia; Arribas Mir, Lorenzo; Cabero Roura, Luis; de Cueto López, Marina; López Sastre, José; Melchor Marcos, Juan Carlos; Puertas Prieto, Alberto; de la Rosa Fraile, Manuel; Salcedo Abizanda, Salvador; Sánchez Luna, Manuel; Sanchez Pérez, María José; Torrejon Cardoso, Rafael

    2013-03-01

    Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  13. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group.

    PubMed

    Leone, F P G; Timmerman, D; Bourne, T; Valentin, L; Epstein, E; Goldstein, S R; Marret, H; Parsons, A K; Gull, B; Istre, O; Sepulveda, W; Ferrazzi, E; Van den Bosch, T

    2010-01-01

    The IETA (International Endometrial Tumor Analysis group) statement is a consensus statement on terms, definitions and measurements that may be used to describe the sonographic features of the endometrium and uterine cavity on gray-scale sonography, color flow imaging and sonohysterography. The relationship between the ultrasound features described and the presence or absence of pathology is not known. However, the IETA terms and definitions may form the basis for prospective studies to predict the risk of different endometrial pathologies based on their ultrasound appearance.

  14. Using process groups to implement failure detection in asynchronous environments

    NASA Technical Reports Server (NTRS)

    Ricciardi, Aleta M.; Birman, Kenneth P.

    1991-01-01

    Agreement on the membership of a group of processes in a distributed system is a basic problem that arises in a wide range of applications. Such groups occur when a set of processes cooperate to perform some task, share memory, monitor one another, subdivide a computation, and so forth. The group membership problems is discussed as it relates to failure detection in asynchronous, distributed systems. A rigorous, formal specification for group membership is presented under this interpretation. A solution is then presented for this problem.

  15. Implementation of Total School Cluster Grouping: A Case Study

    ERIC Educational Resources Information Center

    Necciai, Rodney Alan

    2013-01-01

    This dissertation was designed and conducted to examine perception of classroom grouping practices in elementary schools. It includes a comprehensive review of literature related to grade-level and within-class grouping practices over the past thirty years in American schools. A focus was gleaned from the literature that led to the design of a…

  16. Implement the medical group revenue function. Create competitive advantage.

    PubMed

    Colucci, C

    1998-01-01

    This article shows medical groups how they can employ new financial management and information technology techniques to safeguard their revenue and income streams. These managerial techniques stem from the application of the medical group revenue function, which is defined herein. This article also describes how the medical group revenue function can be used to create value by employing a database and a decision support system. Finally, the article describes how the decision support system can be used to create competitive advantage. Through the wise use of internally generated information, medical groups can negotiate better contract terms, improve their operations, cut their costs, embark on capital investment programs and improve market share. As medical groups gain market power by improving in these areas, they will be more attractive to potential strategic allies, payers and investment bankers.

  17. Monitoring and ordering practices for human papillomavirus in cervical cytology: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 5.

    PubMed

    Booth, Christine N; Bashleben, Christine; Filomena, Carol A; Means, Marilee M; Wasserman, Patricia G; Souers, Rhona J; Henry, Michael R

    2013-02-01

    The association of certain types of human papillomavirus with cervical carcinoma is well established. Human papillomavirus testing is now routinely used to screen for cervical carcinoma and precursor lesions of the cervix (cotesting and reflex testing) and these results are considered in patient triage and management. To provide information about current laboratory practices in human papillomavirus testing and consensus best practice statements based on results from the College of American Pathologists' laboratory-based survey funded by the Centers for Disease Control and Prevention. The College of American Pathologists submitted a paper-based survey to 1245 laboratories in the United States. After review of the initial results, follow-up Web-based survey results, and a literature review by an expert working group, consensus best practice statements were constructed by working group members for presentation at a national consensus conference. These best practice statements were discussed and then voted upon by conference participants. A total of 525 laboratories responded to survey questions about human papillomavirus ordering and monitoring practices, whereas 546 responded to the overall survey. In most laboratories (87.6%), the high-risk human papillomavirus test is ordered as a reflex test by providers. A minority of laboratories (11.9%) routinely bundle low- and high-risk human papillomavirus tests. Most laboratories (84.4%) do not limit testing in patients with atypical squamous cells to women older than 20 years. More than half of laboratories (53.3%) monitor human papillomavirus positive rates in Papanicolaou tests with atypical squamous cells of undetermined significance. It is not appropriate for laboratories to offer low-risk human papillomavirus testing for any clinical circumstance in gynecologic cytology. Laboratories should not order human papillomavirus testing to resolve diagnostic discrepancies. It is a valuable broad measure of laboratory quality

  18. Successful implementation of laboratory budget holding by Pegasus Medical Group.

    PubMed

    Kerr, D; Malcolm, L; Schousboe, J; Pimm, F

    1996-09-13

    To evaluate the effectiveness of budget holding by Pegasus Medical Group for laboratory services expenditure and reasons for the successes observed. Two pilot groups and a nonpilot group of general practitioners were formed with the pilots receiving active feedback, educational programmes and test form redesign within the incentive of savings being retained by the group for improved primary care services. Overall savings of 22.7% were achieved within the budget over a 13 month period. There was a highly significant reduction in expenditure per member especially in the mean and standard deviation of cost per consultation indicating a marked narrowing of the variance in cost between members in the pilot groups compared with the nonpilot group. The study illustrates the effectiveness of a comprehensive strategy of education, active feedback and test form redesign and especially the importance of the incentive of retaining budgetary savings for service improvements. It also illustrates the importance of collaborative as compared with competitive strategies in achieving cost control and value for money gains in health services. However, more work is needed to establish the appropriateness of lower laboratory expenditure by linking test requests to diagnosis.

  19. Management goals for type 1 Gaucher disease: An expert consensus document from the European working group on Gaucher disease.

    PubMed

    Biegstraaten, M; Cox, T M; Belmatoug, N; Berger, M G; Collin-Histed, T; Vom Dahl, S; Di Rocco, M; Fraga, C; Giona, F; Giraldo, P; Hasanhodzic, M; Hughes, D A; Iversen, P O; Kiewiet, A I; Lukina, E; Machaczka, M; Marinakis, T; Mengel, E; Pastores, G M; Plöckinger, U; Rosenbaum, H; Serratrice, C; Symeonidis, A; Szer, J; Timmerman, J; Tylki-Szymańska, A; Weisz Hubshman, M; Zafeiriou, D I; Zimran, A; Hollak, C E M

    2016-10-24

    Gaucher Disease type 1 (GD1) is a lysosomal disorder that affects many systems. Therapy improves the principal manifestations of the condition and, as a consequence, many patients show a modified phenotype which reflects manifestations of their disease that are refractory to treatment. More generally, it is increasingly recognised that information as to how a patient feels and functions [obtained by patient- reported outcome measurements (PROMs)] is critical to any comprehensive evaluation of treatment. A new set of management goals for GD1 in which both trends are reflected is needed. To this end, a modified Delphi procedure among 25 experts was performed. Based on a literature review and with input from patients, 65 potential goals were formulated as statements. Consensus was considered to be reached when ≥75% of the participants agreed to include that specific statement in the management goals. There was agreement on 42 statements. In addition to the traditional goals concerning haematological, visceral and bone manifestations, improvement in quality of life, fatigue and social participation, as well as early detection of long-term complications or associated diseases were included. When applying this set of goals in medical practice, the clinical status of the individual patient should be taken into account.

  20. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group.

    PubMed

    Fernández de Larrea, C; Kyle, R A; Durie, B G M; Ludwig, H; Usmani, S; Vesole, D H; Hajek, R; San Miguel, J F; Sezer, O; Sonneveld, P; Kumar, S K; Mahindra, A; Comenzo, R; Palumbo, A; Mazumber, A; Anderson, K C; Richardson, P G; Badros, A Z; Caers, J; Cavo, M; LeLeu, X; Dimopoulos, M A; Chim, C S; Schots, R; Noeul, A; Fantl, D; Mellqvist, U-H; Landgren, O; Chanan-Khan, A; Moreau, P; Fonseca, R; Merlini, G; Lahuerta, J J; Bladé, J; Orlowski, R Z; Shah, J J

    2013-04-01

    Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells. It is classified as either primary PCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. Primary PCL is a distinct clinic-pathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. The diagnosis is based upon the percentage (≥ 20%) and absolute number (≥ 2 × 10(9)/l) of plasma cells in the peripheral blood. It is proposed that the thresholds for diagnosis be re-examined and consensus recommendations are made for diagnosis, as well as, response and progression criteria. Induction therapy needs to begin promptly and have high clinical activity leading to rapid disease control in an effort to minimize the risk of early death. Intensive chemotherapy regimens and bortezomib-based regimens are recommended followed by high-dose therapy with autologous stem cell transplantation if feasible. Allogeneic transplantation can be considered in younger patients. Prospective multicenter studies are required to provide revised definitions and better understanding of the pathogenesis of PCL.

  1. Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group.

    PubMed

    Glüer, C C

    1997-08-01

    Quantitative ultrasound (QUS) methods have been introduced in recent years for the assessment of skeletal status in osteoporosis. The performance of QUS techniques has been evaluated in a large number of studies. Reviewing existing knowledge, an international expert panel formulated the following consensus regarding the current status of this technology. To date, evidence supports the use of QUS techniques for the assessment of fracture risk in elderly women. This has been best established for water-based calcaneal QUS systems. Future studies should include the predictive validity of other QUS systems. Additional clinical applications of QUS, specifically the assessment of rates of change for monitoring disease progression or response to treatment, require further investigation. Its low cost and portability make QUS an attractive technology for assessing risk of fractures in larger populations than may be suitable or feasible for bone densitometry. Additional investigations that assess innovative QUS techniques in well defined research settings are important to determine and utilize the full potential of this technology for the benefit of early detection and monitoring of osteoporosis.

  2. From the office to the field: Areas of tension and consensus in the implementation of the National Environmental Policy Act within the US Forest Service

    Treesearch

    Marc J. Stern; S. Andrew Predmore; Michael J. Mortimer; David N. Seesholtz

    2010-01-01

    We conducted an online survey (n = 3321) followed by five focus groups with Forest Service employees involved in compliance with the National Environmental Policy Act (NEPA) to explore agency views of how NEPA should be implemented within the agency. We filter these perceptions through the lenses of different functional groups within the agency, each with its own role...

  3. The 1(st) Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2016. Summary and Consensus Statements: Group I - Peri-Implantitis Aetiology, Risk Factors and Pathogenesis.

    PubMed

    Stacchi, Claudio; Andolsek, Francesca; Astramskaite, Inesa; Berton, Federico; Di Lenarda, Roberto; Fernandes, Maria Helena; Frassetto, Andrea; Gomes, Pedro de Sousa; Guobis, Zygimantas; Jimbo, Ryo; Juodzbalys, Gintaras; Khoury, Aiman; Kubilius, Ricardas; Kuoppala, Ritva; Lombardi, Teresa; Maminskas, Julius; Pacauskiene, Ingrida; Perinetti, Giuseppe; Poskevicius, Lukas; Pranskunas, Mindaugas; Puisys, Algirdas; Raustia, Aune

    2016-01-01

    The task of Group 1 was to review and update the existing data concerning aetiology, risk factors and pathogenesis of peri-implantitis. Previous history of periodontitis, poor oral hygiene, smoking and presence of general diseases have been considered among the aetiological risk factors for the onset of peri-implant pathologies, while late dental implant failures are commonly associated with peri-implantitis and/or with the application of incorrect biomechanical forces. Special interest was paid to the bone cells dynamics as part of the pathogenesis of peri-implantitis. The main areas indagated by this group were as follows: influence of smoking, history of periodontitis and general diseases on peri-implantitis development, bio-mechanics of implant loading and its influence on peri-implant bone and cellular dynamics related to the pathogenesis of peri-implantitis. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was screened and reported following the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in Preface chapter. The results and conclusions of the review process are presented in the respective papers. One systematic review with meta-analysis, three systematic reviews and one theoretical analysis were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.

  4. [Consensus document on the evaluation and treatment of moderate-to-severe psoriasis. Spanish psoriasis group of the Spanish Academy of Dermatology and Venereology].

    PubMed

    Puig, L; Bordas, X; Carrascosa, J M; Daudén, E; Ferrándiz, C; Hernanz, J M; López-Estebaranz, J L; Moreno, J C; Sánchez-Carazo, J L; Vanaclocha, F; Vázquez-Veiga, H

    2009-05-01

    The treatment of psoriasis has been revolutionized by the introduction of biologic agents; these agents achieve skin clearance and long-term improvement without the risk of toxicity that has limited use of the classic systemic treatments. The role of systemic treatment in the management of psoriasis is being reviewed on the basis of a large volume of scientific evidence on the efficacy and safety of biologic agents, and new therapeutic goals and strategies are being devised for patients with moderate-to-severe psoriasis. This has led to the need to establish severity criteria that will provide the rationale for the indication of the different systemic agents currently available for the treatment of moderate-to-severe psoriasis, as well as therapeutic goals, efficacy measures, therapeutic strategies, screening protocols, and choice of treatment based on the risk-benefit ratio of the different agents. These criteria must be established through consensus by experienced dermatologists and based on available scientific evidence. The present document reflects the consensus of the Spanish Psoriasis Group on these different issues in the management of moderate-to-severe psoriasis.

  5. Recommendations for a patient-centered approach to the assessment and treatment of scalp psoriasis: a consensus statement from the Asia Scalp Psoriasis Study Group.

    PubMed

    Frez, Maria Lorna F; Asawanonda, Pravit; Gunasekara, Chalukya; Koh, Chuankeng; Loo, Steven; Oon, Hazel H; Thai, Vu Hong; Tsai, Tsen-Fang; Youn, Sang Woong

    2014-02-01

    International consensus statements on the management of scalp psoriasis are available, but no such recommendations exist for Asia. The Asia Scalp Psoriasis Study Group (ASPSG) met in May 2011 to review the epidemiologic pattern of scalp psoriasis in Southeast Asia and to develop Asia-specific recommendations for its management. The overall prevalence of psoriasis in Asia is <0.3%, but 75-90% have scalp involvement, whether isolated or with lesions elsewhere, which can negatively impact quality of life (QoL). Treatment decisions should be based primarily on objective disease severity, but should also take account of patient QoL. Psychosocial support and more aggressive treatment should be offered to all patients with moderate to severe QoL impairment. Topical therapy is indicated first-line in all patients, with combination therapy (corticosteroid + calcipotriol), more occlusive formulations, keratolytics, and very potent corticosteroids for patients needing greater or faster efficacy. Systemic therapies, light or laser treatments should be reserved for patients with severe and recalcitrant disease. The ASPSG recommends a patient-centered approach to scalp psoriasis management, consistent with the international consensus statements. Asian physicians should also consider patient QoL, prior treatment response, formulation preferences, likely adherence, cost, time available for self-management, and potential adverse events.

  6. The therapeutic potential of mesenchymal stem cell transplantation as a treatment for multiple sclerosis: consensus report of the International MSCT Study Group.

    PubMed

    Freedman, Mark S; Bar-Or, Amit; Atkins, Harold L; Karussis, Dimitrios; Frassoni, Francesco; Lazarus, Hillard; Scolding, Neil; Slavin, Shimon; Le Blanc, Katarina; Uccelli, Antonio

    2010-04-01

    Current therapies for multiple sclerosis effectively reduce inflammation, but do little in terms of repair to the damaged central nervous system. Cell-based therapies may provide a new strategy for bolstering regeneration and repair through neuro-axonal protection or remyelination. Mesenchymal stem cells modulate pathological responses in experimental autoimmune encephalitis, alleviating disease, but also stimulate repair of the central nervous system through the release of soluble factors. Autologous and allogeneic mesenchymal stem cells have been safely administered to individuals with hemato-oncological diseases and in a limited number of patients with multiple sclerosis. It is therefore reasonable to move mesenchymal stem cells transplantation into properly controlled human studies to explore their potential as a treatment for multiple sclerosis. Since it is likely that the first such studies will probably involve only small numbers of patients in a few centers, we formed an international panel comprising multiple sclerosis neurology and stem cell experts, as well as immunologists. The aims were to derive a consensus on the utilization of mesenchymal stem cells for the treatment of multiple sclerosis, along with protocols for the culture of the cells and the treatment of patients. This article reviews the consensus derived from our group on the rationale for mesenchymal stem cell transplantation, the methodology for generating mesenchymal stem cells and the first treatment protocol for multiple sclerosis patients.

  7. The 1st Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2016. Summary and Consensus Statements: Group I - Peri-Implantitis Aetiology, Risk Factors and Pathogenesis

    PubMed Central

    Andolsek, Francesca; Astramskaite, Inesa; Berton, Federico; Di Lenarda, Roberto; Fernandes, Maria Helena; Frassetto, Andrea; Gomes, Pedro de Sousa; Guobis, Zygimantas; Jimbo, Ryo; Juodzbalys, Gintaras; Khoury, Aiman; Kubilius, Ricardas; Kuoppala, Ritva; Lombardi, Teresa; Maminskas, Julius; Pacauskiene, Ingrida; Perinetti, Giuseppe; Poskevicius, Lukas; Pranskunas, Mindaugas; Puisys, Algirdas; Raustia, Aune

    2016-01-01

    ABSTRACT Introduction The task of Group 1 was to review and update the existing data concerning aetiology, risk factors and pathogenesis of peri-implantitis. Previous history of periodontitis, poor oral hygiene, smoking and presence of general diseases have been considered among the aetiological risk factors for the onset of peri-implant pathologies, while late dental implant failures are commonly associated with peri-implantitis and/or with the application of incorrect biomechanical forces. Special interest was paid to the bone cells dynamics as part of the pathogenesis of peri-implantitis. Material and Methods The main areas indagated by this group were as follows: influence of smoking, history of periodontitis and general diseases on peri-implantitis development, bio-mechanics of implant loading and its influence on peri-implant bone and cellular dynamics related to the pathogenesis of peri-implantitis. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was screened and reported following the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in Preface chapter. Results The results and conclusions of the review process are presented in the respective papers. One systematic review with meta-analysis, three systematic reviews and one theoretical analysis were performed. The group′s general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article. PMID:27833732

  8. Consensus versus Majority Vote: A Laboratory Experiment.

    ERIC Educational Resources Information Center

    Hare, A. Paul

    1980-01-01

    Small groups of university students each made two decisions, one using consensus, the other using majority vote. Results confirm consensus method characteristics found in community groups studies and indicate that consensus is favored as a group process. Presented at Association for Sociology in Southern Africa, Maseru, Losotho, June 1979.…

  9. Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue

    PubMed Central

    Love, Seth; Chalmers, Katy; Ince, Paul; Esiri, Margaret; Attems, Johannes; Kalaria, Raj; Jellinger, Kurt; Yamada, Masahito; McCarron, Mark; Minett, Thais; Matthews, Fiona; Greenberg, Steven; Mann, David; Kehoe, Patrick Gavin

    2015-01-01

    In a collaboration involving 11 groups with research interests in cerebral amyloid angiopathy (CAA), we used a two-stage process to develop and in turn validate a new consensus protocol and scoring scheme for the assessment of CAA and associated vasculopathic abnormalities in post-mortem brain tissue. Stage one used an iterative Delphi-style survey to develop the consensus protocol. The resultant scoring scheme was tested on a series of digital images and paraffin sections that were circulated blind to a number of scorers. The scoring scheme and choice of staining methods were refined by open-forum discussion. The agreed protocol scored parenchymal and meningeal CAA on a 0-3 scale, capillary CAA as present/absent and vasculopathy on 0-2 scale, in the 4 cortical lobes that were scored separately. A further assessment involving three centres was then undertaken. Neuropathologists in three centres (Bristol, Oxford and Sheffield) independently scored sections from 75 cases (25 from each centre) and high inter-rater reliability was demonstrated. Stage two used the results of the three-centre assessment to validate the protocol by investigating previously described associations between APOE genotype (previously determined), and both CAA and vasculopathy. Association of capillary CAA with or without arteriolar CAA with APOE ε4 was confirmed. However APOE ε2 was also found to be a strong risk factor for the development of CAA, not only in AD but also in elderly non-demented controls. Further validation of this protocol and scoring scheme is encouraged, to aid its wider adoption to facilitate collaborative and replication studies of CAA. PMID:26807344

  10. Erratum: Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue.

    PubMed

    Love, Seth; Chalmers, Katy; Ince, Paul; Esiri, Margaret; Attems, Johannes; Kalaria, Raj; Jellinger, Kurt; Yamada, Masahito; McCarron, Mark; Minett, Thais; Matthews, Fiona; Greenberg, Steven; Mann, David; Kehoe, Patrick Gavin

    2015-01-01

    In a collaboration involving 11 groups with research interests in cerebral amyloid angiopathy (CAA), we used a two-stage process to develop and in turn validate a new consensus protocol and scoring scheme for the assessment of CAA and associated vasculopathic abnormalities in post-mortem brain tissue. Stage one used an iterative Delphi-style survey to develop the consensus protocol. The resultant scoring scheme was tested on a series of digital images and paraffin sections that were circulated blind to a number of scorers. The scoring scheme and choice of staining methods were refined by open-forum discussion. The agreed protocol scored parenchymal and meningeal CAA on a 0-3 scale, capillary CAA as present/absent and vasculopathy on 0-2 scale, in the 4 cortical lobes that were scored separately. A further assessment involving three centres was then undertaken. Neuropathologists in three centres (Bristol, Oxford and Sheffield) independently scored sections from 75 cases (25 from each centre) and high inter-rater reliability was demonstrated. Stage two used the results of the three-centre assessment to validate the protocol by investigating previously described associations between APOE genotype (previously determined), and both CAA and vasculopathy. Association of capillary CAA with or without arteriolar CAA with APOE ε4 was confirmed. However APOE ε2 was also found to be a strong risk factor for the development of CAA, not only in AD but also in elderly non-demented controls. Further validation of this protocol and scoring scheme is encouraged, to aid its wider adoption to facilitate collaborative and replication studies of CAA.[This corrects the article on p. 19 in vol. 3, PMID: 24754000.].

  11. Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue.

    PubMed

    Love, Seth; Chalmers, Katy; Ince, Paul; Esiri, Margaret; Attems, Johannes; Jellinger, Kurt; Yamada, Masahito; McCarron, Mark; Minett, Thais; Matthews, Fiona; Greenberg, Steven; Mann, David; Kehoe, Patrick Gavin

    2014-01-01

    In a collaboration involving 11 groups with research interests in cerebral amyloid angiopathy (CAA), we used a two-stage process to develop and in turn validate a new consensus protocol and scoring scheme for the assessment of CAA and associated vasculopathic abnormalities in post-mortem brain tissue. Stage one used an iterative Delphi-style survey to develop the consensus protocol. The resultant scoring scheme was tested on a series of digital images and paraffin sections that were circulated blind to a number of scorers. The scoring scheme and choice of staining methods were refined by open-forum discussion. The agreed protocol scored parenchymal and meningeal CAA on a 0-3 scale, capillary CAA as present/absent and vasculopathy on 0-2 scale, in the 4 cortical lobes that were scored separately. A further assessment involving three centres was then undertaken. Neuropathologists in three centres (Bristol, Oxford and Sheffield) independently scored sections from 75 cases (25 from each centre) and high inter-rater reliability was demonstrated. Stage two used the results of the three-centre assessment to validate the protocol by investigating previously described associations between APOE genotype (previously determined), and both CAA and vasculopathy. Association of capillary CAA with or without arteriolar CAA with APOE ε4 was confirmed. However APOE ε2 was also found to be a strong risk factor for the development of CAA, not only in AD but also in elderly non-demented controls. Further validation of this protocol and scoring scheme is encouraged, to aid its wider adoption to facilitate collaborative and replication studies of CAA.

  12. Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue

    PubMed Central

    Love, Seth; Chalmers, Katy; Ince, Paul; Esiri, Margaret; Attems, Johannes; Jellinger, Kurt; Yamada, Masahito; McCarron, Mark; Minett, Thais; Matthews, Fiona; Greenberg, Steven; Mann, David; Kehoe, Patrick Gavin

    2014-01-01

    In a collaboration involving 11 groups with research interests in cerebral amyloid angiopathy (CAA), we used a two-stage process to develop and in turn validate a new consensus protocol and scoring scheme for the assessment of CAA and associated vasculopathic abnormalities in post-mortem brain tissue. Stage one used an iterative Delphi-style survey to develop the consensus protocol. The resultant scoring scheme was tested on a series of digital images and paraffin sections that were circulated blind to a number of scorers. The scoring scheme and choice of staining methods were refined by open-forum discussion. The agreed protocol scored parenchymal and meningeal CAA on a 0-3 scale, capillary CAA as present/absent and vasculopathy on 0-2 scale, in the 4 cortical lobes that were scored separately. A further assessment involving three centres was then undertaken. Neuropathologists in three centres (Bristol, Oxford and Sheffield) independently scored sections from 75 cases (25 from each centre) and high inter-rater reliability was demonstrated. Stage two used the results of the three-centre assessment to validate the protocol by investigating previously described associations between APOE genotype (previously determined), and both CAA and vasculopathy. Association of capillary CAA with or without arteriolar CAA with APOE ε4 was confirmed. However APOE ε2 was also found to be a strong risk factor for the development of CAA, not only in AD but also in elderly non-demented controls. Further validation of this protocol and scoring scheme is encouraged, to aid its wider adoption to facilitate collaborative and replication studies of CAA. PMID:24754000

  13. Requirements and design of the PROSPER protocol for implementation of information infrastructures supporting pandemic response: a Nominal Group study.

    PubMed

    Timpka, Toomas; Eriksson, Henrik; Gursky, Elin A; Strömgren, Magnus; Holm, Einar; Ekberg, Joakim; Eriksson, Olle; Grimvall, Anders; Valter, Lars; Nyce, James M

    2011-03-28

    Advanced technical systems and analytic methods promise to provide policy makers with information to help them recognize the consequences of alternative courses of action during pandemics. Evaluations still show that response programs are insufficiently supported by information systems. This paper sets out to derive a protocol for implementation of integrated information infrastructures supporting regional and local pandemic response programs at the stage(s) when the outbreak no longer can be contained at its source. Nominal group methods for reaching consensus on complex problems were used to transform requirements data obtained from international experts into an implementation protocol. The analysis was performed in a cyclical process in which the experts first individually provided input to working documents and then discussed them in conferences calls. Argument-based representation in design patterns was used to define the protocol at technical, system, and pandemic evidence levels. The Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER) outlines the implementation of information infrastructure aligned with pandemic response programs. The protocol covers analyses of the community at risk, the response processes, and response impacts. For each of these, the protocol outlines the implementation of a supporting information infrastructure in hierarchical patterns ranging from technical components and system functions to pandemic evidence production. The PROSPER protocol provides guidelines for implementation of an information infrastructure for pandemic response programs both in settings where sophisticated health information systems already are used and in developing communities where there is limited access to financial and technical resources. The protocol is based on a generic health service model and its functions are adjusted for community-level analyses of outbreak detection and progress, and

  14. Requirements and Design of the PROSPER Protocol for Implementation of Information Infrastructures Supporting Pandemic Response: A Nominal Group Study

    PubMed Central

    Timpka, Toomas; Eriksson, Henrik; Gursky, Elin A.; Strömgren, Magnus; Holm, Einar; Ekberg, Joakim; Eriksson, Olle; Grimvall, Anders; Valter, Lars; Nyce, James M.

    2011-01-01

    Background Advanced technical systems and analytic methods promise to provide policy makers with information to help them recognize the consequences of alternative courses of action during pandemics. Evaluations still show that response programs are insufficiently supported by information systems. This paper sets out to derive a protocol for implementation of integrated information infrastructures supporting regional and local pandemic response programs at the stage(s) when the outbreak no longer can be contained at its source. Methods Nominal group methods for reaching consensus on complex problems were used to transform requirements data obtained from international experts into an implementation protocol. The analysis was performed in a cyclical process in which the experts first individually provided input to working documents and then discussed them in conferences calls. Argument-based representation in design patterns was used to define the protocol at technical, system, and pandemic evidence levels. Results The Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER) outlines the implementation of information infrastructure aligned with pandemic response programs. The protocol covers analyses of the community at risk, the response processes, and response impacts. For each of these, the protocol outlines the implementation of a supporting information infrastructure in hierarchical patterns ranging from technical components and system functions to pandemic evidence production. Conclusions The PROSPER protocol provides guidelines for implementation of an information infrastructure for pandemic response programs both in settings where sophisticated health information systems already are used and in developing communities where there is limited access to financial and technical resources. The protocol is based on a generic health service model and its functions are adjusted for community-level analyses

  15. Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group

    PubMed Central

    De Pauw, Ben; Walsh, Thomas J.; Donnelly, J. Peter; Stevens, David A.; Edwards, John E.; Calandra, Thierry; Pappas, Peter G.; Maertens, Johan; Lortholary, Olivier; Kauffman, Carol A.; Denning, David W.; Patterson, Thomas F.; Maschmeyer, Georg; Bille, Jacques; Dismukes, William E.; Herbrecht, Raoul; Hope, William W.; Kibbler, Christopher C.; Kullberg, Bart Jan; Marr, Kieren A.; Muñoz, Patricia; Odds, Frank C.; Perfect, John R.; Restrepo, Angela; Ruhnke, Markus; Segal, Brahm H.; Sobel, Jack D.; Sorrell, Tania C.; Viscoli, Claudio; Wingard, John R.; Zaoutis, Theoklis; Bennett, John E.

    2009-01-01

    Background Invasive fungal diseases are important causes of morbidity and mortality. Clarity and uniformity in defining these infections are important factors in improving the quality of clinical studies. A standard set of definitions strengthens the consistency and reproducibility of such studies. Methods After the introduction of the original European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group definitions, advances in diagnostic technology and the recognition of areas in need of improvement led to a revision of this document. The revision process started with a meeting of participants in 2003, to decide on the process and to draft the proposal. This was followed by several rounds of consultation until a final draft was approved in 2005. This was made available for 6 months to allow public comment, and then the manuscript was prepared and approved. Results The revised definitions retain the original classifications of “proven,” “probable,” and “possible” invasive fungal disease, but the definition of “probable” has been expanded, whereas the scope of the category “possible” has been diminished. The category of proven invasive fungal disease can apply to any patient, regardless of whether the patient is immunocompromised, whereas the probable and possible categories are proposed for immunocompromised patients only. Conclusions These revised definitions of invasive fungal disease are intended to advance clinical and epidemiological research and may serve as a useful model for defining other infections in high-risk patients. PMID:18462102

  16. Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group.

    PubMed

    Rolfson, Ola; Wissig, Stephanie; van Maasakkers, Lisa; Stowell, Caleb; Ackerman, Ilana; Ayers, David; Barber, Thomas; Benzakour, Thami; Bozic, Kevin; Budhiparama, Nicolaas; Caillouette, James; Conaghan, Philip G; Dahlberg, Leif; Dunn, Jennifer; Grady-Benson, John; Ibrahim, Said A; Lewis, Sally; Malchau, Henrik; Manzary, Mojieb; March, Lyn; Nassif, Nader; Nelissen, Rob; Smith, Noel; Franklin, Patricia D

    2016-11-01

    To define a minimum Standard Set of outcome measures and case-mix factors for monitoring, comparing, and improving health care for patients with clinically diagnosed hip or knee osteoarthritis (OA), with a focus on defining the outcomes that matter most to patients. An international working group of patients, arthroplasty register experts, orthopedic surgeons, primary care physicians, rheumatologists, and physiotherapists representing 10 countries was assembled to review existing literature and practices for assessing outcomes of pharmacologic and nonpharmacologic OA therapies, including surgery. A series of 8 teleconferences, incorporating a modified Delphi process, were held to reach consensus. The working group reached consensus on a concise set of outcome measures to evaluate patients' joint pain, physical functioning, health-related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were defined. Annual outcome measurement is recommended for all patients. We have defined a Standard Set of outcome measures for monitoring the care of people with clinically diagnosed hip or knee OA that is appropriate for use across all treatment and care settings. We believe this Standard Set provides meaningful, comparable, and easy to interpret measures ready to implement in clinics and/or registries globally. We view this set as an initial step that, when combined with cost data, will facilitate value-based health care improvements in the treatment of hip and knee OA. © 2016, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

  17. [Infliximab therapy for Crohn's disease - a practical guideline: actualised consensus of the working group for chronic inflammatory bowel diseases of the Austrian Society for Gastroenterology and Hepatology].

    PubMed

    Reinisch, W; Dejaco, C; Feichtenschlager, T; Haas, T; Kaser, A; Miehsler, W; Novacek, G; Petritsch, W; Platzer, R; Tilg, H; Vogelsang, H; Knoflach, P

    2011-04-01

    Infliximab is a monoclonal antibody against tumor necrosis factor alpha (TNF-α), which is approved for the treatment of chronic inflammatory bowel disease (IBD) such as Crohn's disease (CD), fistulating Crohn's disease (FCD), ulcerative colitis (UC), and paediatric ulcerative colitis (PUC) from 6 years onwards. Besides its therapeutic efficacy, this antibody therapy is characterised by its side effects profile, which has been addressed in a seperate consensus statement by the Working Group for chronic inflammatory bowel diseases within the Austrian Society for Gastroenterology and Hepatology. Infliximab is an effective treatment option for the above-mentioned indications; however, use of this agent requires special knowledge to assess the benefit-risk profile for each patient individually. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Pragmatic, consensus-based minimum standards and structured interview to guide the selection and development of cancer support group leaders: a protocol paper.

    PubMed

    Pomery, Amanda; Schofield, Penelope; Xhilaga, Miranda; Gough, Karla

    2017-06-30

    Across the globe, peer support groups have emerged as a community-led approach to accessing support and connecting with others with cancer experiences. Little is known about qualities required to lead a peer support group or how to determine suitability for the role. Organisations providing assistance to cancer support groups and their leaders are currently operating independently, without a standard national framework or published guidelines. This protocol describes the methods that will be used to generate pragmatic consensus-based minimum standards and an accessible structured interview with user manual to guide the selection and development of cancer support group leaders. We will: (A) identify and collate peer-reviewed literature that describes qualities of support group leaders through a systematic review; (B) content analyse eligible documents for information relevant to requisite knowledge, skills and attributes of group leaders generally and specifically to cancer support groups; (C) use an online reactive Delphi method with an interdisciplinary panel of experts to produce a clear, suitable, relevant and appropriate structured interview comprising a set of agreed questions with behaviourally anchored rating scales; (D) produce a user manual to facilitate standard delivery of the structured interview; (E) pilot the structured interview to improve clinical utility; and (F) field test the structured interview to develop a rational scoring model and provide a summary of existing group leader qualities. The study is approved by the Department Human Ethics Advisory Group of The University of Melbourne. The study is based on voluntary participation and informed written consent, with participants able to withdraw at any time. The results will be disseminated at research conferences and peer review journals. Presentations and free access to the developed structured interview and user manual will be available to cancer agencies. © Article author(s) (or their

  19. Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup: Recommendations on incorporating patient-reported outcomes in clinical trials in epithelial ovarian cancer.

    PubMed

    Joly, Florence; Hilpert, Felix; Okamoto, Aikou; Stuart, Gavin; Ochiai, Kasunori; Friedlander, Michael

    2017-06-01

    Despite the support for including patient-reported outcomes (PROs) and health-related quality of life in clinical trials, there have been deficiencies in how these have been assessed and reported in epithelial ovarian cancer (EOC) clinical trials. To redress this, the 5th Ovarian Cancer Consensus Conference, included a plenary session entitled 'How to include PROs in clinical trials'. The perspective is a summary of the recommendations made by the Gynecologic Cancer InterGroup unanimously agreed on the importance of PROs and PRO end-points in EOC clinical trials. They recognised that effort must be made to ensure the integrity of collection of PRO data and to avoid missing data. PRO end-points should be based on the PRO hypotheses, be context specific and reflect the patient population and the objectives of treatment (e.g. first line, maintenance therapy, early or late relapse). The PRO end-points inform the choice of PRO measures used in the trial and how the results are analysed and reported. There was agreement that progression-free survival should be supported by PROs among patients with late relapse (platinum sensitive) and that progression-free survival alone was not sufficient as the primary end-point of clinical trials in patients with platinum resistant/refractory EOC and PROs should be included as either the primary/co-primary end-point in this subset of patients. Novel approaches to measure the benefit of palliative chemotherapy such as time until definitive deterioration of Health-Related Quality of Life were recommended. There was consensus to endorse the ISOQOL and CONSORT-PRO guidelines on the inclusion and reporting of PRO endpoints in protocols and that all future EOC Gynecologic Cancer InterGroup trials should adhere to these. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Consensus document on the prevention of methylmercury exposure in Spain: Study group for the prevention of Me-Hg exposure in Spain (GEPREM-Hg).

    PubMed

    González-Estecha, Montserrat; Bodas-Pinedo, Andrés; Guillén-Pérez, José Jesús; Rubio-Herrera, Miguel Ángel; Martínez-Álvarez, Jesús Román; Herráiz-Martínez, Miguel Ángel; Martell-Claros, Nieves; Ordóñez-Iriarte, José M; Sáinz-Martín, María; Farré-Rovira, Rosaura; Martínez-Astorquiza, Txantón; García-Donaire, José Antonio; Calvo-Manuel, Elpidio; Bretón-Lesmes, Irene; Prieto-Menchero, Santiago; Llorente-Ballesteros, M Teresa; Martínez-García, M José; Moreno-Rojas, Rafael; Salas-Salvadó, Jordi; Bermejo-Barrera, Pilar; Cuadrado-Cenzual, M Ángeles; Gallardo-Pino, Carmen; Fuentes, María Blanco; Torres-Moreno, Miriam; Trasobares-Iglesias, Elena M; Martín, Bernardino Barceló; Arroyo-Fernández, Manuel; Calle-Pascual, Alfonso

    2015-10-01

    The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet.

  1. CONSENSUS AND CONFORMITY.

    ERIC Educational Resources Information Center

    ALLEN, VERNON L.; LEVINE, JOHN M.

    IN THIS STUDY, PROFESSOR ALLEN EMPLOYS TWO METHODS OF BREAKING GROUP CONSENSUS, AND HE MEASURES THE EFFECTS ON THE RESPONSES OF COLLEGE SUBJECTS TO BOTH OBJECTIVE AND SUBJECTIVE STIMULI. THE RESULTS SUGGEST THE NEED FOR MODIFICATION OF EXISTING THEORIES OF CONFORMITY BEHAVIOR. IN ADDITION, THESE RESULTS EMPHASIZE THE DIFFERENCES IN CONFORMITY OF…

  2. Glycaemic control and implementation of the ADA/EASD-2006 consensus algorithm in type 2 diabetes mellitus patients in primary care in Spain.

    PubMed

    Alvarez-Guisasola, F

    2014-01-01

    In 2006, the American Diabetes Association and the European Association for the Study of Diabetes established a consensus algorithm (ADA/EASD-2006) for the adjustment of drug therapy for type 2 diabetes mellitus (T2DM). To study glycaemic control in T2DM patients and the implementation of the ADA/EASD-2006 recommendations in primary care centres in Spain. Prospective observational study in 1194 patients with T2DM conducted in 250 primary care centres in Spain. Patients were assessed at study inclusion (V0) and at 3 (V1) and 6 months (V2) post baseline. Information was collected at the level of DM control, HbA(1c) < 7% (HbC) and implementation of the ADA/EASD-2006 guidelines. Type 2 diabetes mellitus patients (53% women; mean age 64.9 years) had a mean (SD) HbA(1c) 7.8 (1.4)% and HbC 25.2% at baseline, 95% of them were receiving oral antihyperglycaemic agents (AAs) only. At V1, HbA(1c) was 7.3 (1.1)% and HbC was 38.1%; 65.0% of patients were receiving oral AAs, 5.6% insulin and 27.9% oral AAs plus insulin. At V2, HbA(1c) was 7.1 (0.9)% and HbC was 48.0%; 57.1% of patients were receiving oral AAs, 5.0% insulin and 36.9% oral AAs plus insulin. The ADA/EASD-2006 algorithm was adhered to in 33% patients up to study month 3, vs. 17.2% throughout the entire 6-month period. In patients with T2DM seen in primary care, the HbA1c target was met in 48.0% after adjusting their AAs. However, this is not reflected in greater implementation of the ADA/EASD-2006 guidelines, which are adhered to in only 17%. © 2013 John Wiley & Sons Ltd.

  3. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee.

    PubMed

    Sonnery-Cottet, Bertrand; Daggett, Matthew; Fayard, Jean-Marie; Ferretti, Andrea; Helito, Camilo Partezani; Lind, Martin; Monaco, Edoardo; de Pádua, Vitor Barion Castro; Thaunat, Mathieu; Wilson, Adrian; Zaffagnini, Stefano; Zijl, Jacco; Claes, Steven

    2017-06-01

    Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy's tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the

  4. [AIDS Study Group/Spanish AIDS Consensus Plan Document on sexually transmitted infections in HIV-infected patients].

    PubMed

    2011-04-01

    Sexually transmitted infections (STI) are a major public health problem. Considering their high morbidity and potential short and long term after effects, physicians must have enough knowledge on the management of these infections for a correct prevention, diagnosis and treatment. HIV infection is associated with STI, not only because they share route of transmission, but also because they lead to an increased risk of HIV transmission. In this article, we summarise the updated clinical practice guidelines, for the evaluation, management and prevention of STI in HIV-infected patients, from a panel of experts in HIV, dermatologists, proctologic surgeons, and microbiologists on behalf of the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan (PNS).

  5. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance.

    PubMed

    Allen, Richard P; Picchietti, Daniel L; Garcia-Borreguero, Diego; Ondo, William G; Walters, Arthur S; Winkelman, John W; Zucconi, Marco; Ferri, Raffaele; Trenkwalder, Claudia; Lee, Hochang B

    2014-08-01

    In 2003, following a workshop at the National Institutes of Health, the International Restless Legs Syndrome Study Group (IRLSSG) developed updated diagnostic criteria for restless legs syndrome/Willis-Ekbom disease (RLS/WED). These criteria were integral to major advances in research, notably in epidemiology, biology, and treatment of RLS/WED. However, extensive review of accumulating literature based on the 2003 NIH/IRLSSG criteria led to efforts to improve the diagnostic criteria further. The clinical standards workshop, sponsored by the WED Foundation and IRLSSG in 2008, started a four-year process for updating the diagnostic criteria. That process included a rigorous review of research advances and input from clinical experts across multiple disciplines. After broad consensus was attained, the criteria were formally approved by the IRLSSG executive committee and membership. Major changes are: (i) addition of a fifth essential criterion, differential diagnosis, to improve specificity by requiring that RLS/WED symptoms not be confused with similar symptoms from other conditions; (ii) addition of a specifier to delineate clinically significant RLS/WED; (iii) addition of course specifiers to classify RLS/WED as chronic-persistent or intermittent; and (iv) merging of the pediatric with the adult diagnostic criteria. Also discussed are supportive features and clinical aspects that are important in the diagnostic evaluation. The IRLSSG consensus criteria for RLS/WED represent an international, interdisciplinary, and collaborative effort intended to improve clinical practice and promote further research. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  6. [Alcohol and work. Consensus Document of the La.R.A. (Workers representing a risk for others) group].

    PubMed

    Magnavita, Nicola; De Lorenzo, G; Gallo, M; Garbarino, S; Goggiamani, A; Janiri, L; Messineo, A; Miggiano, G; Pichini, S; Porpora, A; Poscia, A; Sacco, A; Spagnolo, A G; Vogel, L; Ciprani, F; Deidda, B; Fenudi, L; Magrini, A; Morini, L; Moscato, U; Proietti, A R; Ranalletta, D; Santoro, P E; Soave, P M; Stanzani, C; Bottaro, L C; Ricciardi, W

    2014-11-13

    Current Italian legislation obliges employers to prevent workers who are occupationally at risk or who perform jobs that may be hazardous for the safety or health of third parties from consuming alcohol. The LaRA Group undertook to assess whether the law fully safeguards the health and safety of both workers and third parties, without impinging upon the civil rights of workers. A written document expressing agreement was produced following discussions between doctors, lawyers, bioethicists and social partners. There are gaps and inconsistencies in current laws; the differences in local and regional provisions prevent authorities from applying a single strategy at national level. There should be a change in existing rules under which the employer's obligation to enforce the ban on consumption alcohol in the workplace is enacted solely by the "competent" physician whose institutional role is to safeguard and promote health. Some occupational categories that are subject to a ban on alcohol consumption do not currently under-go health surveillance. For example, if road transport drivers are not exposed to a specific occupational risk foreseen under another law, they can be placed under health surveillance only in those regions where the local laws contemplate this type of control. In other cases, the practice of assessing the risk to third parties and providing for compulsory health surveillance in the Risk Assessment Document, is considered by some jurists to be a "consuetudo praeter legem" and therefore acceptable in a field not yet covered by a specific law, but to be "contra legem" or unlawful by other jurists. Moreover, the competent physician who uses a breathanalyser or tests for alcohol addiction faces an ethical dilemma, since by communicating the results to an employer or authorities responsible for the issuing of licenses, he may be violating his professional oath of secrecy. Furthermore, the emphasis placed on testing has induced companies and inspectors to

  7. Canadian asthma consensus report, 1999

    PubMed Central

    Boulet, L P; Becker, A; Bérubé, D; Beveridge, R; Ernst, P

    1999-01-01

    OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings. OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. OUTCOMES: Provision of the best control of asthma by confirmation of the diagnosis using objective measures, rapid achievement and maintenance of control and regular follow-up. EVIDENCE: The key diagnostic and therapeutic recommendations are based on the 1995 Canadian guidelines and a critical review of the literature by small groups before a full meeting of the consensus group. Recommendations are graded according to 5 levels of evidence. Differences of opinion were resolved by consensus following discussion. VALUES: Respirologists, immunoallergists, pediatricians and emergency and family physicians gave prime consideration to the achievement and maintenance of optimal control of asthma through avoidance of environmental inciters, education of patients and the lowest effective regime of pharmacotherapy to reduce morbidity and mortality. BENEFITS, HARMS AND COSTS: Adherence to the guidelines should be accompanied by significant reduction in patients' symptoms, reduced morbidity and mortality, fewer emergency and hospital admissions, fewer adverse side-effects from medications, better quality of life for patients and reduced costs. RECOMMENDATIONS: Recommendations are included in each section of the report. In summary, after a diagnosis of asthma is made based on clinical evaluation, including demonstration of variable airflow obstruction, and contributing factors are identified, a treatment plan is established to obtain and maintain optimal asthma control. The main components of treatment are patient education

  8. Critical appraisal of the International Study Group of Pancreatic Surgery (ISGPS) consensus definition of postoperative hemorrhage after pancreatoduodenectomy.

    PubMed

    Welsch, Thilo; Eisele, Hanna; Zschäbitz, Stefanie; Hinz, Ulf; Büchler, Markus W; Wente, Moritz N

    2011-08-01

    Postpancreatectomy hemorrhage (PPH) is one of the most serious complications after pancreatoduodenectomy (PD). This study analyzed and validated the International Study Group of Pancreatic Surgery (ISGPS) definition of PPH and aimed to identify risk factors for early (<24 h) and late PPH. Patients who underwent PD for pancreatic head tumors between 2001 and 2008 were included and complications were prospectively recorded. Factors associated with PPH were assessed by uni- and multivariate analysis. Complete datasets were available for 796 patients. Classic and pylorus-preserving PD was performed in 13.8% and 86.2% of the patients, respectively. According to the ISGPS definition, PPH occurred in 29.1% of the cases (232 of 796 patients): 4.8% grade A, 15.2% grade B, and 9.2% grade C. The definition is based largely on surrogate markers (e.g., transfusion requirement) that are affected by other critical illnesses and more than 97% of patients with mild PPH had no clinical signs of bleeding. The need for postoperative intensive care as well as the incidence of pancreatic fistula, relaparotomy, and mortality rates significantly increased from grades A to C. Thirty-seven patients (4.6%) required interventional (endoscopy or angiography) and/or relaparotomy for PPH. Relaparotomy for PPH was performed in 3.1% of all patients. Independent risk factors for early PPH were preoperative anemia (hemoglobin, <11 mg/dl) and multivisceral resection while advanced age, chronic renal insufficiency, increased blood loss, and long operation time were associated with late PPH. The ISGPS definition of PPH is feasible and applicable but produces a high rate of false positive mild PPH cases. The different grades still significantly correlate with relevant outcome variables, thus the definition discriminates postoperative courses, but a minor modification of the definition of mild PPH is suggested. The new results further demonstrate the need to optimize preoperative anemia and chronic renal

  9. Development and Implementation of a Psychoeducational Group for Ghanaian Adolescents Experiencing Parental Divorce

    ERIC Educational Resources Information Center

    Nkyi, Anthony K.

    2015-01-01

    This article presents development and informal assessment of a 10-week psychoeducational program designed for 8 adolescent group members experiencing parental divorce in a rural community in Ghana. Group design, cultural considerations, program implementation, and impacts are described. The literature review pertaining to group work as an…

  10. Implementation of Support Groups in Elementary and Middle School Student Assistance Programs.

    ERIC Educational Resources Information Center

    Rainey, Leslie Martin; Hensley, Fran Austin; Crutchfield, Lori B.

    1997-01-01

    Describes the implementation of Student Assistance Program (SAP) support groups in one middle school and one elementary school. The Health Education department administers the program and licensed school counselors serve in local schools as program counselors. Discusses support group offerings, the procedures used in SAP support groups, and…

  11. Implementing Ability Grouping in EFL Contexts: Perceptions of Teachers and Students

    ERIC Educational Resources Information Center

    Kim, YouJin

    2012-01-01

    Ability grouping--defined as a practice that places students into classrooms or small groups based on an initial assessment of their readiness or ability--has received considerable attention in educational research for years in many countries (Ireson & Hallam, 1999, 2001; Slavin, 1987). In Korea, ability grouping has been implemented in…

  12. Implementation of Support Groups in Elementary and Middle School Student Assistance Programs.

    ERIC Educational Resources Information Center

    Rainey, Leslie Martin; Hensley, Fran Austin; Crutchfield, Lori B.

    1997-01-01

    Describes the implementation of Student Assistance Program (SAP) support groups in one middle school and one elementary school. The Health Education department administers the program and licensed school counselors serve in local schools as program counselors. Discusses support group offerings, the procedures used in SAP support groups, and…

  13. Development and Implementation of a Psychoeducational Group for Ghanaian Adolescents Experiencing Parental Divorce

    ERIC Educational Resources Information Center

    Nkyi, Anthony K.

    2015-01-01

    This article presents development and informal assessment of a 10-week psychoeducational program designed for 8 adolescent group members experiencing parental divorce in a rural community in Ghana. Group design, cultural considerations, program implementation, and impacts are described. The literature review pertaining to group work as an…

  14. Implementing Ability Grouping in EFL Contexts: Perceptions of Teachers and Students

    ERIC Educational Resources Information Center

    Kim, YouJin

    2012-01-01

    Ability grouping--defined as a practice that places students into classrooms or small groups based on an initial assessment of their readiness or ability--has received considerable attention in educational research for years in many countries (Ireson & Hallam, 1999, 2001; Slavin, 1987). In Korea, ability grouping has been implemented in…

  15. The Implementation of Group Investigation to Improve the Students' Speaking Skill

    ERIC Educational Resources Information Center

    Iswardati

    2016-01-01

    This research aimed to find out how group investigation improves the student's speaking skill of the second grade students of SMA 2 Samarinda, how group investigation improves the student's participation in speaking of second grade students of SMA 2 Samarinda, and what the obstacles are in the implementation of Group Investigation. The classroom…

  16. 40 CFR 52.823 - PM10 State Implementation Plan Development in Group II Areas.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Iowa § 52.823 PM10 State Implementation Plan Development in Group II Areas. The Iowa Department of Natural Resources..., dated October 28, 1988, Mr. Larry J. Wilson, Director, Iowa Department of Natural Resources,...

  17. 40 CFR 52.823 - PM10 State Implementation Plan Development in Group II Areas.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Iowa § 52.823 PM10 State Implementation Plan Development in Group II Areas. The Iowa Department of Natural Resources..., dated October 28, 1988, Mr. Larry J. Wilson, Director, Iowa Department of Natural Resources,...

  18. 40 CFR 52.823 - PM10 State Implementation Plan Development in Group II Areas.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Iowa § 52.823 PM10 State Implementation Plan Development in Group II Areas. The Iowa Department of Natural Resources..., dated October 28, 1988, Mr. Larry J. Wilson, Director, Iowa Department of Natural Resources,...

  19. 40 CFR 52.823 - PM10 State Implementation Plan Development in Group II Areas.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Iowa § 52.823 PM10 State Implementation Plan Development in Group II Areas. The Iowa Department of Natural Resources..., dated October 28, 1988, Mr. Larry J. Wilson, Director, Iowa Department of Natural Resources,...

  20. Group Coaching on Pre-School Teachers' Implementation of Pyramid Model Strategies: A Program Description

    ERIC Educational Resources Information Center

    Fettig, Angel; Artman-Meeker, Kathleen

    2016-01-01

    The purpose of this article was to describe a group coaching model and present preliminary evidence of its impact on teachers' implementation of Pyramid Model practices. In particular, we described coaching strategies used to support teachers in reflecting and problem solving on the implementation of the evidence-based strategies. Preliminary…

  1. Group Coaching on Pre-School Teachers' Implementation of Pyramid Model Strategies: A Program Description

    ERIC Educational Resources Information Center

    Fettig, Angel; Artman-Meeker, Kathleen

    2016-01-01

    The purpose of this article was to describe a group coaching model and present preliminary evidence of its impact on teachers' implementation of Pyramid Model practices. In particular, we described coaching strategies used to support teachers in reflecting and problem solving on the implementation of the evidence-based strategies. Preliminary…

  2. Outcomes in Women Treated With MammoSite Brachytherapy or Whole Breast Irradiation Stratified by ASTRO Accelerated Partial Breast Irradiation Consensus Statement Groups

    SciTech Connect

    Zauls, A. Jason; Watkins, John M.; Wahlquist, Amy E.; Brackett, N. Craig; Aguero, Eric G.; Baker, Megan K.; Jenrette, Joseph M.; Garrett-Mayer, Elizabeth; Harper, Jennifer L.

    2012-01-01

    Purpose: The American Society for Radiation Oncology published a Consensus Statement for accelerated partial breast irradiation identifying three groups: Suitable, Cautionary, and Unsuitable. The objective of this study was to compare oncologic outcomes in women treated with MammoSite brachytherapy (MB) vs. whole breast irradiation (WBI) after stratification into Statement groups. Methods: Eligible women had invasive carcinoma or ductal carcinoma in situ (DCIS) {<=}3 cm, and {<=}3 lymph nodes positive. Women were stratified by radiation modality and Statement groups. Survival analysis methods including Kaplan-Meier estimation, Cox regression, and competing risks analysis were used to assess overall survival (OS), disease-free survival (DFS), time to local failure (TTLF), and tumor bed failure (TBF). Results: A total of 459 (183 MB and 276 WBI) patients were treated from 2002 to 2009. After a median follow-up of 45 months, we found no statistical differences by stratification group or radiation modality with regard to OS and DFS. At 4 years TTLF or TBF were not statistically different between the cohorts. Univariate analysis in the MB cohort revealed that nodal positivity (pN1 vs. pN0) was related to TTLF (hazard ratio 6.39, p = 0.02). There was a suggestion that DCIS histology had an increased risk of failure when compared with invasive ductal carcinoma (hazard ratio 3.57, p = 0.06). Conclusions: MB and WBI patients stratified by Statement groups seem to combine women who will have similar outcomes regardless of radiation modality. Although outcomes were similar, we remain guarded in overinterpretation of these preliminary results until further analysis and long-term follow-up data become available. Caution should be used in treating women with DCIS or pN1 disease with MB.

  3. Update on Diagnosis and Treatment of Diabetic Retinopathy: A Consensus Guideline of the Working Group of Ocular Health (Spanish Society of Diabetes and Spanish Vitreous and Retina Society)

    PubMed Central

    Corcóstegui, Borja; Durán, Santiago; González-Albarrán, María Olga; Hernández, Cristina; Ruiz-Moreno, José María; Udaondo, Patricia

    2017-01-01

    A group of members of the Spanish Retina and Vitreous Society (SERV) and of the Working Group of Ocular Health of the Spanish Society of Diabetes (SED) updated knowledge regarding the diagnosis and treatment of diabetic retinopathy (DR) based on recent evidence reported in the literature. A synthesis of this consensus forms the basis of the present review, which is intended to inform clinicians on current advances in the field of DR and their clinical applicability to patients with this disease. Aspects presented in this article include screening procedures of DR, new technologies in the early diagnosis of DR, control of risk factors in the different stages of the disease, indications of panretinal laser photocoagulation, efficacy of intravitreal antiangiogenic agents and steroids, and surgical options for treating DR-related complications. Practical information regarding periodicity of screening procedures in patients with type 1 and type 2 diabetes, ophthalmological controls according to the stage of retinopathy and complications, and criteria and degree of urgency for referral of a DR patient to the ophthalmologist are also presented. PMID:28695003

  4. A Systematic Review of Therapeutic Alliance, Group Cohesion, Empathy, and Goal Consensus/Collaboration in Psychotherapeutic Interventions in Cancer: Uncommon Factors?

    PubMed Central

    Schnur, Julie B.; Montgomery, Guy H.

    2010-01-01

    The effects of four empirically supported therapeutic relationship factors (therapeutic alliance, empathy, goal consensus/collaboration, and group cohesion) on the outcome of psychotherapeutic interventions conducted with individuals living with cancer were systematically reviewed. PubMed, PsycINFO, and CINAHL were searched from their inception through November 13, 2008. Studies of psychotherapeutic interventions targeted to individuals living with cancer, which also empirically assessed the association between any of these therapeutic relationship factors and psychotherapy outcome were included in the review (8 of 742 papers initially reviewed). Information on study methodology and results were abstracted independently by the authors using a standardized form. Results indicated that therapist-rated rapport and group cohesion were significantly related to positive psychotherapeutic outcomes. No studies examined empathy. The literature on collaboration was mixed, but showed some support for increased collaboration being related to positive therapeutic outcomes. Overall the current literature on the role of therapeutic relationship factors in the context of individuals living with cancer is scant, and much more research is needed to determine the overall contribution of these four relationship elements to the outcomes of psychotherapeutic interventions for individuals living with cancer. Results of such studies could have important clinical and research implications. PMID:20006414

  5. Clinical practice guidelines for the surgical management of colon cancer: a consensus statement of the Hellenic and Cypriot Colorectal Cancer Study Group by the HeSMO.

    PubMed

    Xynos, Evaghelos; Gouvas, Nikolaos; Triantopoulou, Charina; Tekkis, Paris; Vini, Louiza; Tzardi, Maria; Boukovinas, Ioannis; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Dervenis, Christos; Emmanouilidis, Christos; Georgiou, Panagiotis; Katopodi, Ourania; Kountourakis, Panteleimon; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Vassiliou, Vassilios; Xynogalos, Spyridon; Ziras, Nikolaos; Karachaliou, Niki; Zoras, Odysseas; Agalianos, Christos; Souglakos, John

    2016-01-01

    Despite considerable improvement in the management of colon cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centers in Greece and Cyprus. Discrepancy in the approach strategies and lack of adherence to guidelines for the management of colon cancer may explain the situation. The aim was to elaborate a consensus on the multidisciplinary management of colon cancer, based on European guidelines (ESMO and EURECCA), and also taking into account local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Statements entered the Delphi voting system on two rounds to achieve consensus by multidisciplinary international experts. Statements with an agreement rate of ≥80% achieved a large consensus, while those with an agreement rate of 60-80% a moderate consensus. Statements achieving an agreement of <60% after both rounds were rejected and not presented. Sixty statements on the management of colon cancer were subjected to the Delphi methodology. Voting experts were 109. The median rate of abstain per statement was 10% (range: 0-41%). In the end of the voting process, all statements achieved a consensus by more than 80% of the experts. A consensus on the management of colon cancer was developed by applying the Delphi methodology. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralization, care by a multidisciplinary team, and adherence to guidelines is emphasized.

  6. Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report.

    PubMed

    Shulman, Howard M; Kleiner, David; Lee, Stephanie J; Morton, Thomas; Pavletic, Steven Z; Farmer, Evan; Moresi, J Margaret; Greenson, Joel; Janin, Anne; Martin, Paul J; McDonald, George; Flowers, Mary E D; Turner, Maria; Atkinson, Jane; Lefkowitch, Jay; Washington, M Kay; Prieto, Victor G; Kim, Stella K; Argenyi, Zsolt; Diwan, A Hafeez; Rashid, Asif; Hiatt, Kim; Couriel, Dan; Schultz, Kirk; Hymes, Sharon; Vogelsang, Georgia B

    2006-01-01

    This consensus document provides an update for pathologists and clinicians about the interpretation of biopsy results and use of this information in the management of hematopoietic cell transplantation patients. Optimal sampling and tissue preparation are discussed. Minimal criteria for the diagnosis of graft-versus-host disease (GVHD) are proposed, together with specific requirements for the diagnosis of chronic GVHD. Four final diagnostic categories (no GVHD, possible GVHD, consistent with GVHD, and definite GVHD) reflect the integration of histopathology with clinical, laboratory, and radiographic information. Finally, the Working Group developed a set of worksheets to facilitate communication of clinical information to the interpreting pathologist and to aid in clinicopathologic correlation studies. Forms are available at . The recommendations of the Working Group represent a consensus opinion supplemented by evaluation of available peer-reviewed literature. Consensus recommendations and suggested data-capture forms should be validated in prospective clinicopathologic studies.

  7. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    SciTech Connect

    Goodman, Karyn A.; Regine, William F.; Dawson, Laura A.; Ben-Josef, Edgar; Haustermans, Karin; Bosch, Walter R.; Turian, Julius; Abrams, Ross A.

    2012-07-01

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  8. Assessment of antibody responses against gp41 in HIV-1-infected patients using soluble gp41 fusion proteins and peptides derived from M group consensus envelope

    PubMed Central

    Penn-Nicholson, Adam; Han, Dong P.; Kim, Soon J.; Park, Hanna; Ansari, Rais; Montefiori, David C.; Cho, Michael W.

    2008-01-01

    Human immunodeficiency virus type 1 (HIV-1) transmembrane glycoprotein gp41 is targeted by broadly-reactive neutralizing antibodies 2F5 and 4E10, making it an attractive target for vaccine development. To better assess immunogenic properties of gp41, we generated five soluble glutathione S-transferase fusion proteins encompassing C-terminal 30, 64, 100, 142, or 172 (full-length) amino acids of gp41 ectodomain from M group consensus envelope sequence. Antibody responses in HIV-1-infected patients were evaluated using these proteins and overlapping peptides. We found (i) antibody responses against different regions of gp41 varied tremendously among individual patients, (ii) patients with stronger antibody responses against membrane-proximal external region exhibit broader and more potent neutralizing activity, and (iii) several patients mounted antibodies against epitopes that are near, or overlap with, those targeted by 2F5 or 4E10. These soluble gp41 fusion proteins could be an important source of antigens for future vaccine development efforts. PMID:18068750

  9. Consensus report on the radiological management of patients with gastrointestinal stromal tumours (GIST): recommendations of the German GIST Imaging Working Group.

    PubMed

    Kalkmann, Janine; Zeile, Martin; Antoch, Gerald; Berger, Frank; Diederich, Stefan; Dinter, Dietmar; Fink, Christian; Janka, Rolf; Stattaus, Jörg

    2012-05-07

    The aim was to reach consensus in imaging for staging and follow-up as well as for therapy response assessment in patients with gastrointestinal stromal tumours (GIST). The German GIST Imaging Working Group was formed by 9 radiologists engaged in assessing patients with GIST treated with targeted therapy. The following topics were discussed: indication and optimal acquisition techniques of computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET)/CT; tumour response assessment considering response criteria and measurement techniques on CT, MRI and PET/CT; result interpretation; staging interval and pitfalls. Contrast-enhanced CT is the standard method for GIST imaging. MRI is the method of choice in case of liver-specific questions or contraindications to CT. PET/CT should be used for early response assessment or inconclusive results on morphologic imaging. All imaging techniques should be standardized allowing a reliable response assessment. Response has to be assessed with respect to lesion size, lesion density and appearance of new lesions. A critical issue is pseudoprogression due to myxoid degeneration or intratumoural haemorrhage. The management of patients with GIST receiving a targeted therapy requires a standardized algorithm for imaging and an appropriate response assessment with respect to changes in lesion size and density.

  10. [Adalimumab for the treatment of ulcerative colitis--a consensus report by the working group inflammatory bowel diseases of the Austrian Society of Gastroenterology and Hepatology].

    PubMed

    Novacek, G; Dejaco, C; Knoflach, P; Moschen, A; Petritsch, W; Vogelsang, H; Reinisch, W

    2014-02-01

    TNF alpha antibodies have clearly improved the outcome of moderately to severely active ulcerative colitis. Adalimumab is the first fully human, monoclonal TNF alpha antibody, which is administered subcutaneously. Since April 2012 adalimumab is approved for the treatment of moderately to severely active ulcerative colitis in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and an immunosuppressant or who are intolerant to or have medical contraindications for such therapies. Adalimumab can induce and maintain clinical remission and mucosal healing compared to placebo in moderately to severely active ulcerative colitis, can reduce the rate of ulcerative colitis related hospitalisations and improve health-related quality of life. The response can be observed after two weeks of treatment. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Studies on the treatment of ulcerative colitis with adalimumab did not reveal new safety aspects. The present consensus report by the Working Group Inflammatory Bowel Diseases of the Austrian Society of Gastroenterology and Hepatology presents the existing evidence of adalimumab for the treatment of ulcerative colitis and is aimed to assist as code of its practice. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics".

    PubMed

    Muscaritoli, M; Anker, S D; Argilés, J; Aversa, Z; Bauer, J M; Biolo, G; Boirie, Y; Bosaeus, I; Cederholm, T; Costelli, P; Fearon, K C; Laviano, A; Maggio, M; Rossi Fanelli, F; Schneider, S M; Schols, A; Sieber, C C

    2010-04-01

    Chronic diseases as well as aging are frequently associated with deterioration of nutritional status, loss muscle mass and function (i.e. sarcopenia), impaired quality of life and increased risk for morbidity and mortality. Although simple and effective tools for the accurate screening, diagnosis and treatment of malnutrition have been developed during the recent years, its prevalence still remains disappointingly high and its impact on morbidity, mortality and quality of life clinically significant. Based on these premises, the Special Interest Group (SIG) on cachexia-anorexia in chronic wasting diseases was created within ESPEN with the aim of developing and spreading the knowledge on the basic and clinical aspects of cachexia and anorexia as well as of increasing the awareness of cachexia among health professionals and care givers. The definition, the assessment and the staging of cachexia, were identified as a priority by the SIG. This consensus paper reports the definition of cachexia, pre-cachexia and sarcopenia as well as the criteria for the differentiation between cachexia and other conditions associated with sarcopenia, which have been developed in cooperation with the ESPEN SIG on nutrition in geriatrics. Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  12. Assessment of antibody responses against gp41 in HIV-1-infected patients using soluble gp41 fusion proteins and peptides derived from M group consensus envelope

    SciTech Connect

    Penn-Nicholson, Adam; Han, Dong P.; Kim, Soon J.; Park, Hanna; Ansari, Rais; Montefiori, David C.; Cho, Michael W.

    2008-03-15

    Human immunodeficiency virus type 1 (HIV-1) transmembrane glycoprotein gp41 is targeted by broadly-reactive neutralizing antibodies 2F5 and 4E10, making it an attractive target for vaccine development. To better assess immunogenic properties of gp41, we generated five soluble glutathione S-transferase fusion proteins encompassing C-terminal 30, 64, 100, 142, or 172 (full-length) amino acids of gp41 ectodomain from M group consensus envelope sequence. Antibody responses in HIV-1-infected patients were evaluated using these proteins and overlapping peptides. We found (i) antibody responses against different regions of gp41 varied tremendously among individual patients, (ii) patients with stronger antibody responses against membrane-proximal external region exhibit broader and more potent neutralizing activity, and (iii) several patients mounted antibodies against epitopes that are near, or overlap with, those targeted by 2F5 or 4E10. These soluble gp41 fusion proteins could be an important source of antigens for future vaccine development efforts.

  13. Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation.

    PubMed

    Bourke, Billy; Ceponis, Peter; Chiba, Naoki; Czinn, Steve; Ferraro, Richard; Fischbach, Lori; Gold, Ben; Hyunh, Hien; Jacobson, Kevan; Jones, Nicola L; Koletzko, Sibylle; Lebel, Sylvie; Moayyedi, Paul; Ridell, Robert; Sherman, Philip; van Zanten, Sander; Beck, Ivan; Best, Linda; Boland, Margaret; Bursey, Ford; Chaun, Hugh; Cooper, Geraldine; Craig, Brian; Creuzenet, Carole; Critch, Jeffrey; Govender, Krishnasamy; Hassall, Eric; Kaplan, Alan; Keelan, Monica; Noad, Garth; Robertson, Marli; Smith, Lesley; Stein, Markus; Taylor, Diane; Walters, Thomas; Persaud, Robin; Whitaker, Scott; Woodland, Robert

    2005-07-01

    As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H. pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H. pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H. pylori infection; recurrent abdominal pain of childhood is not an indication to test for H. pylori infection; H. pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H. pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H. pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H. pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H. pylori infection; serological antibody tests are not recommended as diagnostic tools for H. pylori infection in children; first-line therapy for H. pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics

  14. Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection

    PubMed Central

    Bajaj, L.; Hoffman, J.; Alessandrini, E.; Ballard, D. W.; Norris, R.; Tzimenatos, L.; Swietlik, M.; Tham, E.; Grundmeier, R. W.; Kuppermann, N.; Dayan, P. S.

    2015-01-01

    Summary Background Overuse of cranial computed tomography scans in children with blunt head trauma unnecessarily exposes them to radiation. The Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma prediction rules identify children who do not require a computed tomography scan. Electronic health record (EHR) based clinical decision support (CDS) may effectively implement these rules but must only be provided for appropriate patients in order to minimize excessive alerts. Objectives To develop, implement and evaluate site-specific groupings of chief complaints (CC) that accurately identify children with head trauma, in order to activate data collection in an EHR. Methods As part of a 13 site clinical trial comparing cranial computed tomography use before and after implementation of CDS, four PECARN sites centrally developed and locally implemented CC groupings to trigger a clinical trial alert (CTA) to facilitate the completion of an emergency department head trauma data collection template. We tested and chose CC groupings to attain high sensitivity while maintaining at least moderate specificity. Results Due to variability in CCs available, identical groupings across sites were not possible. We noted substantial variability in the sensitivity and specificity of seemingly similar CC groupings between sites. The implemented CC groupings had sensitivities greater than 90% with specificities between 75–89%. During the trial, formal testing and provider feedback led to tailoring of the CC groupings at some sites. Conclusions CC groupings can be successfully developed and implemented across multiple sites to accurately identify patients who should have a CTA triggered to facilitate EHR data collection. However, CC groupings will necessarily vary in order to attain high sensitivity and moderate-to-high specificity. In future trials, the balance between sensitivity and specificity should be considered based on the nature of the clinical condition

  15. 40 CFR 52.1423 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... classified as Group II areas for the purpose of PM10 State Implementation Plan (SIP) development. The... accordance with the requirements for PM10 SIP development, the State of Nebraska commits to perform the following PM10 monitoring and SIP development activities for these Group II areas: (1) Gather ambient...

  16. 40 CFR 52.1423 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... classified as Group II areas for the purpose of PM10 State Implementation Plan (SIP) development. The... accordance with the requirements for PM10 SIP development, the State of Nebraska commits to perform the following PM10 monitoring and SIP development activities for these Group II areas: (1) Gather ambient...

  17. 40 CFR 52.1423 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... classified as Group II areas for the purpose of PM10 State Implementation Plan (SIP) development. The... accordance with the requirements for PM10 SIP development, the State of Nebraska commits to perform the following PM10 monitoring and SIP development activities for these Group II areas: (1) Gather ambient...

  18. Creating and Implementing a Faculty Interest Group for Historically Underrepresented Faculty

    ERIC Educational Resources Information Center

    Follins, Lourdes D.; Paler, Lisa K.; Nanin, Jose E.

    2015-01-01

    This article describes the creation and implementation of a faculty interest group for historically underrepresented faculty at a large, urban community college in the Northeast. Faculty interest groups provide opportunities for faculty across disciplines to meet to explore common interests and share concerns and best practices. The faculty…

  19. Implementation of IAEA /1/INT/054 Project in Nuclear Analytical Techniques Group of Argentina: Current State

    SciTech Connect

    Sara, Resnizky; Rita, Pla; Alba, Zaretzky

    2008-08-14

    This paper presents the implementation of the training received through the IAEA Project 'Preparation of Reference Materials and Organization of Proficiency Tests Rounds' in the Nuclear Analytical (NAT) Group of CNEA. Special emphasis is done on those activities related to the first Proficiency Test being carried out by the NAT Group.

  20. 40 CFR 52.1423 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... development in group II areas. 52.1423 Section 52.1423 Protection of Environment ENVIRONMENTAL PROTECTION...) Nebraska § 52.1423 PM10 State implementation plan development in group II areas. The state of Nebraska committed to conform to the PM10 regulations as set forth in 40 CFR part 51. In a letter to Morris Kay, EPA...

  1. Implementation of IAEA /1/INT/054 Project in Nuclear Analytical Techniques Group of Argentina: Current State

    NASA Astrophysics Data System (ADS)

    Sara, Resnizky; Rita, Plá; Alba, Zaretzky

    2008-08-01

    This paper presents the implementation of the training received through the IAEA Project "Preparation of Reference Materials and Organization of Proficiency Tests Rounds" in the Nuclear Analytical (NAT) Group of CNEA. Special emphasis is done on those activities related to the first Proficiency Test being carried out by the NAT Group.

  2. Role of Imaging in the Staging and Response Assessment of Lymphoma: Consensus of the International Conference on Malignant Lymphomas Imaging Working Group

    PubMed Central

    Barrington, Sally F.; Mikhaeel, N. George; Kostakoglu, Lale; Meignan, Michel; Hutchings, Martin; Müeller, Stefan P.; Schwartz, Lawrence H.; Zucca, Emanuele; Fisher, Richard I.; Trotman, Judith; Hoekstra, Otto S.; Hicks, Rodney J.; O'Doherty, Michael J.; Hustinx, Roland; Biggi, Alberto; Cheson, Bruce D.

    2014-01-01

    Purpose Recent advances in imaging, use of prognostic indices, and molecular profiling techniques have the potential to improve disease characterization and outcomes in lymphoma. International trials are under way to test image-based response–adapted treatment guided by early interim positron emission tomography (PET) –computed tomography (CT). Progress in imaging is influencing trial design and affecting clinical practice. In particular, a five-point scale to grade response using PET-CT, which can be adapted to suit requirements for early- and late-response assessment with good interobserver agreement, is becoming widely used both in practice- and response-adapted trials. A workshop held at the 11th International Conference on Malignant Lymphomas (ICML) in 2011 concluded that revision to current staging and response criteria was timely. Methods An imaging working group composed of representatives from major international cooperative groups was asked to review the literature, share knowledge about research in progress, and identify key areas for research pertaining to imaging and lymphoma. Results A working paper was circulated for comment and presented at the Fourth International Workshop on PET in Lymphoma in Menton, France, and the 12th ICML in Lugano, Switzerland, to update the International Harmonisation Project guidance regarding PET. Recommendations were made to optimize the use of PET-CT in staging and response assessment of lymphoma, including qualitative and quantitative methods. Conclusion This article comprises the consensus reached to update guidance on the use of PET-CT for staging and response assessment for [18F]fluorodeoxyglucose-avid lymphomas in clinical practice and late-phase trials. PMID:25113771

  3. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

    PubMed Central

    Carpenter, Paul A.; Kitko, Carrie L.; Elad, Sharon; Flowers, Mary E.D.; Gea-Banacloche, Juan C.; Halter, Jörg P.; Hoodin, Flora; Johnston, Laura; Lawitschka, Anita; McDonald, George B.; Opipari, Anthony W.; Savani, Bipin N.; Schultz, Kirk R.; Smith, Sean R.; Syrjala, Karen L.; Treister, Nathaniel; Vogelsang, Georgia B.; Williams, Kirsten M.; Pavletic, Steven Z.; Martin, Paul J.; Lee, Stephanie J.; Couriel, Daniel R.

    2016-01-01

    The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence. PMID:25838185

  4. Consensus on consensus: a synthesis of consensus estimates on human-caused global warming

    NASA Astrophysics Data System (ADS)

    Cook, John; Oreskes, Naomi; Doran, Peter T.; Anderegg, William R. L.; Verheggen, Bart; Maibach, Ed W.; Carlton, J. Stuart; Lewandowsky, Stephan; Skuce, Andrew G.; Green, Sarah A.; Nuccitelli, Dana; Jacobs, Peter; Richardson, Mark; Winkler, Bärbel; Painting, Rob; Rice, Ken

    2016-04-01

    The consensus that humans are causing recent global warming is shared by 90%-100% of publishing climate scientists according to six independent studies by co-authors of this paper. Those results are consistent with the 97% consensus reported by Cook et al (Environ. Res. Lett. 8 024024) based on 11 944 abstracts of research papers, of which 4014 took a position on the cause of recent global warming. A survey of authors of those papers (N = 2412 papers) also supported a 97% consensus. Tol (2016 Environ. Res. Lett. 11 048001) comes to a different conclusion using results from surveys of non-experts such as economic geologists and a self-selected group of those who reject the consensus. We demonstrate that this outcome is not unexpected because the level of consensus correlates with expertise in climate science. At one point, Tol also reduces the apparent consensus by assuming that abstracts that do not explicitly state the cause of global warming (‘no position’) represent non-endorsement, an approach that if applied elsewhere would reject consensus on well-established theories such as plate tectonics. We examine the available studies and conclude that the finding of 97% consensus in published climate research is robust and consistent with other surveys of climate scientists and peer-reviewed studies.

  5. Statewide implementation of recovery support groups for people with serious mental illness: a multidimensional evaluation.

    PubMed

    Mancini, Michael A; Linhorst, Donald M; Menditto, Anthony A; Coleman, James

    2013-10-01

    This study evaluated a statewide demonstration project to implement a group-based intervention called Procovery in selected inpatient and community mental health centers. Procovery is a facilitated mutual support group designed to build hope and a sense of social inclusion by raising consciousness and helping people develop an understanding of the ways one can move toward recovery in their own lives. This evaluation sought to determine both consumer outcomes and perceptions of the program and implementation efforts held by consumers and the facilitators of the intervention. A multidimensional approach was used, including a quasi-experimental design with consumers, questionnaires and focus groups with the intervention facilitators, and individual interviews with administrators. The Procovery model was shown to have a positive impact on consumers' recoveries and was viewed favorably by consumers, facilitators, and administrators. Several barriers to effective implementation were identified. These findings and their implications for future practice and research are discussed.

  6. [Stability of home based care arrangements for people with dementia : Development of a consensus definition of stability using expert focus groups].

    PubMed

    von Kutzleben, Milena; Köhler, Kerstin; Dreyer, Jan; Holle, Bernhard; Roes, Martina

    2017-04-01

    The majority of people with dementia in Germany live at home. These informal care arrangements, which are mostly coordinated by informal carers, are the backbone of home-based dementia care. Creating and maintaining stability is an underlying theme in informal care; however, a definition of the complex phenomenon of 'stability' in this context is still lacking. The aim was to develop a working definition of stability of home-based care arrangements for people with dementia, which can be applied in current and future research projects at the German Center for Neurodegenerative Diseases in Witten (DZNE Witten) and others. Ensuing from prior research a preliminary version of the definition was formulated. This definition was discussed in a focus group of scientific experts with expertise in dementia research and care (n = 8). After data analysis using content analysis, the definition was revised during a scientific colloquium (n = 18) and a consensus was finally reached. There were four major themes which were considered by the experts as being relevant for the definition of stability: (1) creating and maintaining stability as a continuous adaptation process, (2) a qualitative component of stability, (3) persons with dementia and informal carers as pivotal players and (4) transitions to residential care. The working definition introduced in this article reflects the authors' understanding of the phenomenon of stability of home-based care arrangements for people with dementia. In times of increasing need for evidence-based interventions it is necessary to develop elaborated definitions of complex phenomena in order to be able to systematically evaluate the efficacy of interventions on the basis of a common understanding.

  7. The clinical utility of CA125/MUC16 in pancreatic cancer: A consensus of diagnostic, prognostic and predictive updates by the Chinese Study Group for Pancreatic Cancer (CSPAC).

    PubMed

    Liu, Liang; Xiang, Jinfeng; Chen, Rufu; Fu, Deliang; Hong, Defei; Hao, Jihui; Li, Yixiong; Li, Jiangtao; Li, Shengping; Mou, Yiping; Mai, Gang; Ni, Quanxing; Peng, Li; Qin, Renyi; Qian, Honggang; Shao, Chenghao; Sun, Bei; Sun, Yongwei; Tao, Min; Tian, Bole; Wang, Hongxia; Wang, Jian; Wang, Liwei; Wang, Wei; Wang, Weilin; Zhang, Jun; Zhao, Gang; Zhou, Jun; Yu, Xianjun

    2016-03-01

    The prognosis for pancreatic cancer (PC) is poor; however, the timely and accurate treatment of this disease will significantly improve prognosis. Serum biomarkers involve non-invasive tests that facilitate the early detection of tumors, predict outcomes and assess responses to therapy, so that the patient can be continuously monitored and receive the most appropriate therapy. Studies have reported that cancer antigen (CA)125 [also known as mucin 16 (MUC16)] has functional significance in the tumorigenic, metastatic and drug resistant properties of PC. Our aim was to use this biomarker in the diagnosis, detection of metastasis, prognosis and in the monitoring of the treatment effects of PC. Members of the Chinese Study Group for Pancreatic Cancer (CSPAC) reviewed the literature on CA125/MUC16 and developed an objective consensus on the clinical utility of CA125/MUC16 for PC. They confirmed the role of CA125/MUC16 in tumorigenesis and the progression of PC, and recommended monitoring CA125/MUC16 levels in all aspects of the diagnosis and treatment of PC, particularly those that involve the monitoring of treatments. In addition, they suggested that the combination of other biomarkers and imaging techniques, together with CA125/MUC16, would improve the accuracy of the clinical decision-making process, thereby facilitating the optimization of treatment strategies. Periodic clinical updates of the use of CA125/MUC16 have been established, which are important for further analyses and comparisons of clinical results from affiliates and countries, particularly as regards the in-depth biological function and clinical translational research of this biomarker.

  8. Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: a consensus process by an EBMT/ELN international working group.

    PubMed

    Kröger, N M; Deeg, J H; Olavarria, E; Niederwieser, D; Bacigalupo, A; Barbui, T; Rambaldi, A; Mesa, R; Tefferi, A; Griesshammer, M; Gupta, V; Harrison, C; Alchalby, H; Vannucchi, A M; Cervantes, F; Robin, M; Ditschkowski, M; Fauble, V; McLornan, D; Ballen, K; Popat, U R; Passamonti, F; Rondelli, D; Barosi, G

    2015-11-01

    The aim of this work is to produce recommendations on the management of allogeneic stem cell transplantation (allo-SCT) in primary myelofibrosis (PMF). A comprehensive systematic review of articles released from 1999 to 2015 (January) was used as a source of scientific evidence. Recommendations were produced using a Delphi process involving a panel of 23 experts appointed by the European LeukemiaNet and European Blood and Marrow Transplantation Group. Key questions included patient selection, donor selection, pre-transplant management, conditioning regimen, post-transplant management, prevention and management of relapse after transplant. Patients with intermediate-2- or high-risk disease and age <70 years should be considered as candidates for allo-SCT. Patients with intermediate-1-risk disease and age <65 years should be considered as candidates if they present with either refractory, transfusion-dependent anemia, or a percentage of blasts in peripheral blood (PB) >2%, or adverse cytogenetics. Pre-transplant splenectomy should be decided on a case by case basis. Patients with intermediate-2- or high-risk disease lacking an human leukocyte antigen (HLA)-matched sibling or unrelated donor, should be enrolled in a protocol using HLA non-identical donors. PB was considered the most appropriate source of hematopoietic stem cells for HLA-matched sibling and unrelated donor transplants. The optimal intensity of the conditioning regimen still needs to be defined. Strategies such as discontinuation of immune-suppressive drugs, donor lymphocyte infusion or both were deemed appropriate to avoid clinical relapse. In conclusion, we provided consensus-based recommendations aimed to optimize allo-SCT in PMF. Unmet clinical needs were highlighted.

  9. Pilot Implementation of a Wellness and Tobacco Cessation Curriculum in North Carolina Group Homes.

    PubMed

    Baker, Hannah M; Ranney, Leah M; Goldstein, Adam O

    2016-05-01

    Despite a steady decline in smoking rates in recent decades, individuals with mental illness continue to smoke at disproportionately higher rates than the general population. Adults with mental illness are motivated to quit and quit with rates similar to the general population when evidence-based cessation interventions are used. To build an evidence base for a wellness and cessation curriculum aimed at individuals with mental illness, the Breathe Easy Live Well (BELW) program was pilot tested in two group homes in North Carolina in the spring of 2014. Evaluators conducted pre- and post-implementation site visits and interviews with program instructors to assess outcomes as well as barriers and facilitators to implementation. Qualitative analysis of the data indicated that implementation was successful in both group homes, and the following themes emerged: (1) Training and technical assistance provided throughout implementation was sufficient; (2) Instructors used prior professional experiences and goal setting to facilitate program success and participant engagement; (3) Fostering positive coping strategies contributed to reports of reduced smoking; (4) Curriculum length may be a barrier to recruitment. Additional results included an increased interest among group home residents in more diligently managing mental illness symptoms and one group home moving the designated smoking area out of the direct path of the entrance/exit. Results of this pilot project suggest that BELW could be a potentially useful tool for group home staff to address health and wellness along with smoking cessation among individuals with mental illness.

  10. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report

    PubMed Central

    Jagasia, Madan H.; Greinix, Hildegard T.; Arora, Mukta; Williams, Kirsten M.; Wolff, Daniel; Cowen, Edward W.; Palmer, Jeanne; Weisdorf, Daniel; Treister, Nathaniel S.; Cheng, Guang-Shing; Kerr, Holly; Stratton, Pamela; Duarte, Rafael F.; McDonald, George B.; Inamoto, Yoshihiro; Vigorito, Afonso; Arai, Sally; Datiles, Manuel B.; Jacobsohn, David; Heller, Theo; Kitko, Carrie L.; Mitchell, Sandra A.; Martin, Paul J.; Shulman, Howard; Wu, Roy S.; Cutler, Corey S.; Vogelsang, Georgia B.; Lee, Stephanie J.; Pavletic, Steven Z.; Flowers, Mary E.D.

    2015-01-01

    The 2005 National Institutes of Health (NIH) Consensus Conference proposed new criteria for diagnosing and scoring the severity of chronic GVHD. The 2014 NIH consensus maintains the framework of the prior consensus with further refinement based on new evidence. Revisions have been made to address areas of controversy or confusion, such as the overlap chronic GVHD subcategory and the distinction between active disease and past tissue damage. Diagnostic criteria for involvement of mouth, eyes, genitalia, and lungs have been revised. Categories of chronic GVHD should be defined in ways that indicate prognosis, guide treatment, and define eligibility for clinical trials. Revisions have been made to focus attention on the causes of organ-specific abnormalities. Attribution of organ-specific abnormalities to chronic GVHD has been addressed. This paradigm shift provides greater specificity, more accurately measures the global burden of disease attributed to GVHD, and will facilitate biomarker association studies. PMID:25529383

  11. Forming and activating an internal facilitation group for successful implementation: A qualitative study.

    PubMed

    McCullough, Megan B; Gillespie, Chris; Petrakis, Beth Ann; Jones, Ellen A; Park, Angela M; Lukas, Carol VanDeusen; Rose, Adam J

    detailing how internal facilitators learn their skills over time, and how a group of internal facilitators can help each other succeed. These findings can guide those who wish to incorporate internal facilitation teams as an implementation strategy, and demonstrate how sites can build capacity for implementation efforts. This study focuses on an implementation facilitation strategy to improve the delivery of anticoagulation care within pharmacy-run clinics across 8 Veterans Health Administration medical centers. Internal facilitators (IFs) guided by and supported by an external facilitators (EF), successfully implemented the clinical innovation. This study examines how the IF group became instrumental in the successful implementation of evidence-based practice change. Published by Elsevier Inc.

  12. Sporting programs for inactive population groups: factors influencing implementation in the organized sports setting.

    PubMed

    Ooms, Linda; Veenhof, Cindy; Schipper-van Veldhoven, Nicolette; de Bakker, Dinny H

    2015-01-01

    The organized sports sector has received increased attention as a setting to promote health-enhancing physical activity (HEPA) to the general population. For significant public health impact, it is important that successful HEPA programs are widely adopted, implemented and continued as ongoing practice. The importance of evaluating the context in which programs are implemented has been identified as critical. However, little research has focused on understanding the organized sports implementation context, including factors facilitating and impeding implementation. In this study, the main factors influencing implementation of HEPA programs in the organized sports setting were studied. Fourteen sporting programs in the Netherlands aimed at increasing participation in sports by inactive population groups and funded within the National Action Plan for Sport and Exercise (NAPSE) were investigated. The programs were developed by ten Dutch National Sports Federations (NSFs) and implemented by different sports clubs in the Netherlands over a 3-year implementation period (June 2008-June 2011). The qualitative research component involved yearly face-to-face interviews (i.e. fourteen interviews each year, n = 12 program coordinators) and a group meeting with the program coordinators of the NSFs (n = 8). Cross-case comparisons and thematic analyses were performed to identify and categorize important facilitating and impeding factors respectively. The quantitative research component, used to identify the most important facilitating and impeding factors across all sporting programs, consisted of ranking of factors according to importance by the program coordinators (n = 12). Different factors act during six identified (implementation) phases. When comparing factors across phases, several key learnings were evident. Successful implementation relied, for example, on program design and enthusiastic individuals within sporting organizations. On the other hand, inactive

  13. Implementing high-fidelity simulations with large groups of nursing students.

    PubMed

    Hooper, Barbara; Shaw, Luanne; Zamzam, Rebekah

    2015-01-01

    Nurse educators are increasing the use of simulation as a teaching strategy. Simulations are conducted typically with a small group of students. This article describes the process for implementing 6 high-fidelity simulations with a large group of undergraduate nursing students. The goal was to evaluate if student knowledge increased on postsimulation quiz scores when only a few individuals actively participated in the simulation while the other students observed.

  14. The implementation of problem-based learning in collaborative groups in a chiropractic program in Malaysia

    PubMed Central

    Win, Ni Ni; Nadarajah, Vishna Devi V; Win, Daw Khin

    2015-01-01

    Purpose: Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness. Methods: This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students’ perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work. Results: Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students’ motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001). Conclusion: The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources. PMID:25961676

  15. The implementation of problem-based learning in collaborative groups in a chiropractic program in Malaysia.

    PubMed

    Win, Ni Ni; Nadarajah, Vishna Devi V; Win, Daw Khin

    2015-01-01

    Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness. This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students' perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work. Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students' motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001). The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources.

  16. Students' Reflections on Implementation of Group Investigation in Korean Secondary Science Classrooms

    ERIC Educational Resources Information Center

    Oh, Phil Seok; Shin, Myeong-Kyeong

    2005-01-01

    Student reflective ideas were examined with respect to Group Investigation (GI), which was employed in 11th grade Korean earth science classrooms. A modified GI method was implemented during the course of an action research effort consisting of two yearlong projects. Students' writings, which had been produced twice a year, were analyzed to reveal…

  17. Development and Implementation of an International Counseling Outreach Effort in Bhutan: A Group Stage Conceptualization

    ERIC Educational Resources Information Center

    Guth, Lorraine J.; Lorelle, Sonya; Hinkle, J. Scott; Remley, Theodore P.

    2015-01-01

    This article highlights the development and implementation of an international counseling outreach program in Bhutan using a group stage conceptualization that includes the initial, transition, working, and final stages. The initial stage included a counseling initiative started by one of the queens as well as meetings with key leaders from the…

  18. 40 CFR 52.881 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... State implementation plan development in group II areas. The state has submitted a committal SIP for Kansas City, Kansas. The committal SIP contains all the requirements identified in the July 1, 1987, promulgation of the SIP requirements for PM10 at 52 FR 24681, except the state will report the PM10 data...

  19. 40 CFR 52.881 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... State implementation plan development in group II areas. The state has submitted a committal SIP for Kansas City, Kansas. The committal SIP contains all the requirements identified in the July 1, 1987, promulgation of the SIP requirements for PM10 at 52 FR 24681, except the state will report the PM10 data...

  20. 40 CFR 52.881 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... State implementation plan development in group II areas. The state has submitted a committal SIP for Kansas City, Kansas. The committal SIP contains all the requirements identified in the July 1, 1987, promulgation of the SIP requirements for PM10 at 52 FR 24681, except the state will report the PM10 data...

  1. 40 CFR 52.881 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... State implementation plan development in group II areas. The state has submitted a committal SIP for Kansas City, Kansas. The committal SIP contains all the requirements identified in the July 1, 1987, promulgation of the SIP requirements for PM10 at 52 FR 24681, except the state will report the PM10 data...

  2. 40 CFR 52.881 - PM10 State implementation plan development in group II areas.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... State implementation plan development in group II areas. The state has submitted a committal SIP for Kansas City, Kansas. The committal SIP contains all the requirements identified in the July 1, 1987, promulgation of the SIP requirements for PM10 at 52 FR 24681, except the state will report the PM10 data...

  3. Implementing Primary Social and Emotional Aspects of Learning (SEAL) Small Group Interventions: Recommendations for Practitioners

    ERIC Educational Resources Information Center

    Lendrum, Ann; Humphrey, Neil; Kalambouka, Afroditi; Wigelsworth, Michael

    2009-01-01

    This article presents an extended vignette describing a good practice model for implementing SEAL small group work at "Mellington Primary", a fictional school. The vignette/model was developed from in-depth case studies at five primary schools in the north-west of England during a national evaluation of primary SEAL by the authors. The…

  4. The Effect of Extra Small Group Session during PBL Implementation on Student's Achievement

    ERIC Educational Resources Information Center

    Khalil, Mahmoud Salah; Al Rukban, Mohammad Othman

    2010-01-01

    Problem based learning (PBL) started to spread in health professions in Saudi Arabia at the beginning of this century. There are several challenges facing its implementation such as defects on interpersonal communications and self-directed learning. These challenges would affect students' performance in small group discussions and their…

  5. Implementing Primary Social and Emotional Aspects of Learning (SEAL) Small Group Interventions: Recommendations for Practitioners

    ERIC Educational Resources Information Center

    Lendrum, Ann; Humphrey, Neil; Kalambouka, Afroditi; Wigelsworth, Michael

    2009-01-01

    This article presents an extended vignette describing a good practice model for implementing SEAL small group work at "Mellington Primary", a fictional school. The vignette/model was developed from in-depth case studies at five primary schools in the north-west of England during a national evaluation of primary SEAL by the authors. The…

  6. The Effect of Extra Small Group Session during PBL Implementation on Student's Achievement

    ERIC Educational Resources Information Center

    Khalil, Mahmoud Salah; Al Rukban, Mohammad Othman

    2010-01-01

    Problem based learning (PBL) started to spread in health professions in Saudi Arabia at the beginning of this century. There are several challenges facing its implementation such as defects on interpersonal communications and self-directed learning. These challenges would affect students' performance in small group discussions and their…

  7. Consensus on the management of advanced radioactive iodine-refractory differentiated thyroid cancer on behalf of the Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and Spanish Rare Cancer Working Group (GETHI).

    PubMed

    Capdevila, J; Galofré, J C; Grande, E; Zafón Llopis, C; Ramón Y Cajal Asensio, T; Navarro González, E; Jiménez-Fonseca, P; Santamaría Sandi, J; Gómez Sáez, J M; Riesco Eizaguirre, G

    2017-03-01

    Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC.

  8. Is There a Consensus on Consensus Methodology? Descriptions and Recommendations for Future Consensus Research.

    PubMed

    Waggoner, Jane; Carline, Jan D; Durning, Steven J

    2016-05-01

    The authors of this article reviewed the methodology of three common consensus methods: nominal group process, consensus development panels, and the Delphi technique. The authors set out to determine how a majority of researchers are conducting these studies, how they are analyzing results, and subsequently the manner in which they are reporting their findings. The authors conclude with a set of guidelines and suggestions designed to aid researchers who choose to use the consensus methodology in their work.Overall, researchers need to describe their inclusion criteria. In addition to this, on the basis of the current literature the authors found that a panel size of 5 to 11 members was most beneficial across all consensus methods described. Lastly, the authors agreed that the statistical analyses done in consensus method studies should be as rigorous as possible and that the predetermined definition of consensus must be included in the ultimate manuscript. More specific recommendations are given for each of the three consensus methods described in the article.

  9. Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding.

    PubMed

    Baxter, Louisa; Nash, David B

    2013-01-01

    Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.

  10. The density matrix renormalization group algorithm on kilo-processor architectures: Implementation and trade-offs

    NASA Astrophysics Data System (ADS)

    Nemes, Csaba; Barcza, Gergely; Nagy, Zoltán; Legeza, Örs; Szolgay, Péter

    2014-06-01

    In the numerical analysis of strongly correlated quantum lattice models one of the leading algorithms developed to balance the size of the effective Hilbert space and the accuracy of the simulation is the density matrix renormalization group (DMRG) algorithm, in which the run-time is dominated by the iterative diagonalization of the Hamilton operator. As the most time-dominant step of the diagonalization can be expressed as a list of dense matrix operations, the DMRG is an appealing candidate to fully utilize the computing power residing in novel kilo-processor architectures. In the paper a smart hybrid CPU-GPU implementation is presented, which exploits the power of both CPU and GPU and tolerates problems exceeding the GPU memory size. Furthermore, a new CUDA kernel has been designed for asymmetric matrix-vector multiplication to accelerate the rest of the diagonalization. Besides the evaluation of the GPU implementation, the practical limits of an FPGA implementation are also discussed.

  11. European consensus conference on faecal microbiota transplantation in clinical practice.

    PubMed

    Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

    2017-04-01

    Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements.

  12. European consensus conference on faecal microbiota transplantation in clinical practice

    PubMed Central

    Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

    2017-01-01

    Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements. PMID:28087657

  13. Swedish nurses' perception of nursing research and its implementation in clinical practice: a focus group study.

    PubMed

    Bohman, Doris M; Ericsson, Terese; Borglin, Gunilla

    2013-09-01

    Nowadays, nursing research is seen as an integral part of professional nursing although implementing knowledge derived from nursing research into the practice setting is still problematic. Current research, conducted mainly with a descriptive quantitative design, highlights the struggle experienced by Registered Nurses (RNs) to use and implement research findings in clinical practice. Therefore, the aim of this naturalistic inquiry was to explore nurses' perception of nursing research and its implementation in a clinical context. A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs (three men and 13 women) working in a secondary care setting. The transcribed texts were analysed, inspired by Burnard's description of content analysis. The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs' views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background--the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. Our findings, although based on a small qualitative study, are congruent with others, indicating that further research is warranted concerning the impact of education on RNs' views of nursing research and its implementation. Hence, it might well be that the RNs' educational point of departure needs to be stressed more than what so far have been anticipated. In the meanwhile, it is possible that a number of strategies could be tested to promote a more favourable view in these issues and where the nursing education has the possibility to influence this endeavour. © 2012 The Authors. Scandinavian Journal of

  14. Stakeholders' contributions to tailored implementation programs: an observational study of group interview methods.

    PubMed

    Huntink, Elke; van Lieshout, Jan; Aakhus, Eivind; Baker, Richard; Flottorp, Signe; Godycki-Cwirko, Maciek; Jäger, Cornelia; Kowalczyk, Anna; Szecsenyi, Joachim; Wensing, Michel

    2014-12-06

    Tailored strategies to implement evidence-based practice can be generated in several ways. In this study, we explored the usefulness of group interviews for generating these strategies, focused on improving healthcare for patients with chronic diseases. Participants included at least four categories of stakeholders (researchers, quality officers, health professionals, and external stakeholders) in five countries. Interviews comprised brainstorming followed by a structured interview and focused on different chronic conditions in each country. We compared the numbers and types of strategies between stakeholder categories and between interview phases. We also determined which strategies were actually used in tailored intervention programs. In total, 127 individuals participated in 25 group interviews across five countries. Brainstorming generated 8 to 120 strategies per group; structured interviews added 0 to 55 strategies. Healthcare professionals and researchers provided the largest numbers of strategies. The type of strategies for improving healthcare practice did not differ systematically between stakeholder groups in four of the five countries. In three out of five countries, all components of the chosen intervention programs were mentioned by the group of researchers. Group interviews with different stakeholder categories produced many strategies for tailored implementation of evidence-based practice, of which the content was largely similar across stakeholder categories.

  15. Feedbacks from Focus Group Meeting on Training and Implementation of Building Energy Codes in China

    SciTech Connect

    Shui, Bin; Lin , Haiyan; Song, Bo; Halverson, Mark A.; Evans, Meredydd; Zhu, Xiaojiao

    2011-01-01

    A focus group meeting is a very effective quality research approach to collect information on a specific project. Through focus group meetings at both Changchun and Ningbo in August 2010, the project team gained a more complete understandings of key stakeholders (such as their education level), their training needs and expectations, key factors influencing their decision making, and incurred implementation difficulties. In addition, the meeting helped the project team (especially PNNL) improve its understanding of the implementation status of building energy codes in other regions (such as small cities and counties neighboring to urban areas, small townships and rural areas distant from urban areas). The collected feedbacks will serve as important input not only for better design of training materials and the development of an on-line training website, but also for development of follow-up projects to promote building energy codes in China.

  16. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening.

    PubMed

    Sung, J J Y; Ng, S C; Chan, F K L; Chiu, H M; Kim, H S; Matsuda, T; Ng, S S M; Lau, J Y W; Zheng, S; Adler, S; Reddy, N; Yeoh, K G; Tsoi, K K F; Ching, J Y L; Kuipers, E J; Rabeneck, L; Young, G P; Steele, R J; Lieberman, D; Goh, K L

    2015-01-01

    Since the publication of the first Asia Pacific Consensus on Colorectal Cancer (CRC) in 2008, there are substantial advancements in the science and experience of implementing CRC screening. The Asia Pacific Working Group aimed to provide an updated set of consensus recommendations. Members from 14 Asian regions gathered to seek consensus using other national and international guidelines, and recent relevant literature published from 2008 to 2013. A modified Delphi process was adopted to develop the statements. Age range for CRC screening is defined as 50-75 years. Advancing age, male, family history of CRC, smoking and obesity are confirmed risk factors for CRC and advanced neoplasia. A risk-stratified scoring system is recommended for selecting high-risk patients for colonoscopy. Quantitative faecal immunochemical test (FIT) instead of guaiac-based faecal occult blood test (gFOBT) is preferred for average-risk subjects. Ancillary methods in colonoscopy, with the exception of chromoendoscopy, have not proven to be superior to high-definition white light endoscopy in identifying adenoma. Quality of colonoscopy should be upheld and quality assurance programme should be in place to audit every aspects of CRC screening. Serrated adenoma is recognised as a risk for interval cancer. There is no consensus on the recruitment of trained endoscopy nurses for CRC screening. Based on recent data on CRC screening, an updated list of recommendations on CRC screening is prepared. These consensus statements will further enhance the implementation of CRC screening in the Asia Pacific region. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. CenteringPregnancySmiles: implementation of a small group prenatal care model with oral health.

    PubMed

    Skelton, Judith; Mullins, Raynor; Langston, LeAnn Todd; Womack, Sara; Ebersole, Jeffrey L; Rising, Sharon Schindler; Kovarik, Robert

    2009-05-01

    Preterm/low birth weights are the leading perinatal problem in the U.S., and an association between preterm/low birth weight outcomes and oral health has been identified. In response to this, a group prenatal care program--CenteringPregnancySmiles--was implemented in rural Kentucky in 2006. This report describes the model and preliminary outcomes of the CenteringPregnancySmiles program.

  18. What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders

    PubMed Central

    Wouters, Eveline JM; Luijkx, Katrien G; Vrijhoef, Hubertus JM

    2016-01-01

    Background There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. Objective To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Methods Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis. Results Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults’ needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying

  19. What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders.

    PubMed

    Peek, Sebastiaan Theodorus Michaël; Wouters, Eveline J M; Luijkx, Katrien G; Vrijhoef, Hubertus J M

    2016-05-03

    There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis. Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults' needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying differences emerged, for example, with regard

  20. Consensus development for healthcare professionals

    PubMed Central

    Kea, Bory; Sun, Benjamin C.

    2015-01-01

    Consensus development sprang from a desire to synthesize clinician and expert opinions on clinical practice and research agendas in the 1950s. And since the American Institute of Medicine formally defined “guidelines” in 1990, there has been a proliferation of clinical practice guidelines (CPG) both formally and informally. This modern decision making tool used by both physicians and patients, requires extensive planning to meet the challenges of consensus development while reaping its rewards. Consensus allows for a group approach with multiple experts sharing ideas to form consensus on topics ranging from appropriateness of procedures to research agenda development. Disagreements can shed light on areas of controversy and launch further discussions. It has five main components: three inputs (defining the task, participant identification and recruitment, and information synthesis), the approach (consensus development by explicit or implicit means), and the output (dissemination of results). Each aspect requires extensive planning a priori as they influence the entire process, from how information will be interpreted, the interaction of participants, the resulting judgment, to whether there will be uptake of results. Implicit approaches utilize qualitative methods and/or a simple voting structure of majority wins, and are used in informal consensus development methods and consensus development conferences. Explicit approaches aggregate results or judgments using explicit rules set a priori with definitions of “agreement” or consensus. Because the implicit process can be more opaque, unforeseen challenges can emerge such as the undue influence of a minority. And yet, the logistics of explicit approaches may be more time consuming and not appropriate when speed is a priority. In determining which method to use, it is important to understand the pros and cons of the different approaches and how it will affect the overall input, approach, and outcome. PMID

  1. Consensus development for healthcare professionals.

    PubMed

    Kea, Bory; Sun, Benjamin Chih-An

    2015-04-01

    Consensus development sprang from a desire to synthesize clinician and expert opinions on clinical practice and research agendas in the 1950s. And since the American Institute of Medicine formally defined "guidelines" in 1990, there has been a proliferation of clinical practice guidelines (CPG) both formally and informally. This modern decision-making tool used by both physicians and patients, requires extensive planning to overcome the challenges of consensus development while reaping its rewards. Consensus allows for a group approach of multiple experts sharing ideas to form consensus on topics ranging from appropriateness of procedures to research agenda development. Disagreements can shed light on areas of controversy and launch further discussions. It has five main components: three inputs (defining the task, participant identification and recruitment, and information synthesis), the approach (consensus development by explicit or implicit means), and the output (dissemination of results). Each aspect requires extensive planning a priori as they influence the entire process, from how information will be interpreted, the interaction of participants, the resulting judgment, to whether there will be uptake of results. Implicit approaches utilize qualitative methods and/or a simple voting structure of majority wins, and are used in informal consensus development methods and consensus development conferences. Explicit approaches aggregate results or judgments using explicit rules set a priori with definitions of "agreement" or consensus. Because the implicit process can be more opaque, unforeseen challenges can emerge such as the undue influence of a minority. And yet, the logistics of explicit approaches may be more time consuming and not appropriate when speed is a priority. In determining which method to use, it is important to understand the pros and cons of different approaches and how it will affect the overall input, approach, and outcome.

  2. Implementation of group supervision in child welfare: findings from Arizona's Supervision Circle Project.

    PubMed

    Lietz, Cynthia A

    2008-01-01

    The process of supervision plays an important role in developing the skills necessary to respond effectively to reports of child maltreatment. Specifically, educational supervision prompting discussion and critical thinking can enhance the analytic skills needed to consider the complexity commonly found in child welfare practice. To this end, group supervision was implemented with supervisors in Arizona to enrich supervisory dialog to better prepare for the unique and often unexpected challenges of child welfare. Post-test data collected from participants suggest group supervision may be one way the field of child protection can enhance critical thinking.

  3. Implementing evidence-based medicine in general practice: a focus group based study

    PubMed Central

    Hannes, Karin; Leys, Marcus; Vermeire, Etienne; Aertgeerts, Bert; Buntinx, Frank; Depoorter, Anne-Marie

    2005-01-01

    Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed. PMID:16153300

  4. Expert Consensus Panel Guidelines on Geriatric Assessment in Oncology

    PubMed Central

    O'Donovan, A.; Mohile, S.G.; Leech, M.

    2015-01-01

    Introduction Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. Methods A four round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations in order to gain consensus on a given topic Results Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cutoff for assessment represented a higher degree of disagreement. Discussion The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. PMID:25757457

  5. C3 glomerulopathy: consensus report.

    PubMed

    Pickering, Matthew C; D'Agati, Vivette D; Nester, Carla M; Smith, Richard J; Haas, Mark; Appel, Gerald B; Alpers, Charles E; Bajema, Ingeborg M; Bedrosian, Camille; Braun, Michael; Doyle, Mittie; Fakhouri, Fadi; Fervenza, Fernando C; Fogo, Agnes B; Frémeaux-Bacchi, Véronique; Gale, Daniel P; Goicoechea de Jorge, Elena; Griffin, Gene; Harris, Claire L; Holers, V Michael; Johnson, Sally; Lavin, Peter J; Medjeral-Thomas, Nicholas; Paul Morgan, B; Nast, Cynthia C; Noel, Laure-Hélène; Peters, D Keith; Rodríguez de Córdoba, Santiago; Servais, Aude; Sethi, Sanjeev; Song, Wen-Chao; Tamburini, Paul; Thurman, Joshua M; Zavros, Michael; Cook, H Terence

    2013-12-01

    C3 glomerulopathy is a recently introduced pathological entity whose original definition was glomerular pathology characterized by C3 accumulation with absent or scanty immunoglobulin deposition. In August 2012, an invited group of experts (comprising the authors of this document) in renal pathology, nephrology, complement biology, and complement therapeutics met to discuss C3 glomerulopathy in the first C3 Glomerulopathy Meeting. The objectives were to reach a consensus on: the definition of C3 glomerulopathy, appropriate complement investigations that should be performed in these patients, and how complement therapeutics should be explored in the condition. This meeting report represents the current consensus view of the group.

  6. Implementation of novel biomarkers in the diagnosis, prognosis, and management of acute kidney injury: executive summary from the tenth consensus conference of the Acute Dialysis Quality Initiative (ADQI).

    PubMed

    McCullough, Peter A; Bouchard, Josee; Waikar, Sushrut S; Siew, Edward D; Endre, Zoltan H; Goldstein, Stuart L; Koyner, Jay L; Macedo, Etienne; Doi, Kent; Di Somma, Salvatore; Lewington, Andrew; Thadhani, Ravi; Chakravarthi, Raj; Ice, Can; Okusa, Mark D; Duranteau, Jacques; Doran, Peter; Yang, Li; Jaber, Bertrand L; Meehan, Shane; Kellum, John A; Haase, Michael; Murray, Patrick T; Cruz, Dinna; Maisel, Alan; Bagshaw, Sean M; Chawla, Lakhmir S; Mehta, Ravindra L; Shaw, Andrew D; Ronco, Claudio

    2013-01-01

    Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures.

  7. Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

    PubMed Central

    McCullough, Peter A.; Bouchard, Josee; Waikar, Sushrut S.; Siew, Edward D.; Endre, Zoltan H.; Goldstein, Stuart L.; Koyner, Jay L.; Macedo, Etienne; Doi, Kent; Di Somma, Salvatore; Lewington, Andrew; Thadhani, Ravi; Chakravarthi, Raj; Ice, Can; Okusa, Mark D.; Duranteau, Jacques; Doran, Peter; Yang, Li; Jaber, Bertrand L.; Meehan, Shane; Kellum, John A.; Haase, Michael; Murray, Patrick T.; Cruz, Dinna; Maisel, Alan; Bagshaw, Sean M.; Chawla, Lakhmir S.; Mehta, Ravindra L.; Shaw, Andrew D.; Ronco, Claudio

    2013-01-01

    Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures. PMID:23689652

  8. [AIDS Study Group/Spanish AIDS Plan consensus document on antiretroviral therapy in adults with human immunodeficiency virus infection (updated January 2010)].

    PubMed

    2010-01-01

    This consensus document is an update of antiretroviral therapy recommendations for adult patients with human immunodeficiency virus infection. To formulate these recommendations a panel made up of members of the Grupo de Estudio de Sida (Gesida, AIDS Study Group) and the Plan Nacional sobre el Sida (PNS, Spanish AIDS Plan) reviewed the advances in the current understanding of the pathophysiology of human immunodeficiency virus (HIV) infection, the efficacy and safety of clinical trials, and cohort and pharmacokinetic studies published in biomedical journals or presented at scientific meetings. Three levels of evidence were defined according to the data source: randomized studies (level A), cohort or case-control studies (level B), and expert opinion (level C). The decision to recommend, consider or not to recommend ART was established in each situation. Currently, the treatment of choice for chronic HIV infection is the combination of three drugs of two different classes, including 2 nucleosides or nucleotide analogs (NRTI) plus 1 non-nucleoside (NNRTI) or 1 boosted protease inhibitor (PI/r), but other combinations are possible. Initiation of ART is recommended in patients with symptomatic HIV infection. In asymptomatic patients, initiation of ART is recommended on the basis of CD4 lymphocyte counts, plasma viral load and patient co-morbidities, as follows: 1) therapy should be started in patients with CD4 counts below 350 cells/microl; 2) When CD4 counts are between 350 and 500 cells/microl, therapy should be started in case of cirrhosis, chronic hepatitis C, high cardiovascular risk, HIV nephropathy, HIV viral load above 100,000 copies/ml, proportion of CD4 cells under 14%, and in people aged over 55; 3) Therapy should be deferred when CD4 are above 500 cells/microl, but could be considered if any of previous considerations concurs. Treatment should be initiated in case of hepatitis B requiring treatment and should be considered for reduce sexual transmission

  9. Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.

    PubMed

    Campbell, S M; Sheaff, R; Sibbald, B; Marshall, M N; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M O

    2002-03-01

    To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Qualitative case studies using semi-structured interviews and documentation review. Twelve purposively sampled PCG/Ts in England. Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Participants' perceptions of the role of clinical governance in PCG/Ts. PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

  10. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group.

    PubMed

    Van den Bosch, T; Dueholm, M; Leone, F P G; Valentin, L; Rasmussen, C K; Votino, A; Van Schoubroeck, D; Landolfo, C; Installé, A J F; Guerriero, S; Exacoustos, C; Gordts, S; Benacerraf, B; D'Hooghe, T; De Moor, B; Brölmann, H; Goldstein, S; Epstein, E; Bourne, T; Timmerman, D

    2015-09-01

    The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.

  11. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease

    PubMed Central

    2013-01-01

    Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed. PMID:23763839

  12. Microscopic enteritis: Bucharest consensus.

    PubMed

    Rostami, Kamran; Aldulaimi, David; Holmes, Geoffrey; Johnson, Matt W; Robert, Marie; Srivastava, Amitabh; Fléjou, Jean-François; Sanders, David S; Volta, Umberto; Derakhshan, Mohammad H; Going, James J; Becheanu, Gabriel; Catassi, Carlo; Danciu, Mihai; Materacki, Luke; Ghafarzadegan, Kamran; Ishaq, Sauid; Rostami-Nejad, Mohammad; Peña, A Salvador; Bassotti, Gabrio; Marsh, Michael N; Villanacci, Vincenzo

    2015-03-07

    Microscopic enteritis (ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. This work recognises a need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. The consensus working party reviewed statements about the aetiology, diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment. Following the 5(th) International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME. A five-step agreement scale (from strong agreement to strong disagreement) was used to score 21 statements, independently. There was strong agreement on all statements about ME histology (95%-100%). Statements concerning diagnosis achieved 85% to 100% agreement. A statement on the management of ME elicited agreement from the lowest rate (60%) up to 100%. The remaining two categories showed general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of ME. There was strong agreement on the histological definition of ME. Weaker agreement on management indicates a need for further investigations, better definitions and clinical trials to produce quality guidelines for management. This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.

  13. Microscopic enteritis: Bucharest consensus

    PubMed Central

    Rostami, Kamran; Aldulaimi, David; Holmes, Geoffrey; Johnson, Matt W; Robert, Marie; Srivastava, Amitabh; Fléjou, Jean-François; Sanders, David S; Volta, Umberto; Derakhshan, Mohammad H; Going, James J; Becheanu, Gabriel; Catassi, Carlo; Danciu, Mihai; Materacki, Luke; Ghafarzadegan, Kamran; Ishaq, Sauid; Rostami-Nejad, Mohammad; Peña, A Salvador; Bassotti, Gabrio; Marsh, Michael N; Villanacci, Vincenzo

    2015-01-01

    Microscopic enteritis (ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. This work recognises a need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. The consensus working party reviewed statements about the aetiology, diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment. Following the 5th International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME. A five-step agreement scale (from strong agreement to strong disagreement) was used to score 21 statements, independently. There was strong agreement on all statements about ME histology (95%-100%). Statements concerning diagnosis achieved 85% to 100% agreement. A statement on the management of ME elicited agreement from the lowest rate (60%) up to 100%. The remaining two categories showed general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of ME. There was strong agreement on the histological definition of ME. Weaker agreement on management indicates a need for further investigations, better definitions and clinical trials to produce quality guidelines for management. This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy. PMID:25759526

  14. The Beutelsbach Consensus

    ERIC Educational Resources Information Center

    Reinhardt, Sibylle

    2016-01-01

    In 2016 an important anniversary is coming up for "The Beutelsbach consensus". It will have its 40th birthday. This consensus is of vital significance for the German dispute and discussion on teaching civics. "The Beutelsbach consensus" contains, and describes three points: (1) Prohibition against overwhelming the student. It…

  15. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process.

    PubMed

    Carr, Norman J; Cecil, Thomas D; Mohamed, Faheez; Sobin, Leslie H; Sugarbaker, Paul H; González-Moreno, Santiago; Taflampas, Panos; Chapman, Sara; Moran, Brendan J

    2016-01-01

    Pseudomyxoma peritonei (PMP) is a complex disease with unique biological behavior that usually arises from appendiceal mucinous neoplasia. The classification of PMP and its primary appendiceal neoplasia is contentious, and an international modified Delphi consensus process was instigated to address terminology and definitions. A classification of mucinous appendiceal neoplasia was developed, and it was agreed that "mucinous adenocarcinoma" should be reserved for lesions with infiltrative invasion. The term "low-grade appendiceal mucinous neoplasm" was supported and it was agreed that "cystadenoma" should no longer be recommended. A new term of "high-grade appendiceal mucinous neoplasm" was proposed for lesions without infiltrative invasion but with high-grade cytologic atypia. Serrated polyp with or without dysplasia was preferred for tumors with serrated features confined to the mucosa with an intact muscularis mucosae. Consensus was achieved on the pathologic classification of PMP, defined as the intraperitoneal accumulation of mucus due to mucinous neoplasia characterized by the redistribution phenomenon. Three categories of PMP were agreed-low grade, high grade, and high grade with signet ring cells. Acellular mucin should be classified separately. It was agreed that low-grade and high-grade mucinous carcinoma peritonei should be considered synonymous with disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis, respectively. A checklist for the pathologic reporting of PMP and appendiceal mucinous neoplasms was also developed. By adopting the classifications and definitions that were agreed, different centers will be able to use uniform terminology that will allow meaningful comparison of their results.

  16. Five Topics Health Care Simulation Can Address to Improve Patient Safety: Results From a Consensus Process.

    PubMed

    Sollid, Stephen J M; Dieckman, Peter; Aase, Karina; Søreide, Eldar; Ringsted, Charlotte; Østergaard, Doris

    2016-03-28

    There is little knowledge about which elements of health care simulation are most effective in improving patient safety. When empirical evidence is lacking, a consensus statement can help define priorities in, for example, education and research. A consensus process was therefore initiated to define priorities in health care simulation that contribute the most to improve patient safety. An international group of experts took part in a 4-stage consensus process based on a modified nominal group technique. Stages 1 to 3 were based on electronic communication; stage 4 was a 2-day consensus meeting at the Utstein Abbey in Norway. The goals of stage 4 were to agree on the top 5 topics in health care simulation that contribute the most to patient safety, identify the patient safety problems they relate to, and suggest solutions with implementation strategies for these problems. The expert group agreed on the following topics: technical skills, nontechnical skills, system probing, assessment, and effectiveness. For each topic, 5 patient safety problems were suggested that each topic might contribute to solve. Solutions to these problems and implementation strategies for these solutions were identified for technical skills, nontechnical skills, and system probing. In the case of assessment and effectiveness, the expert group found it difficult to suggest solutions and implementation strategies mainly because of lacking consensus on metrics and methodology. The expert group recommends that the 5 topics identified in this consensus process should be the main focus when health care simulation is implemented in patient safety curricula.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

  17. Research methods for formal consensus development.

    PubMed

    James, Daphne; Warren-Forward, Helen

    2015-01-01

    This paper reviews three research methods for developing consensus. Consensus statements and guidelines are increasingly used to clarify and standardise practice, and inform health policy, when relevant and rigorous evidence is lacking. Clinicians need to evaluate the quality of practice guidelines to determine whether to incorporate them into clinical practice or reject them. Formal methods of developing consensus provide a scientific method that uses expert panel members to evaluate current evidence and expert opinions to produce consensus statements for clinical problems. Online search for relevant literature was conducted in Medline and CINAHL. A literature review of consensus, consensus development and research methods papers published in English in peer-reviewed journals. The three methods of developing consensus discussed are the Delphi technique, nominal group technique and the consensus development conference. The techniques and their respective advantages are described, and examples from the literature are provided. The three methods are compared and a flowchart to assist researchers selecting an appropriate method is included. Online resources with information on the development and evaluation of clinical guidelines are reviewed. This paper will help researchers to select an appropriate research method for developing consensus statements and guidelines. When developing consensus guidelines for clinical practice, researchers should use a formal research method to ensure rigour and credibility.

  18. Global oral health inequalities: task group--implementation and delivery of oral health strategies.

    PubMed

    Sheiham, A; Alexander, D; Cohen, L; Marinho, V; Moysés, S; Petersen, P E; Spencer, J; Watt, R G; Weyant, R

    2011-05-01

    This paper reviews the shortcomings of present approaches to reduce oral diseases and inequalities, details the importance of social determinants, and links that to research needs and policies on implementation of strategies to reduce oral health inequalities. Inequalities in health are not narrowing. Attention is therefore being directed at determinants of major health conditions and the extent to which those common determinants vary within, between, and among groups, because if inequalities in health vary across groups, then so must underlying causes. Tackling inequalities in health requires strategies tailored to determinants and needs of each group along the social gradient. Approaches focusing mainly on downstream lifestyle and behavioral factors have limited success in reducing health inequalities. They fail to address social determinants, for changing people's behaviors requires changing their environment. There is a dearth of oral health research on social determinants that cause health-compromising behaviors and on risk factors common to some chronic diseases. The gap between what is known and implemented by other health disciplines and the dental fraternity needs addressing. To re-orient oral health research, practice, and policy toward a 'social determinants' model, a closer collaboration between and integration of dental and general health research is needed. Here, we suggest a research agenda that should lead to reductions in global inequalities in oral health.

  19. [Argentine Consensus of Respiratory Rehabilitation].

    PubMed

    Sívori, Martín; Benzo, Roberto; Rhodius, Edgardo; Jolly, Enrique; Boim, Clarisa; Saadia, Marcela; Conti, Ernesto; Guevara, Ivan; Carles, Daniel; Victorio, Carlos; Santini, Fabian; Ratto, Patricia; Capparelli, Ignacio; Prieto, Ernesto; Azvalinsky, Marcos; Alais, Maria

    2004-01-01

    A group of pulmonologists and physical therapists from the Asociacion Argentina de Medicina Respiratoria revised the scientific literature on Respiratory Rehabilitation (RR) to elaborate evidence-based national recommendations to promote its use. RR is a multidisciplinary program of care for patients with chronic respiratory impairment, individually tailored, designed to optimize physical and social performance and autonomy of patients. It is particularly indicated in patients with Chronic Obstructive Pulmonary Disease (COPD) with exercise intolerance. Inclusion and exclusion criteria, guidelines for initial evaluation and follow up have been defined. The resources needed were defined. It was recommended a hospital ambulatory program with domiciliary complement. A pulmonologist and physical therapist were required for the program as minimum. Aerobic training was recommended for lower limb (LL) (Evidence A) and upper limb (UL) (Evidence B), strength training for LL and UL (Evidence C), as well as respiratory muscles training by resistive inspiratory threshold load (Evidence D) and other physiotherapy techniques were recommended for specific patients. In addition recommendations have been made for educational objectives of the program, nutritional and psychological support. The positive impact of RR on health care was analyzed through the reduction in exacerbation of COPD, length of hospital stay and cost. RR is a key component in the treatment of COPD patients. This evidenced-based consensus statement was prepared to provide recommendations to be implemented nationally.

  20. Case Study of Implementation of Flexible Grouping in One School Framed within the Change Based Adoption Model

    ERIC Educational Resources Information Center

    Slaydon, Donda

    2013-01-01

    This case study was designed to investigate the implementation of flexible grouping at one elementary school framed within the Change Based Adoption Model. Using interviews and observations, data were compiled to answer research questions related to the steps taken to implement flexible grouping, challenges faced, overall effects of flexible…

  1. Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants.

    PubMed

    Kim, Son Chae; Stichler, Jaynelle F; Ecoff, Laurie; Brown, Caroline E; Gallo, Ana-Maria; Davidson, Judy E

    2016-10-01

    A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings. © 2016 Sigma Theta Tau International.

  2. Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications.

    PubMed

    Sundaram, Hema; Signorini, Massimo; Liew, Steven; Trindade de Almeida, Ada R; Wu, Yan; Vieira Braz, André; Fagien, Steven; Goodman, Greg J; Monheit, Gary; Raspaldo, Hervé

    2016-03-01

    Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction. A multinational, multidisciplinary group of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated consensus recommendations with a worldwide perspective for botulinum toxin and hyaluronic acid fillers. This publication on botulinum toxin type A considers advances in facial analysis, injection techniques, and avoidance and management of complications. Use of botulinum toxin has evolved from the upper face to also encompass the lower face, neck, and midface. The Global Aesthetics Consensus Group emphasizes an integrative, diagnostic approach. Injection dosage and placement are based on analysis of target muscles in the context of adjacent ones and associated soft and hard tissues. The indication for selection of botulinum toxin as a primary intervention is that excessive muscular contraction is the primary etiology of the facial disharmony to be addressed. Global Aesthetics Consensus Group recommendations demonstrate a paradigm shift toward neuromodulation rather than paralysis, including lower dosing of the upper face, more frequent combination treatment with hyaluronic acid fillers, and intracutaneous injection where indicated to limit depth and degree of action. The accumulation of clinical evidence and experience with botulinum toxin has led to refinements in treatment planning and implementation. The Global Aesthetics Consensus Group advocates an etiology-driven, patient-tailored approach, to enable achievement of optimal efficacy and safety in patient populations that are rapidly diversifying with respect to ethnicity, gender, and age. Therapeutic, V.

  3. Borderline intellectual functioning: consensus and good practice guidelines.

    PubMed

    Salvador-Carulla, Luis; García-Gutiérrez, Juan Carlos; Ruiz Gutiérrez-Colosía, Mencía; Artigas-Pallarès, Josep; García Ibáñez, José; González Pérez, Joan; Nadal Pla, Margarida; Aguilera Inés, Francisco; Isus, Sofia; Cereza, Josep Maria; Poole, Miriam; Portero Lazcano, Guillermo; Monzón, Patricio; Leiva, Marta; Parellada, Mara; García Nonell, Katia; Martínez I Hernández, Andreu; Rigau, Eugenia; Martínez-Leal, Rafael

    2013-01-01

    The Borderline Intellectual Functioning (BIF) is conceptualized as the frontier that delimits "normal" intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined. To elaborate a conceptual framework and to establish consensus guidelines. A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. Scientific publications covering BIF are scarce. The term that yields a bigger number of results is "Borderline Intelligence". The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual. Copyright © 2011 SEP y SEPB. Published by Elsevier Espana. All rights reserved.

  4. The role of monitoring interpretive rates, concordance between cytotechnologist and pathologist interpretations before sign-out, and turnaround time in gynecologic cytology quality assurance: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 1.

    PubMed

    Clary, Karen M; Davey, Diane D; Naryshkin, Sonya; Austin, R Marshall; Thomas, Nicole; Chmara, Beth Anne; Sugrue, Chiara; Tworek, Joseph

    2013-02-01

    The College of American Pathologists (CAP) conducted a national survey of gynecologic cytology quality assurance (QA) practices. Experts in gynecologic cytology were asked to join 5 working groups that studied the survey data on different aspects of QA. Evaluating the survey data and follow-up questions online, together with a review of pertinent literature, the working groups developed a series of preliminary statements on good laboratory practices in cytology QA. These were presented at a consensus conference and electronic voting occurred. To evaluate a set of QA monitors in gynecologic cytology. Working group 1 evaluated (1) monitoring interpretive rate categories for Papanicolaou tests (Pap tests), (2) concordance of cytotechnologist and pathologist interpretations before sign-out, and (3) turnaround time for Pap tests. The statements are based on a survey of gynecologic cytology QA practice patterns and of opinions from working group members and consensus conference attendees. The outcomes of this process demonstrate the current state of practice patterns in gynecologic cytology QA. Monitoring interpretive rates for all Bethesda System categories is potentially useful, and it is most useful to monitor interpretive rates for cytotechnologists individually and in comparison to the entire laboratory. Laboratories need to determine what level of discrepancy between cytotechnologist and pathologist interpretations of Pap tests is important to track. Laboratories should consider formalizing procedures and policies to adjudicate such discrepant interpretations. Turnaround time should be monitored in gynecologic cytology, but individual laboratories should determine how to measure and use turnaround time internally.

  5. Thrombotic Microangiopathy Care Pathway: A Consensus Statement for the Mayo Clinic Complement Alternative Pathway-Thrombotic Microangiopathy (CAP-TMA) Disease-Oriented Group.

    PubMed

    Go, Ronald S; Winters, Jeffrey L; Leung, Nelson; Murray, David L; Willrich, Maria A; Abraham, Roshini S; Amer, Hatem; Hogan, William J; Marshall, Ariela L; Sethi, Sanjeev; Tran, Cheryl L; Chen, Dong; Pruthi, Rajiv K; Ashrani, Aneel A; Fervenza, Fernando C; Cramer, Carl H; Rodriguez, Vilmarie; Wolanskyj, Alexandra P; Thomé, Stephan D; Hook, C Christopher

    2016-09-01

    Thrombotic microangiopathies (TMAs) comprise a heterogeneous set of conditions linked by a common histopathologic finding of endothelial damage resulting in microvascular thromboses and potentially serious complications. The typical clinical presentation is microangiopathic hemolytic anemia accompanied by thrombocytopenia with varying degrees of organ ischemia. The differential diagnoses are generally broad, while the workup is frequently complex and can be confusing. This statement represents the joint recommendations from a multidisciplinary team of Mayo Clinic physicians specializing in the management of TMA. It comprises a series of evidence- and consensus-based clinical pathways developed to allow a uniform approach to the spectrum of care including when to suspect TMA, what differential diagnoses to consider, which diagnostic tests to order, and how to provide initial empiric therapy, as well as some guidance on subsequent management.

  6. Diagnosis and management of non-alcoholic fatty liver disease and related metabolic disorders: consensus statement from the Study Group of Liver and Metabolism, Chinese Society of Endocrinology.

    PubMed

    Gao, Xin; Fan, Jian-Gao

    2013-12-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries, affecting 20%-33% of the general population. Large population-based surveys in China indicate a prevalence of approximately 15%-30%. Worldwide, including in China, the prevalence of NAFLD has increased rapidly in parallel with regional trends of obesity, type 2 diabetes and metabolic syndrome. In addition, NAFLD has contributed significantly to increased overall, as well as cardiovascular and liver-related, mortality in the general population. In view of rapid advances in research into NAFLD in recent years, this consensus statement provides a brief update on the progress in the field and suggests preferred approaches for the comprehensive management of NAFLD and its related metabolic diseases.

  7. SU-E-T-181: Clinical Implementation of Task Group 176

    SciTech Connect

    Burgdorf, B; Yeager, C; Zhou, F; Hand, C

    2015-06-15

    Purpose: The implementation of TG-176 with regards to immobilization devices and couch tops as they effect dosimetric treatment planning. Methods: The external devices used clinically were scanned to measure their HU values. Plans were created in the Eclipse treatment planning system (TPS) using these devices, one that accounted for the correct HU value of the each device and another that did not include the device as a structure. A dose subtraction was performed between the two plans to evaluate the dosimetric differences. The metrics used for evaluation included attenuation and surface dose. Plan parameters were varied to evaluate the impact of the devices in different clinical scenarios. Results: While the exact HU values of our results are clinic-dependent, the protocol being implemented is widely applicable. We recommend a four step process for implementing this task group. First, physics should scan each treatment device to determine accurate HU values. Second, CT therapists should include in the setup note which table top was used during patient CT simulation and are asked to make immobilization devices as uniform in thickness as possible. Therapists should also index the devices whenever possible so beam will traverse the same area of the device. Third, the dosimetrist should manually correct the HU value for any external device, including the couch. For H&N cases, the rails must be removed from the couch structure. When rails are used during treatments, it is important to make note of their exact position in the setup notes. Finally, physicians should be made aware that there could be changes in surface doses depending on whether or not immobilization devices or couch tops are in the beam path. Conclusion: The protocol outlined above was implemented to reduce the errors that arise from ignoring effects of external devices, thus ensuring safer, more accurate patient treatments.

  8. Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance

    PubMed Central

    Campbell, S; Sheaff, R; Sibbald, B; Marshall, M; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M

    2002-01-01

    Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Design: Qualitative case studies using semi-structured interviews and documentation review. Setting: Twelve purposively sampled PCG/Ts in England. Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts. Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance. PMID:12078380

  9. ERP Software Implementation Best Practices.

    ERIC Educational Resources Information Center

    Frantz, Pollyanne S.; Southerland, Arthur R.; Johnson, James T.

    2002-01-01

    Studied the perceptions of chief financial and information officers of enterprise resource planning (ERP) software implementation best practices. Usable responses from 159 respondents show consensus for the most part between the perceptions of the two groups and describe some best practices that represent common ground. (SLD)

  10. ERP Software Implementation Best Practices.

    ERIC Educational Resources Information Center

    Frantz, Pollyanne S.; Southerland, Arthur R.; Johnson, James T.

    2002-01-01

    Studied the perceptions of chief financial and information officers of enterprise resource planning (ERP) software implementation best practices. Usable responses from 159 respondents show consensus for the most part between the perceptions of the two groups and describe some best practices that represent common ground. (SLD)

  11. The need for harmonisation and innovation of neuropsychological assessment in neurodegenerative dementias in Europe: consensus document of the Joint Program for Neurodegenerative Diseases Working Group.

    PubMed

    Costa, Alberto; Bak, Thomas; Caffarra, Paolo; Caltagirone, Carlo; Ceccaldi, Mathieu; Collette, Fabienne; Crutch, Sebastian; Della Sala, Sergio; Démonet, Jean François; Dubois, Bruno; Duzel, Emrah; Nestor, Peter; Papageorgiou, Sokratis G; Salmon, Eric; Sikkes, Sietske; Tiraboschi, Pietro; van der Flier, Wiesje M; Visser, Pieter Jelle; Cappa, Stefano F

    2017-04-17

    Cognitive, behavioural, and functional assessment is crucial in longitudinal studies of neurodegenerative dementias (NDD). Central issues, such as the definition of the study population (asymptomatic, at risk, or individuals with dementia), the detection of change/decline, and the assessment of relevant outcomes depend on quantitative measures of cognitive, behavioural, and functional status.Currently, we are far from having available reliable protocols and tools for the assessment of dementias in Europe. The main problems are the heterogeneity of the tools used across different European countries, the lack of standardisation of administration and scoring methods across centres, and the limited information available about the psychometric properties of many tests currently in widespread use. This situation makes it hard to compare results across studies carried out in different centres, thus hampering research progress, in particular towards the contribution to a "big data" common data set.We present here the results of a project funded by the Joint Program for Neurodegenerative Diseases (JPND) and by the Italian Ministry of Health. The project aimed at providing a consensus framework for the harmonisation of assessment tools to be applied to research in neurodegenerative disorders affecting cognition across Europe. A panel of European experts reviewed the current methods of neuropsychological assessment, identified pending issues, and made recommendations for the harmonisation of neuropsychological assessment of neurodegenerative dementias in Europe.A consensus was achieved on the general recommendations to be followed in developing procedures and tools for neuropsychological assessment, with the aim of harmonising tools and procedures to achieve more reliable data on the cognitive-behavioural examination. The results of this study should be considered as a first step to enhancing a common view and practise on NDD assessment across European countries.

  12. 5th Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG): Clinical trial design for rare ovarian tumours.

    PubMed

    Leary, A F; Quinn, M; Fujiwara, K; Coleman, R L; Kohn, E; Sugiyama, T; Glasspool, R; Ray-Coquard, I; Colombo, N; Bacon, M; Zeimet, A; Westermann, A; Gomez-Garcia, E; Provencher, D; Welch, S; Small, W; Millan, D; Okamoto, A; Stuart, G; Ochiai, K

    2016-12-19

    This manuscript reports the consensus statements on designing clinical trials in rare ovarian tumours reached at the 5th Ovarian Cancer Consensus Conference (OCCC) held in Tokyo, November 2015. Three important questions were identified concerning rare ovarian tumours (rare epithelial ovarian cancers (eOC), sex-cord stromal tumours (SCST) and germ cell tumours (GCT)): (1) What are the research and trial issues that are unique to rare ovarian tumours? There is a lack of randomised phase III data defining standards of care which makes it difficult to define control arms, but identifies unmet needs that merit investigation. Internationally agreed upon diagnostic criteria, expert pathological review, and translational research are crucial. (2) What should be investigated in rare eOC, GCT and SCST? Trials dedicated to each rare ovarian tumour should be encouraged. Nonetheless, where the question is relevant, rare eOC can be included in eOC trials but with rigorous stratification. Although there is emerging evidence suggesting that rare eOC have different molecular profiles, trials are needed to define new type-specific standards for each rare eOC (clear cell, low grade serous and mucinous). For GCTs, a priority is reducing toxicities from treatment while maintaining cure rates. Both a robust prognostic scoring system and more effective treatments for de novo poor prognosis and relapsed GCTs are needed. For SCSTs, validated prognostic markers as well as alternatives to the current standard of bleomycin/etoposide/cisplatin (BEP) should be identified. (3) Are randomised trials feasible? Randomised controlled trials (RCT) should be feasible in any of the rare tumours through international collaboration. Ongoing trials have already demonstrated the feasibility of RCT in rare eOC and SCST. Mucinous OC may be considered for inclusion, stratified, into RCTs of non-gynaecological mucinous tumours, while RCTs in high risk or relapsed GCT may be performed as a subset of male and

  13. [Consensus statement on assistance to women with human immunodeficiency virus infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA)].

    PubMed

    2014-02-01

    To develop a consensus document on clinical recommendations for the health care of women with human immunodeficiency virus (HIV) infection. We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan and GeSIDA that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, and two panel members acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (i, ii, iii), already used in previous documents from SPNS/GeSIDA. We provide multiple recommendations for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. The consensus recommends gender mainstreaming in health care, and promoting training for healthcare professionals in order to avoid gender bias. With currently available data it seems that the effectiveness of the treatment is the same in both men and women, there being no limitation as to the use of any antiretroviral for this reason. Women have more treatments suspended for reasons other than virological failure, thus they require better monitoring. This document presents recommendations for addressing women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, disease development, and treatment between men and women. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  14. The Huygens Probe Descent Trajectory Working Group: Organizational framework, goals, and implementation

    NASA Astrophysics Data System (ADS)

    Atkinson, David H.; Kazeminejad, Bobby; Lebreton, Jean-Pierre; Witasse, Olivier; Pérez-Ayúcar, Miguel; Matson, Dennis L.

    2007-11-01

    Cassini/Huygens, a flagship mission to explore the rings, atmosphere, magnetic field, and moons that make up the Saturn system, is a joint endeavor of the National Aeronautics and Space Administration, the European Space Agency, and Agenzia Spaziale Italiana. Comprising two spacecraft - a Saturn orbiter built by NASA and a Titan entry/descent probe built by the European Space Agency - Cassini/Huygens was launched in October 1997. The Huygens probe parachuted to the surface of Titan in January 2005. During the descent, six science instruments provided in situ measurements of Titan's atmosphere, clouds, and winds, and photographed Titan's surface. To correctly interpret and correlate results from the probe science experiments, and to provide a reference set of data for ground-truth calibration of orbiter remote sensing measurements, an accurate reconstruction of the probe entry and descent trajectory and surface landing location is necessary. The Huygens Descent Trajectory Working Group was chartered in 1996 as a subgroup of the Huygens Science Working Team to develop and implement an organizational framework and retrieval methodologies for the probe descent trajectory reconstruction from the entry altitude of 1270 km to the surface using navigation data, and engineering and science data acquired by the instruments on the Huygens Probe. This paper presents an overview of the Descent Trajectory Working Group, including the history, rationale, goals and objectives, organizational framework, rules and procedures, and implementation.

  15. The implementation evaluation of primary care groups of practice: a focus on organizational identity

    PubMed Central

    2010-01-01

    Background Since 2002 the Health Ministry of Québec (Canada) has been implementing a primary care organizational innovation called 'family medicine groups'. This is occurring in a political context in which the reorganization of primary care is considered necessary to improve health care system performance. More specifically, the purpose of this reform has been to overcome systemic deficiencies in terms of accessibility and continuity of care. This paper examines the first years of implementation of the family medicine group program, with a focus on the emergence of the organizational identity of one of the pilot groups located in the urban area of Montreal. Methods An in-depth longitudinal case study was conducted over two and a half years. Face to face individual interviews with key informants from the family medicine group under study were conducted over the research period considered. Data was gathered throuhg observations and documentary analysis. The data was analyzed using temporal bracketing and Fairclough's three-dimensional critical discourse analytical techniques. Results Three different phases were identified over the period under study. During the first phase, which corresponded to the official start-up of the family medicine group program, new resources and staff were only available at the end of the period, and no changes occurred in medical practices. Power struggles between physicians and nurses characterized the second phase, resulting in a very difficult integration of advanced nurse practitioners into the group. Indeed, the last phase was portrayed by initial collaborative practices associated with a sensegiving process prompted by a new family medicine group director. Conclusions The creation of a primary care team is a very challenging process that goes beyond the normative policy definitions of who is on the team or what the team has to do. To fulfil expectations of quality improvement through team-based care, health care professionals who

  16. Comparison study of the rates of manual peripheral blood smear review from 3 automated hematology analyzers, Unicel DxH 800, ADVIA 2120i, and XE 2100, using international consensus group guidelines.

    PubMed

    Kim, Sue Jung; Kim, Yoonjung; Shin, Saeam; Song, Jaewoo; Choi, Jong Rak

    2012-11-01

    In the clinical laboratory, it is important both to reduce the number of peripheral blood slide reviews to save time and money and to avoid reporting false results. To determine differences in the slide review rates of 3 widely used automated hematologic analyzers, the Unicel DxH 800 (Beckman Coulter Inc, Fullerton, California), ADVIA 2120i (Siemens Diagnostics, Tarrytown, New York), and XE 2100 (Sysmex, Kobe, Japan), using International Consensus Group for Hematology Review guidelines. A total of 1485 samples were tested, and 300 were manually reviewed. Slide review rates, sensitivity, specificity, and false-positive and false-negative rates were estimated using consensus group rules and compared using χ(2) tests, Fisher exact tests, or generalized estimating equations. Unicel DxH 800, ADVIA 2120i, and XE 2100 showed 22.8%, 20.2%, and 28.6% slide review rates; 14.3%, 14.3%, and 9.7% false-negative rates; and 13.7, 11.3%, and 17.3% false-positive rates, respectively. All analyzers showed significantly higher false-negative rates than that of the consensus group (2.9%). False-negative rates were higher than the recommended levels. Among 3 automated hematologic analyzers, XE 2100 showed the highest rate of slide review. Because the present study clearly shows that the slide review rates have distinct characteristics among the studied analyzers, each individual laboratory should consider selecting the most appropriate analyzer according to clinical characteristics. Analyzers with high sensitivity may be advantageous in outpatient settings for screening patients, whereas analyzers with high specificity may be beneficial in inpatient settings for efficient patient care.

  17. Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography.

    PubMed

    Habib, Gilbert; Bucciarelli-Ducci, Chiara; Caforio, Alida L P; Cardim, Nuno; Charron, Philippe; Cosyns, Bernard; Dehaene, Aurélie; Derumeaux, Genevieve; Donal, Erwan; Dweck, Marc R; Edvardsen, Thor; Erba, Paola Anna; Ernande, Laura; Gaemperli, Oliver; Galderisi, Maurizio; Grapsa, Julia; Jacquier, Alexis; Klingel, Karin; Lancellotti, Patrizio; Neglia, Danilo; Pepe, Alessia; Perrone-Filardi, Pasquale; Petersen, Steffen E; Plein, Sven; Popescu, Bogdan A; Reant, Patricia; Sade, L Elif; Salaun, Erwan; Slart, Riemer H J A; Tribouilloy, Christophe; Zamorano, Jose

    2017-10-01

    Restrictive cardiomyopathies (RCMs) are a diverse group of myocardial diseases with a wide range of aetiologies, including familial, genetic and acquired diseases and ranging from very rare to relatively frequent cardiac disorders. In all these diseases, imaging techniques play a central role. Advanced imaging techniques provide important novel data on the diagnostic and prognostic assessment of RCMs. This EACVI consensus document provides comprehensive information for the appropriateness of all non-invasive imaging techniques for the diagnosis, prognostic evaluation, and management of patients with RCM. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  18. Implementing an evidence-based metabolic syndrome prevention and treatment program utilizing group visits.

    PubMed

    Greer, Deborah M; Hill, Dawn C

    2011-02-01

    To develop and implement a pilot program designed as a shared medical group visit targeting metabolic syndrome prevention in two ethnically diverse patient populations. The Cooperative Health Care Clinics (CHCC) module was utilized for group sessions to focus on interactive discussions following the L.E.A.R.N. format in order to encourage healthy lifestyle changes. Participants completed a pre- and postknowledge base test that encompassed information on healthy lifestyle changes in addition to disease processes associated with metabolic syndrome. Each didactic session was evaluated using mean ± standard deviation for the knowledge tests. Analysis of variance was used in determining body mass index (BMI) and weight measured at weeks 1, 5, and 10. Participants completed a 5-point Likert scale satisfaction survey on week 10. Independent means t-test compared clinic results along with the Satterthwaite approximate t-test because of unequal sample sizes to evaluate differences in means. There were no significant statistical differences in mean weight or BMI on weeks 1 and 5. However, on week 10, there was a statistically significant difference for waist circumference in both clinics (p= .0466). Knowledge base improved in both clinics with a premean (0 score = 87 ± 18) and postmean (0 score = 93 ± 14). Both sites received high scores for patient satisfaction. The shared medical group visits program implemented in both clinic sites demonstrated that this is an effective model in which to provide intensive patient education, foster peer support, and facilitate health-related behavioral changes. Peer support, self-management, and continuity appear to be important factors in behavior change and improved knowledge. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  19. Consensus methods: review of original methods and their main alternatives used in public health

    PubMed Central

    Bourrée, Fanny; Michel, Philippe; Salmi, Louis Rachid

    2008-01-01

    Summary Background Consensus-based studies are increasingly used as decision-making methods, for they have lower production cost than other methods (observation, experimentation, modelling) and provide results more rapidly. The objective of this paper is to describe the principles and methods of the four main methods, Delphi, nominal group, consensus development conference and RAND/UCLA, their use as it appears in peer-reviewed publications and validation studies published in the healthcare literature. Methods A bibliographic search was performed in Pubmed/MEDLINE, Banque de Données Santé Publique (BDSP), The Cochrane Library, Pascal and Francis. Keywords, headings and qualifiers corresponding to a list of terms and expressions related to the consensus methods were searched in the thesauri, and used in the literature search. A search with the same terms and expressions was performed on Internet using the website Google Scholar. Results All methods, precisely described in the literature, are based on common basic principles such as definition of subject, selection of experts, and direct or remote interaction processes. They sometimes use quantitative assessment for ranking items. Numerous variants of these methods have been described. Few validation studies have been implemented. Not implementing these basic principles and failing to describe the methods used to reach the consensus were both frequent reasons contributing to raise suspicion regarding the validity of consensus methods. Conclusion When it is applied to a new domain with important consequences in terms of decision making, a consensus method should be first validated. PMID:19013039

  20. Full symmetry implementation in condensed matter and molecular physics-Modified group projector technique

    NASA Astrophysics Data System (ADS)

    Damnjanović, Milan; Milošević, Ivanka

    2015-06-01

    Symmetry is well established as one of the fundamental concepts in physics, accurately extracting relevant characteristics of the studied object, giving deep and transparent insight to its properties. In the solid state and molecular physics the most abundant application is reduction of the dimension of the eigenproblem of the Hamiltonian, with the resulting eigenvectors labeled by good quantum numbers, forming the so called symmetry adapted basis. Such a basis is the starting point for subsequent analysis of the physical properties of the system, performed usually by applying adequate perturbation technique. Standard procedure for finding a symmetry adapted basis involves Wigner operators, which are sums of the operators acting in the quantum state space (Hilbert space, most usually) over all elements of the symmetry group of the systems. However, both the dimension of the state space and the number of the symmetry transformations are infinite even in the simplest approximate models in crystal physics making obstacles for direct application of the standard Wigner projector technique, and its numerical implementation. On the other hand, there is a minimal part of the system, the full symmetry elementary cell (symcell), from which the whole system can be built by action of the full symmetry group elements on it. A clear heuristic idea, that symcell and full symmetry group, determine the properties of the entire system, is fully realized within modified group projector technique. Namely, when applying this technique, the full symmetry of the system is used to provide reduction of calculations to the symcell only, singling out its state space (of a finite dimension!) as the effective state space to be worked in. Physical observables, expressed through their irreducible tensor components, obtain their counterparts in this finite-dimensional space of a symcell. It remains to consider only the symmetry transformations which leave the symcell invariant. This is absolutely

  1. Diagnostic standards for dopaminergic augmentation of restless legs syndrome: report from a World Association of Sleep Medicine-International Restless Legs Syndrome Study Group consensus conference at the Max Planck Institute.

    PubMed

    García-Borreguero, Diego; Allen, Richard P; Kohnen, Ralf; Högl, Birgit; Trenkwalder, Claudia; Oertel, Wolfgang; Hening, Wayne A; Paulus, Walter; Rye, David; Walters, Arthur; Winkelmann, Juliane; Earley, Christopher J

    2007-08-01

    Augmentation of symptom severity is the main complication of dopaminergic treatment of restless legs syndrome (RLS). The current article reports on the considerations of augmentation that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored Consensus Conference in April 2006 at the Max Planck Institute (MPI) in Munich, Germany, the conclusions of which were endorsed by the International RLS Study Group (IRLSSG) and the World Association of Sleep Medicine (WASM). The Consensus Conference sought to develop a better understanding of augmentation and generate a better operational definition for its clinical identification. Current concepts of the pathophysiology, clinical features, and therapy of RLS augmentation were evaluated by subgroups who presented a summary of their findings for general consideration and discussion. Recent data indicating sensitivity and specificity of augmentation features for identification of augmentation were also evaluated. The diagnostic criteria of augmentation developed at the National Institutes of Health (NIH) conference in 2002 were reviewed in light of current data and theoretical understanding of augmentation. The diagnostic value and criteria for each of the accepted features of augmentation were considered by the group. A consensus was then developed for a revised statement of the diagnostic criteria for augmentation. Five major diagnostic features of augmentation were identified: usual time of RLS symptom onset each day, number of body parts with RLS symptoms, latency to symptoms at rest, severity of the symptoms when they occur, and effects of dopaminergic medication on symptoms. The quantitative data available relating the time of RLS onset and the presence of other features indicated optimal augmentation criteria of either a 4-h advance in usual starting time for RLS symptoms or a combination of the occurrence of other features. A paradoxical response to changes in medication dose also indicates

  2. Consensus theoretic classification methods

    NASA Technical Reports Server (NTRS)

    Benediktsson, Jon A.; Swain, Philip H.

    1992-01-01

    Consensus theory is adopted as a means of classifying geographic data from multiple sources. The foundations and usefulness of different consensus theoretic methods are discussed in conjunction with pattern recognition. Weight selections for different data sources are considered and modeling of non-Gaussian data is investigated. The application of consensus theory in pattern recognition is tested on two data sets: 1) multisource remote sensing and geographic data and 2) very-high-dimensional remote sensing data. The results obtained using consensus theoretic methods are found to compare favorably with those obtained using well-known pattern recognition methods. The consensus theoretic methods can be applied in cases where the Gaussian maximum likelihood method cannot. Also, the consensus theoretic methods are computationally less demanding than the Gaussian maximum likelihood method and provide a means for weighting data sources differently.

  3. Intergroup Consensus/Disagreement in Support of Group-Based Hierarchy: An Examination of Socio-Structural and Psycho-Cultural Factors

    ERIC Educational Resources Information Center

    Lee, I-Ching; Pratto, Felicia; Johnson, Blair T.

    2011-01-01

    A meta-analysis examined the extent to which socio-structural and psycho-cultural characteristics of societies correspond with how much gender and ethnic/racial groups differ on their support of group-based hierarchy. Robustly, women opposed group-based hierarchy more than men did, and members of lower power ethnic/racial groups opposed…

  4. Intergroup Consensus/Disagreement in Support of Group-Based Hierarchy: An Examination of Socio-Structural and Psycho-Cultural Factors

    ERIC Educational Resources Information Center

    Lee, I-Ching; Pratto, Felicia; Johnson, Blair T.

    2011-01-01

    A meta-analysis examined the extent to which socio-structural and psycho-cultural characteristics of societies correspond with how much gender and ethnic/racial groups differ on their support of group-based hierarchy. Robustly, women opposed group-based hierarchy more than men did, and members of lower power ethnic/racial groups opposed…

  5. Implementing Kanban for agile process management within the ALMA Software Operations Group

    NASA Astrophysics Data System (ADS)

    Reveco, Johnny; Mora, Matias; Shen, Tzu-Chiang; Soto, Ruben; Sepulveda, Jorge; Ibsen, Jorge

    2014-07-01

    After the inauguration of the Atacama Large Millimeter/submillimeter Array (ALMA), the Software Operations Group in Chile has refocused its objectives to: (1) providing software support to tasks related to System Integration, Scientific Commissioning and Verification, as well as Early Science observations; (2) testing the remaining software features, still under development by the Integrated Computing Team across the world; and (3) designing and developing processes to optimize and increase the level of automation of operational tasks. Due to their different stakeholders, each of these tasks presents a wide diversity of importances, lifespans and complexities. Aiming to provide the proper priority and traceability for every task without stressing our engineers, we introduced the Kanban methodology in our processes in order to balance the demand on the team against the throughput of the delivered work. The aim of this paper is to share experiences gained during the implementation of Kanban in our processes, describing the difficulties we have found, solutions and adaptations that led us to our current but still evolving implementation, which has greatly improved our throughput, prioritization and problem traceability.

  6. Nonperturbative renormalization group preserving full-momentum dependence: Implementation and quantitative evaluation

    NASA Astrophysics Data System (ADS)

    Benitez, F.; Blaizot, J.-P.; Chaté, H.; Delamotte, B.; Méndez-Galain, R.; Wschebor, N.

    2012-02-01

    We present the implementation of the Blaizot-Méndez-Wschebor approximation scheme of the nonperturbative renormalization group we present in detail, which allows for the computation of the full-momentum dependence of correlation functions. We discuss its significance and its relation with other schemes, in particular, the derivative expansion. Quantitative results are presented for the test ground of scalar O(N) theories. Besides critical exponents, which are zero-momentum quantities, we compute the two-point function at criticality in the whole momentum range in three dimensions and, in the high-temperature phase, the universal structure factor. In all cases, we find very good agreement with the best existing results.

  7. European Commission project: European Guideline for Target Group-Oriented Psychosocial Aftercare-Implementation.

    PubMed

    Vymetal, Stepan; Deistler, Albert; Bering, Robert; Schedlich, Claudia; Rooze, Magda; Orengo, Francisco; Zurek, Gisela; Krtickova, Michaela

    2011-06-01

    After disasters, the individual health and well-being of first responders and affected population are affected for years. Therefore, psychosocial help is needed. Although most victims recover on their own, a minority of survivors, members of rescue teams, or relatives develop long-term, disaster-related psychic disorders, such as post-traumatic stress disorder (PTSD). This subgroup especially should receive timely and appropriate psychosocial help. Many European countries offer post-disaster psychosocial care from a variety of caregivers (i.e., professionals and volunteers, non-governmental organizations, church or commercial organizations). Therefore, European standards for providing post-disaster psychosocial support currently is required. This article describes the project European Guideline for Target Group-Oriented Psychosocial Aftercare-Implementation, supported by the European Commission.

  8. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement.

    PubMed

    Moon, James C; Messroghli, Daniel R; Kellman, Peter; Piechnik, Stefan K; Robson, Matthew D; Ugander, Martin; Gatehouse, Peter D; Arai, Andrew E; Friedrich, Matthias G; Neubauer, Stefan; Schulz-Menger, Jeanette; Schelbert, Erik B

    2013-10-14

    Rapid innovations in cardiovascular magnetic resonance (CMR) now permit the routine acquisition of quantitative measures of myocardial and blood T1 which are key tissue characteristics. These capabilities introduce a new frontier in cardiology, enabling the practitioner/investigator to quantify biologically important myocardial properties that otherwise can be difficult to ascertain clinically. CMR may be able to track biologically important changes in the myocardium by: a) native T1 that reflects myocardial disease involving the myocyte and interstitium without use of gadolinium based contrast agents (GBCA), or b) the extracellular volume fraction (ECV)-a direct GBCA-based measurement of the size of the extracellular space, reflecting interstitial disease. The latter technique attempts to dichotomize the myocardium into its cellular and interstitial components with estimates expressed as volume fractions. This document provides recommendations for clinical and research T1 and ECV measurement, based on published evidence when available and expert consensus when not. We address site preparation, scan type, scan planning and acquisition, quality control, visualisation and analysis, technical development. We also address controversies in the field. While ECV and native T1 mapping appear destined to affect clinical decision making, they lack multi-centre application and face significant challenges, which demand a community-wide approach among stakeholders. At present, ECV and native T1 mapping appear sufficiently robust for many diseases; yet more research is required before a large-scale application for clinical decision-making can be recommended.

  9. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement

    PubMed Central

    2013-01-01

    Rapid innovations in cardiovascular magnetic resonance (CMR) now permit the routine acquisition of quantitative measures of myocardial and blood T1 which are key tissue characteristics. These capabilities introduce a new frontier in cardiology, enabling the practitioner/investigator to quantify biologically important myocardial properties that otherwise can be difficult to ascertain clinically. CMR may be able to track biologically important changes in the myocardium by: a) native T1 that reflects myocardial disease involving the myocyte and interstitium without use of gadolinium based contrast agents (GBCA), or b) the extracellular volume fraction (ECV)–a direct GBCA-based measurement of the size of the extracellular space, reflecting interstitial disease. The latter technique attempts to dichotomize the myocardium into its cellular and interstitial components with estimates expressed as volume fractions. This document provides recommendations for clinical and research T1 and ECV measurement, based on published evidence when available and expert consensus when not. We address site preparation, scan type, scan planning and acquisition, quality control, visualisation and analysis, technical development. We also address controversies in the field. While ECV and native T1 mapping appear destined to affect clinical decision making, they lack multi-centre application and face significant challenges, which demand a community-wide approach among stakeholders. At present, ECV and native T1 mapping appear sufficiently robust for many diseases; yet more research is required before a large-scale application for clinical decision-making can be recommended. PMID:24124732

  10. Interactions of selected policy-stakeholder groups implementing middle school science standards-based systemic reform

    NASA Astrophysics Data System (ADS)

    Boydston, Theodore Lewis, III

    1999-12-01

    This research is an interpretive inquiry into the views and interactions of stakeholders in a district office of a large school system responsible for implementing science systemic reform. Three major sources of data were used in this research: surveys, stakeholder interviews, and autobiographical reflection on experiences as part of the reform initiative. This is an emergent research that is evident in the shift in the focus of research questions and their supporting assumptions during the research. The literature review describes standards-based reform, arguments about reform, and the major dimensions of reform research. The results of the survey of stakeholders revealed that the views among the stakeholder groups followed the system hierarchy and could be separated into two large groups; staff responsible for implementing the reform initiative and the other stakeholder groups. Each of these groups was composed of identifiable subgroups. The interviews with stakeholders revealed how their different attitudes, values, and beliefs frame the context of stakeholder interactions. An over reliance on an authoritarian view of decision-making leaves many stakeholders feeling disempowered and critical of others. This atmosphere promotes blaming, which inhibits collegial interaction. Work experiences in the district office revealed how stakeholders' unaddressed assumptions, attitudes, and beliefs promote fragmentation and competition rather than cooperation. Hidden assumptions about management by control and mandate, competition, and teaching and learning appear to restrain the interactions of stakeholders. Support of the National Science Education Standards was identified as a unifying view among the stakeholders, yet the professional development program focused on content and pedagogical knowledge without addressing stakeholder concerns and beliefs about the intended constructivist framework of the program. Stakeholders' attitudes about the issue of equity demonstrated

  11. Analysis of a cultural consensus model of two good-life sub-domains--health & well-being and migration & socioeconomic milieu--in three population groups in Croatia.

    PubMed

    Peternel, Lana; Malnar, Ana; Klarić, Irena Martinović

    2015-07-01

    In this study the construct of a 'good life' was explored among upper secondary school senior pupils and their parents and teachers by applying cultural consensus model analysis. A total of 469 students, 474 parents and 158 teachers from four Croatian cities participated in the study, which was conducted in 2011/2012. The information collected through interviewing and free-listing during the first phase of the study was used to create a set of structured questionnaire questions as a part of the survey in the second phase of data collection. The results are reported on two good-life sub-domains: 'health & well-being' and 'migration & socioeconomic milieu'. The results indicate heterogeneity of the sample groups, incomplete inter-generational transmission of cultural values and examples of two sub-groups that resist cultural norms and do not comply with the dominant 'competence-as-sharing' paradigm. The value of testing the cultural consensus model based on the emic approach and locally significant phenomena is demonstrated for planning and conducting holistic anthropological research.

  12. Cost Sensitive Moving Target Consensus

    SciTech Connect

    Duan, Sisi; Li, Yun; Levitt, Karl N.

    2016-01-01

    Consensus is a fundamental approach to implementing fault-tolerant services through replication where there exists a tradeoff between the cost and the resilience. For instance, Crash Fault Tolerant (CFT) protocols have a low cost but can only handle crash failures while Byzantine Fault Tolerant (BFT) protocols handle arbitrary failures but have a higher cost. Hybrid protocols enjoy the benefits of both high performance without failures and high resiliency under failures by switching among different subprotocols. However, it is challenging to determine which subprotocols should be used. We propose a moving target approach to switch among protocols according to the existing system and network vulnerability. At the core of our approach is a formalized cost model that evaluates the vulnerability and performance of consensus protocols based on real-time Intrusion Detection System (IDS) signals. Based on the evaluation results, we demonstrate that a safe, cheap, and unpredictable protocol is always used and a high IDS error rate can be tolerated.

  13. Consensus Recommendations from the Spanish Germ Cell Cancer Group on the Use of High-dose Chemotherapy in Germ Cell Cancer.

    PubMed

    González-Billalabeitia, Enrique; Sepúlveda, Juan Manuel; Maroto, Pablo; Aparicio, Jorge; Arranz, Jose Angel; Esteban, Emilio; Gironés, Regina; López-Brea, Marta; Mendez-Vidal, María José; Pinto, Alvaro; Sastre, Javier; de Prado, Diego Soto; Terrasa, Josefa; Vázquez, Sergio; Powles, Thomas; Beyer, Jörg; Castellano, Daniel; Del Muro, Xavier García

    2016-07-18

    High-dose chemotherapy (HDCT) has been studied in several clinical scenarios in advanced germ cell cancer (GCC). To establish a clinical practice guideline for HDCT use in the treatment of GCC patients. An expert panel reviewed information available from the literature. The panel addressed relevant issues concerning and related to HDCT. The guideline was externally reviewed by two international experts. The efficacy of HDCT has been demonstrated in selected GCC patients. The most conclusive evidence comes from retrospective analyses that need to be interpreted with caution. HDCT can cure a significant proportion of heavily treated GCC patients. When indicated, sequential HDCT with regimens containing carboplatin and etoposide, as well as peripheral stem-cell support, is recommended. There is no conclusive evidence to recommend HDCT as first-line therapy. According to a multinational retrospective pooled analysis, HDCT might be superior to conventional CT as first salvage treatment in selected patients. There is an urgent need for prospective clinical trials addressing the value of HDCT in GCC patients who experience failure on first-line cisplatin-based CT. In patients who progress on conventional-dose salvage CT, HDCT should be considered. Treatment of these patients at experienced centers is strongly recommended. It has been demonstrated that HDCT cures selected GCC patients who experience disease progression on conventional rescue regimens. The panel recommends the inclusion of GCC patients in randomized clinical trials including HDCT. This consensus establishes clinical practice guidelines for the use and study of high-dose chemotherapy in patients with germ cell cancer. Copyright © 2016. Published by Elsevier B.V.

  14. Recommendations for the Design, Implementation and Evaluation of Social Support in Online Communities, Networks, and Groups

    PubMed Central

    Weiss, Jacob B.; Berner, Eta S.; Johnson, Kevin B.; Giuse, Dario A.; Murphy, Barbara A.; Lorenzi, Nancy M.

    2014-01-01

    A new model of health care is emerging in which individuals can take charge of their health by connecting to online communities and social networks for personalized support and collective knowledge. Web 2.0 technologies expand the traditional notion of online support groups into a broad and evolving range of informational, emotional, as well as community-based concepts of support. In order to apply these technologies to patient-centered care, it is necessary to incorporate more inclusive conceptual frameworks of social support and community-based research methodologies. This paper introduces a conceptualization of online social support, reviews current challenges in online support research, and outlines six recommendations for the design, evaluation, and implementation of social support in online communities, networks, and groups. The six recommendations are illustrated by CanConnect, an online community for cancer survivors in Middle Tennessee. These recommendations address the interdependencies between online and real-world support and emphasize an inclusive framework of interpersonal and community-based support. The applications of these six recommendations are illustrated through a discussion of online support for cancer survivors. PMID:23583424

  15. Recommendations for the design, implementation and evaluation of social support in online communities, networks, and groups.

    PubMed

    Weiss, Jacob B; Berner, Eta S; Johnson, Kevin B; Giuse, Dario A; Murphy, Barbara A; Lorenzi, Nancy M

    2013-12-01

    A new model of health care is emerging in which individuals can take charge of their health by connecting to online communities and social networks for personalized support and collective knowledge. Web 2.0 technologies expand the traditional notion of online support groups into a broad and evolving range of informational, emotional, as well as community-based concepts of support. In order to apply these technologies to patient-centered care, it is necessary to incorporate more inclusive conceptual frameworks of social support and community-based research methodologies. This paper introduces a conceptualization of online social support, reviews current challenges in online support research, and outlines six recommendations for the design, evaluation, and implementation of social support in online communities, networks, and groups. The six recommendations are illustrated by CanConnect, an online community for cancer survivors in middle Tennessee. These recommendations address the interdependencies between online and real-world support and emphasize an inclusive framework of interpersonal and community-based support. The applications of these six recommendations are illustrated through a discussion of online support for cancer survivors.

  16. Intergroup consensus/disagreement in support of group-based hierarchy: an examination of socio-structural and psycho-cultural factors.

    PubMed

    Lee, I-Ching; Pratto, Felicia; Johnson, Blair T

    2011-11-01

    A meta-analysis examined the extent to which socio-structural and psycho-cultural characteristics of societies correspond with how much gender and ethnic/racial groups differ on their support of group-based hierarchy. Robustly, women opposed group-based hierarchy more than men did, and members of lower power ethnic/racial groups opposed group-based hierarchy more than members of higher power ethnic/racial groups did. As predicted by social dominance theory, gender differences were larger, more stable, and less variable from sample to sample than differences between ethnic/racial groups. Subordinate gender and ethnic/racial group members disagreed more with dominants in their views of group-based hierarchy in societies that can be considered more liberal and modern (e.g., emphasizing individualism and change from traditions), as well as in societies that enjoyed greater gender equality. The relations between gender and ethnic/racial groups are discussed, and implications are developed for social dominance theory, social role theory, biosocial theory, social identity theory, system justification theory, realistic group conflict theory, and relative deprivation theory. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

  17. Intergroup Consensus/Disagreement in Support of Group Based Hierarchy: An Examination of Socio-Structural and Psycho-Cultural Factors

    PubMed Central

    Lee, I-Ching; Pratto, Felicia; Johnson, Blair T.

    2011-01-01

    A meta-analysis examined the extent to which socio-structural and psycho-cultural characteristics of societies correspond with how much gender and ethnic/racial groups differ on their support of group-based hierarchy. Robustly, women opposed group-based hierarchy more than men did and members of lower-power ethnic/racial groups opposed group-based hierarchy more than members of higher-power ethnic/racial groups. As predicted by social dominance theory, gender differences were larger, more stable, and less variable from sample to sample than differences between ethnic/racial groups. Subordinate gender and ethnic/racial group members disagreed more with dominants in their views of group-based hierarchy in societies that can be considered more liberal and modern (e.g., emphasizing individualism and change from traditions), as well as in societies that enjoyed greater gender equality. The relations between gender and ethnic/racial groups are discussed and implications are developed for social dominance theory, social role theory and biosocial theory, social identity theory, system justification theory, realistic group conflict theory and relative deprivation theory. PMID:22023142

  18. RTOG Sarcoma Radiation Oncologists Reach Consensus on Gross Tumor Volume and Clinical Target Volume on Computed Tomographic Images for Preoperative Radiotherapy of Primary Soft Tissue Sarcoma of Extremity in Radiation Therapy Oncology Group Studies

    SciTech Connect

    Wang Dian; Bosch, Walter; Roberge, David; Finkelstein, Steven E.; Petersen, Ivy; Haddock, Michael; Chen, Yen-Lin E.; Saito, Naoyuki G.; Kirsch, David G.; Hitchcock, Ying J.; Wolfson, Aaron H.; DeLaney, Thomas F.

    2011-11-15

    Objective: To develop a Radiation Therapy Oncology Group (RTOG) atlas delineating gross tumor volume (GTV) and clinical target volume (CTV) to be used for preoperative radiotherapy of primary extremity soft tissue sarcoma (STS). Methods and Materials: A consensus meeting was held during the RTOG meeting in January 2010 to reach agreement about GTV and CTV delineation on computed tomography (CT) images for preoperative radiotherapy of high-grade large extremity STS. Data were presented to address the local extension of STS. Extensive discussion ensued to develop optimal criteria for GTV and CTV delineation on CT images. Results: A consensus was reached on appropriate CT-based GTV and CTV. The GTV is gross tumor defined by T1 contrast-enhanced magnetic resonance images. Fusion of magnetic resonance and images is recommended to delineate the GTV. The CTV for high-grade large STS typically includes the GTV plus 3-cm margins in the longitudinal directions. If this causes the field to extend beyond the compartment, the field can be shortened to include the end of a compartment. The radial margin from the lesion should be 1.5 cm, including any portion of the tumor not confined by an intact fascial barrier, bone, or skin surface. Conclusion: The consensus on GTV and CTV for preoperative radiotherapy of high-grade large extremity STS is available as web-based images and in a descriptive format through the RTOG. This is expected to improve target volume consistency and allow for rigorous evaluation of the benefits and risks of such treatment.

  19. Implementation

    EPA Pesticide Factsheets

    Describes elements for the set of activities to ensure that control strategies are put into effect and that air quality goals and standards are fulfilled, permitting programs, and additional resources related to implementation under the Clean Air Act.

  20. [GEITDAH consensus on attention deficit hyperactivity disorder].

    PubMed

    Montañés-Rada, F; Gastaminza-Pérez, X; Catalá, M A; Ruiz-Sanz, F; Ruiz-Lázaro, P M; Herreros-Rodríguez, O; García-Giral, M; Ortiz-Guerra, J; Alda-Díez, J A; Mojarro-Práxedes, D; Cantó-Díez, T; Mardomingo-Sanz, M J; Sasot-Llevadot, J; Pàmias, M; Rey-Sánchez, F

    2010-11-16

    In this article, the GEITDAH -the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyper-activity Disorder (ADHD)- presents a consensus reached by experts in the management of ADHD from all over Spain. The consensus concerns fundamental aspects that should be the starting point for future local or regional consensus guides. Another aim of this consensus is also to reduce the amount of variability that occurs in the health care offered to patients with ADHD in our country, as well as to act as a stimulus in educational matters. That fact that it is not very long will make it more popular among greater numbers of people and this will allow these goals to be reached more effectively. The conclusions in the consensus guide have been constructed around an introduction dealing with basic aspects and recommendations for diagnosis, treatment (both pharmacological and psychotherapeutic), patient flow and organisational aspects.

  1. Implementation of Simple and Functional Web Applications at the Alaska Volcano Observatory Remote Sensing Group

    NASA Astrophysics Data System (ADS)

    Skoog, R. A.

    2007-12-01

    Web pages are ubiquitous and accessible, but when compared to stand-alone applications they are limited in capability. The Alaska Volcano Observatory (AVO) Remote Sensing Group has implemented web pages and supporting server software that provide relatively advanced features to any user able to meet basic requirements. Anyone in the world with access to a modern web browser (such as Mozilla Firefox 1.5 or Internet Explorer 6) and reasonable internet connection can fully use the tools, with no software installation or configuration. This allows faculty, staff and students at AVO to perform many aspects of volcano monitoring from home or the road as easily as from the office. Additionally, AVO collaborators such as the National Weather Service and the Anchorage Volcanic Ash Advisory Center are able to use these web tools to quickly assess volcanic events. Capabilities of this web software include (1) ability to obtain accurate measured remote sensing data values on an semi- quantitative compressed image of a large area, (2) to view any data from a wide time range of data swaths, (3) to view many different satellite remote sensing spectral bands and combinations, to adjust color range thresholds, (4) and to export to KML files which are viewable virtual globes such as Google Earth. The technologies behind this implementation are primarily Javascript, PHP, and MySQL which are free to use and well documented, in addition to Terascan, a commercial software package used to extract data from level-0 data files. These technologies will be presented in conjunction with the techniques used to combine them into the final product used by AVO and its collaborators for operational volcanic monitoring.

  2. Strategies to implement evidence into practice to improve palliative care: recommendations of a nominal group approach with expert opinion leaders.

    PubMed

    van Riet Paap, Jasper; Vissers, Kris; Iliffe, Steve; Radbruch, Lukas; Hjermstad, Marianne J; Chattat, Rabih; Vernooij-Dassen, Myrra; Engels, Yvonne

    2015-09-29

    In the past decades, many new insights and best practices in palliative care, a relatively new field in health care, have been published. However, this knowledge is often not implemented. The aim of this study therefore was to identify strategies to implement improvement activities identified in a research project within daily palliative care practice. A nominal group technique was used with members of the IMPACT consortium, being international researchers and clinicians in cancer care, dementia care and palliative care. Participants identified and prioritized implementation strategies. Data was analyzed qualitatively using inductive coding. Twenty international clinicians and researchers participated in one of two parallel nominal group sessions. The recommended strategies to implement results from a research project were grouped in five common themes: 1. Dissemination of results e.g. by publishing results tailored to relevant audiences, 2. Identification and dissemination of unique selling points, 3. education e.g. by developing e-learning tools and integrating scientific evidence into core curricula, 4. Stimulation of participation of stakeholders, and 5. consideration of consequences e.g. rewarding services for their implementation successes but not services that fail to implement quality improvement activities. The added value of this nominal group study lies in the prioritisation by the experts of strategies to influence the implementation of quality improvement activities in palliative care. Efforts to ensure future use of scientific findings should be built into research projects in order to prevent waste of resources.

  3. What European gynaecologists need to master: Consensus on medical expertise outcomes of pan-European postgraduate training in obstetrics & gynaecology.

    PubMed

    van der Aa, Jessica E; Tancredi, Annalisa; Goverde, Angelique J; Velebil, Petr; Feyereisl, Jaroslav; Benedetto, Chiara; Teunissen, Pim W; Scheele, Fedde

    2017-09-01

    European harmonisation of training standards in postgraduate medical education in Obstetrics and Gynaecology is needed because of the increasing mobility of medical specialists. Harmonisation of training will provide quality assurance of training and promote high quality care throughout Europe. Pan-European training standards should describe medical expertise outcomes that are required from the European gynaecologist. This paper reports on consensus development on the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. A Delphi procedure was performed amongst European gynaecologists and trainees in Obstetrics & Gynaecology, to develop consensus on outcomes of training. The consensus procedure consisted of two questionnaire rounds, followed by a consensus meeting. To ensure reasonability and feasibility for implementation of the training standards in Europe, implications of the outcomes were considered in a working group thereafter. We invited 142 gynaecologists and trainees in Obstetrics & Gynaecology for participation representing a wide range of European countries. They were selected through the European Board & College of Obstetrics and Gynaecology and the European Network of Trainees in Obstetrics & Gynaecology. Sixty people participated in round 1 and 2 of the consensus procedure, 38 (63.3%) of whom were gynaecologists and 22 (36.7%) were trainees in Obstetrics & Gynaecology. Twenty-eight European countries were represented in this response. Round 3 of the consensus procedure was performed in a consensus meeting with six experts. Implications of the training outcomes were discussed in a working group meeting, to ensure reasonability and feasibility of the material for implementation in Europe. The entire consensus procedure resulted in a core content of training standards of 188 outcomes, categorised in ten topics. European consensus was developed regarding the medical expertise outcomes of pan-European training in Obstetrics and

  4. Biology of soft tissue wound healing and regeneration--consensus report of Group 1 of the 10th European Workshop on Periodontology.

    PubMed

    Hämmerle, Christoph H F; Giannobile, William V

    2014-04-01

    The scope of this consensus was to review the biological processes of soft tissue wound healing in the oral cavity and to histologically evaluate soft tissue healing in clinical and pre-clinical models. To review the current knowledge regarding the biological processes of soft tissue wound healing at teeth, implants and on the edentulous ridge. Furthermore, to review soft tissue wound healing at these sites, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Searches of the literature with respect to recessions at teeth and soft tissue deficiencies at implants, augmentation of the area of keratinized tissue and soft tissue volume were conducted. The available evidence was collected, categorized and summarized. Oral mucosal and skin wound healing follow a similar pattern of the four phases of haemostasis, inflammation, proliferation and maturation/matrix remodelling. The soft connective tissue determines the characteristics of the overlaying oral epithelium. Within 7-14 days, epithelial healing of surgical wounds at teeth is completed. Soft tissue healing following surgery at implants requires 6-8 weeks for maturation. The resulting tissue resembles scar tissue. Well-designed pre-clinical studies providing histological data have been reported describing soft tissue wound healing, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Few controlled clinical studies with low numbers of patients are available for some of the treatments reviewed at teeth. Whereas, histological new attachment has been demonstrated in pre-clinical studies resulting from some of the treatments reviewed, human histological data commonly report a lack of new attachment but rather long junctional epithelial attachment and connective tissue adhesion. Regarding soft tissue healing at implants human data are very scarce. Oral soft tissue healing at teeth, implants and the edentulous ridge follows the same phases

  5. Management of sporadic desmoid-type fibromatosis: a European consensus approach based on patients' and professionals' expertise - a sarcoma patients EuroNet and European Organisation for Research and Treatment of Cancer/Soft Tissue and Bone Sarcoma Group initiative.

    PubMed

    Kasper, B; Baumgarten, C; Bonvalot, S; Haas, R; Haller, F; Hohenberger, P; Moreau, G; van der Graaf, W T A; Gronchi, A

    2015-01-01

    Desmoid-type fibromatosis (DF) is a rare monoclonal, fibroblastic proliferation characterised by a variable and often unpredictable clinical course. It may affect nearly all parts of the body including extremities, trunk and abdomen. Considering the variable clinical presentations, anatomic locations and biological behaviours, an individualised treatment approach is required. No established or evidence-based approach for the treatment of this neoplasm is available as of today. Therefore, we propose a consensus treatment algorithm based on a round table meeting bringing together sarcoma experts from the European Organisation for Research and Treatment of Cancer (EORTC) Soft Tissue and Bone Sarcoma Group (STBSG) with patient advocates from Sarcoma Patients EuroNet (SPAEN). The aim of the meeting was to develop - for the first time ever - a consensus approach based on professionals' AND patients' expertise. As a fundamental prerequisite, all patients should be discussed in a multidisciplinary setting in centres or professional networks with a specific expertise in the disease. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Insulin Resistance in Children: Consensus, Perspective, and Future Directions

    PubMed Central

    Levy-Marchal, Claire; Arslanian, Silva; Cutfield, Wayne; Sinaiko, Alan; Druet, Celine; Marcovecchio, M. Loredana; Chiarelli, Francesco

    2010-01-01

    Objective: Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. Participants: The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. Evidence: An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. Consensus Process: The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. Conclusions: Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases. PMID:20829185

  7. Improve consensus via decentralized predictive mechanisms

    NASA Astrophysics Data System (ADS)

    Zhang, H.-T.; Chen, M. Z. Q.; Zhou, T.

    2009-05-01

    For biogroups and groups of self-driven agents, making decisions often depends on interactions among group members. In this paper, we seek to understand the fundamental predictive mechanisms used by group members in order to perform such coordinated behaviors. In particular, we show that the future dynamics of each node in the network can be predicted solely using local information provided by its neighbors. Using this predicted future dynamics information, we propose a decentralized predictive consensus protocol, which yields drastic improvements in terms of both consensus speed and internal communication cost. In natural science, this study provides an evidence for the idea that some decentralized predictive mechanisms may exist in widely-spread biological swarms/flocks. From the industrial point of view, incorporation of a decentralized predictive mechanism allows for not only a significant increase in the speed of convergence towards consensus but also a reduction in the communication energy required to achieve a predefined consensus performance.

  8. Implementation and Design Issues in Group-Randomized Prevention Trials: Lessons from the Youth Matters Public Schools Study

    ERIC Educational Resources Information Center

    Jenson, Jeffrey M.; Dieterich, William A.; Rinner, Jenifer R.; Washington, Felicia; Burgoyne, Kathleen E.

    2006-01-01

    Group-randomized trials (GRTs)--studies that evaluate the efficacy or effectiveness of interventions occurring at the group level--are increasingly used to assess the effects of school-based prevention programs on behavioral outcomes of children and adolescents. These designs pose many implementation and design challenges for school…

  9. The Development, Implementation, and Evaluation of a Model for Teaching Composition Which Utilizes Individualized Learning and Peer Grouping.

    ERIC Educational Resources Information Center

    Lagana, Jean Remaley

    In this study a method of teaching composition using individualized learning and peer grouping was developed, implemented, and evaluated. The model was used with 30 students in a tenth grade English class while a control group of 30 students received more traditional instruction. It was found that significantly greater gains were made by the…

  10. Consensus protein design

    PubMed Central

    Porebski, Benjamin T.; Buckle, Ashley M.

    2016-01-01

    A popular and successful strategy in semi-rational design of protein stability is the use of evolutionary information encapsulated in homologous protein sequences. Consensus design is based on the hypothesis that at a given position, the respective consensus amino acid contributes more than average to the stability of the protein than non-conserved amino acids. Here, we review the consensus design approach, its theoretical underpinnings, successes, limitations and challenges, as well as providing a detailed guide to its application in protein engineering. PMID:27274091

  11. Establishing support groups for HIV-infected women: using experiences to develop guiding principles for project implementation.

    PubMed

    Visser, Maretha J; Mundell, Jonathan P

    2008-07-01

    HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences and interaction with clinic staff and clients were used as sources of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. The socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. The metaphor of building a bridge over a gorge was used to describe the different phases in and obstacles to the implementation of the intervention. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings.

  12. The density matrix renormalization group for strongly correlated electron systems: A generic implementation

    NASA Astrophysics Data System (ADS)

    Alvarez, G.

    2009-09-01

    The purpose of this paper is (i) to present a generic and fully functional implementation of the density-matrix renormalization group (DMRG) algorithm, and (ii) to describe how to write additional strongly-correlated electron models and geometries by using templated classes. Besides considering general models and geometries, the code implements Hamiltonian symmetries in a generic way and parallelization over symmetry-related matrix blocks. Program summaryProgram title: DMRG++ Catalogue identifier: AEDJ_v1_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEDJ_v1_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: See file LICENSE No. of lines in distributed program, including test data, etc.: 15 795 No. of bytes in distributed program, including test data, etc.: 83 454 Distribution format: tar.gz Programming language: C++, MPI Computer: PC, HP cluster Operating system: Any, tested on Linux Has the code been vectorized or parallelized?: Yes RAM: 1 GB (256 MB is enough to run included test) Classification: 23 External routines: BLAS and LAPACK Nature of problem: Strongly correlated electrons systems, display a broad range of important phenomena, and their study is a major area of research in condensed matter physics. In this context, model Hamiltonians are used to simulate the relevant interactions of a given compound, and the relevant degrees of freedom. These studies rely on the use of tight-binding lattice models that consider electron localization, where states on one site can be labeled by spin and orbital degrees of freedom. The calculation of properties from these Hamiltonians is a computational intensive problem, since the Hilbert space over which these Hamiltonians act grows exponentially with the number of sites on the lattice. Solution method: The DMRG is a numerical variational technique to study quantum many body Hamiltonians. For one-dimensional and quasi one-dimensional systems, the

  13. International consensus on allergy immunotherapy.

    PubMed

    Jutel, Marek; Agache, Ioana; Bonini, Sergio; Burks, A Wesley; Calderon, Moises; Canonica, Walter; Cox, Linda; Demoly, Pascal; Frew, Antony J; O'Hehir, Robin; Kleine-Tebbe, Jörg; Muraro, Antonella; Lack, Gideon; Larenas, Désirée; Levin, Michael; Nelson, Harald; Pawankar, Ruby; Pfaar, Oliver; van Ree, Ronald; Sampson, Hugh; Santos, Alexandra F; Du Toit, George; Werfel, Thomas; Gerth van Wijk, Roy; Zhang, Luo; Akdis, Cezmi A

    2015-09-01

    Allergen immunotherapy (AIT) has been used to treat allergic disease since the early 1900s. Despite numerous clinical trials and meta-analyses proving AIT efficacious, it remains underused and is estimated to be used in less than 10% of patients with allergic rhinitis or asthma worldwide. In addition, there are large differences between regions, which are not only due to socioeconomic status. There is practically no controversy about the use of AIT in the treatment of allergic rhinitis and allergic asthma, but for atopic dermatitis or food allergy, the indications for AIT are not well defined. The elaboration of a wider consensus is of utmost importance because AIT is the only treatment that can change the course of allergic disease by preventing the development of asthma and new allergen sensitizations and by inducing allergen-specific immune tolerance. Safer and more effective AIT strategies are being continuously developed both through elaboration of new allergen preparations and adjuvants and alternate routes of administration. A number of guidelines, consensus documents, or both are available on both the international and national levels. The international community of allergy specialists recognizes the need to develop a comprehensive consensus report to harmonize, disseminate, and implement the best AIT practice. Consequently, the International Collaboration in Asthma, Allergy and Immunology, formed by the European Academy of Allergy and Clinical Immunology; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma & Immunology; and the World Allergy Organization, has decided to issue an international consensus on AIT. Copyright © 2015. Published by Elsevier Inc.

  14. [Neurophysiological monitoring options in brain tumour resections. Consensus statement from the Spanish Society of Neurosurgery's (SENEC) Neuro-oncology Working Group and the Spanish Society of Clinical Neurophysiology (SENFC)].

    PubMed

    de Quintana-Schmidt, Cristian; Lladó-Carbo, Estela; Cortés-Doñate, Victoria Eugenia

    2017-10-05

    Brain tumours located in or in proximity to eloquent areas are a significant neurosurgical challenge. Performing this kind of surgery with neurophysiological monitoring to improve resections with reduced permanent focal neurological deficit has become widely accepted in the literature. However, how to conduct this monitoring, the exact definition of an eloquent area and whether to perform this surgery with the patient awake or asleep are still subject to rigorous scientific debate. Members of the Neuro-oncology Working Group (GTNO) of the Spanish Society of Neurosurgery (SENEC) and members of the Spanish Society of Clinical Neurophysiology (SENFC) have published a consensus statement to explain the different neurophysiological monitoring options currently available in awake and asleep patients to obtain better surgical resection without neurological deficits. An exhaustive review of the literature has also been conducted. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group.

    PubMed

    Guerriero, S; Condous, G; van den Bosch, T; Valentin, L; Leone, F P G; Van Schoubroeck, D; Exacoustos, C; Installé, A J F; Martins, W P; Abrao, M S; Hudelist, G; Bazot, M; Alcazar, J L; Gonçalves, M O; Pascual, M A; Ajossa, S; Savelli, L; Dunham, R; Reid, S; Menakaya, U; Bourne, T; Ferrero, S; Leon, M; Bignardi, T; Holland, T; Jurkovic, D; Benacerraf, B; Osuga, Y; Somigliana, E; Timmerman, D

    2016-09-01

    The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  16. Using Nominal Group Technique to Develop a Consensus Derived Model for Peer Review of Teaching across a Multi-School Faculty

    ERIC Educational Resources Information Center

    Burrows, Tracy; Findlay, Naomi; Killen, Chloe; Dempsey, Shane E.; Hunter, Sharyn; Chiarelli, Pauline; Snodgrass, Suzanne

    2011-01-01

    This paper describes the development of a peer review of teaching model for the Faculty of Health at the University of Newcastle, Australia. The process involved using the nominal group technique to engage Faculty academic staff to consider seven key decision points that informed the development of the peer review of teaching model. Use of the…

  17. Consensus on management of advanced medullary thyroid carcinoma on behalf of the Working Group of Thyroid Cancer of the Spanish Society of Endocrinology (SEEN) and the Spanish Task Force Group for Orphan and Infrequent Tumors (GETHI).

    PubMed

    Grande, E; Santamaría Sandi, J; Capdevila, J; Navarro González, E; Zafón Llopis, C; Ramón Y Cajal Asensio, T; Gómez Sáez, J M; Jiménez-Fonseca, P; Riesco-Eizaguirre, G; Galofré, J C

    2016-08-01

    Of all thyroid cancers, <5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression.

  18. Consensus on the management of advanced medullary thyroid carcinoma on behalf of the Working Group of Thyroid Cancer of the Spanish Society of Endocrinology (SEEN) and the Spanish Task Force Group for Orphan and Infrequent Tumors (GETHI).

    PubMed

    Galofré, Juan C; Santamaría Sandi, Javier; Capdevila, Jaume; Navarro González, Elena; Zafón Llopis, Carles; Ramón Y Cajal Asensio, Teresa; Gómez Sáez, José Manuel; Jiménez-Fonseca, Paula; Riesco Eizaguirre, Garcilaso; Grande, Enrique

    2015-04-01

    In Spain medullary thyroid carcinoma (MTC) would not exceed 80 new cases per year and less than half of them would be good candidates for systemic treatment with novel agents. Relevant literature was reviewed, including PubMed searches supplemented with additional articles. The consensus summarizes the clinical outcomes in terms of activity and toxicity of each of the available drugs. A brief summary of the minimum requirements in terms of follow up and genetic counseling around MTC is also included. Only those patients with objective imaging progression in the last 12-14 months with large volume of disease are clear candidates to start systemic treatment. However, those patients with low disease volume should be considered for 'wait and see' strategy until symptoms of the disease appear. Multidisciplinary approach for the management of MTC patient is mandatory nowadays. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  19. Aljoya Consensus Statement

    EPA Pesticide Factsheets

    A consensus statement of 100 experts meeting at the Aljoya Conference Center in Seattle, Washington in July 2000 for the First International Conference on Trans-Pacific Transport of Atmospheric Contaminants.

  20. Eliciting Public Attitudes Regarding Bioremediation Cleanup Technologies: Lessons Learned from a Consensus Workshop in Idaho

    SciTech Connect

    Denise Lach, Principle Investigator; Stephanie Sanford, Co-P.I.

    2003-03-01

    During the summer of 2002, we developed and implemented a ''consensus workshop'' with Idaho citizens to elicit their concerns and issues regarding the use of bioremediation as a cleanup technology for radioactive nuclides and heavy metals at Department of Energy (DOE) sites. The consensus workshop is a derivation of a technology assessment method designed to ensure dialogue between experts and lay people. It has its origins in the United States in the form of ''consensus development conferences'' used by the National Institutes of Health (NIH) to elicit professional knowledge and concerns about new medical treatments. Over the last 25 years, NIH has conducted over 100 consensus development conferences. (Jorgensen 1995). The consensus conference is grounded in the idea that technology assessment and policy needs to be socially negotiated among many different stakeholders and groups rather than narrowly defined by a group of experts. To successfully implement new technology, the public requires access to information that addresses a full complement of issues including understanding the organization proposing the technology. The consensus conference method creates an informed dialogue, making technology understandable to the general public and sets it within perspectives and priorities that may differ radically from those of the expert community. While specific outcomes differ depending on the overall context of a conference, one expected outcome is that citizen panel members develop greater knowledge of the technology during the conference process and, sometimes, the entire panel experiences a change in attitude toward the technology and/or the organization proposing its use (Kluver 1995). The purpose of this research project was to explore the efficacy of the consensus conference model as a way to elicit the input of the general public about bioremediation of radionuclides and heavy metals at Department of Energy sites. Objectives of the research included: (1

  1. [Diagnosis and treatment of gastroesophageal reflux disease in the mentally retarded: guidelines of a multidisciplinary consensus work group. Dutch Association of Physicians in Care of Mentally Handicapped].

    PubMed

    Gimbel, H

    2000-06-10

    Gastroesophageal reflux disease (GORD) is more frequent among people with intellectual disability than among the intellectually normal population. Also GORD is more serious in this population. The diagnosis is often missed, because most intellectually disabled cannot express their complaints of GORD. For that reason a multidisciplinary working group of the Dutch Association of physicians active in the care of persons with a mental handicap has developed guidelines. The working group recommends endoscopy in case of a (alarm) symptoms: haematemesis, prolonged vomiting, irondeficiency anaemia e.c.i., and a 24 hour oesophageal pH test in case of b (aspecific) symptoms: recurrent pneumonia, refusal of food, regurgitation, rumination, dental erosions. In general most patients are cured with drug treatment (omeprazol or another proton pump inhibitor). If symptoms are not improved after 6 months of optimal treatment, surgical treatment may be considered.

  2. [A comprehensive review of literature to investigate development of global knowledge and consensus on asbestos carcinogenicity: up to the report and recommendations by UICC Working Group in 1964].

    PubMed

    Kurumatani, Norio

    2012-01-01

    This author comprehensively reviewed the literature on asbestos carcinogenicity up to the Report and Recommendations by Union Internationale Contra Cancrum (UICC) Working Group on asbestos and cancer in 1964. The first cases of mesothelioma and lung cancer in necropsied patients with asbestosis were reported in 1933 and 1934, respectively. After that, various studies examining the association between each of the diseases and asbestos exposure had been carried out until the meeting of the UICC Working Group: case report studies, case series studies, prevalence studies, historical cohort studies, and case-control studies. Newly reported studies including experimental studies in that meeting all supported the association. These findings on asbestos and cancer correspond well with Hill's criteria, which were just then advocated for evaluating causality epidemiologically. The Report and Recommendations by the Working Group concluded, "There is evidence of an association between exposure to asbestos and malignant neoplasia." and "The types of tumors ... are ... (1) carcinoma of the lungs, and (2) diffuse mesothelioma of the pleura and peritoneum." This author considers that the causal association between lung cancer or mesothelioma and asbestos was established at the meeting of UICC Working Group in 1964, not by the report on asbestos carcinogenicity in ILO (International Labour Organization) or IARC (International Agency for Research on Cancer) expert meetings in 1972, as the Japanese government announced. The amount of asbestos import in Japan doubled from 130,000 to 280,000 tons annually from 1964 to 1972. The government should have recognized the global knowledge on asbestos carcinogenicity in 1964; the amount of asbestos import could have been reduced greatly.

  3. Glycemic control parameters in insulin-naïve patients with uncontrolled type 2 diabetes referred to endocrinologists, and degree of implementation of the national Spanish consensus for the management of hyperglycemia.

    PubMed

    Azriel, Sharona; Casal, Florentino; Dalama, Belén; Varillas, Francisco; Villarroel, África; Soto, Alfonso; Barberá, Gloria

    2014-12-01

    To assess blood glucose in patients with uncontrolled type 2 diabetes mellitus treated with oral antidiabetic drugs in primary care at the time of referral to specialized endocrinologists, and the degree of implementation of the national consensus guidelines of the Spanish Society of Diabetes by evaluating steps one (S1), two (S2), and three (S3) of the escalating therapy. Retrospective, observational study where 81 endocrinologists evaluated patients ≥40 years of age referred from primary care between July 2012 and July 2013, treated with 1 to 2 oral antidiabetic drugs but no insulin therapy, and with glycosylated hemoglobin (HbA(1c)) levels ≥6.5%. Patients also had to have HbA(1c) levels and both fasting and postprandial plasma glucose measurements from the previous three months. A total of 285 patients (57.6% males) were assessed. Mean (SD) age was 63.1 (9.7) years, mean HbA1c was 8.5 (1.2) %, mean FPG was 171.7 (43) mg/dL, and mean postprandial plasma glucose was 206.8 (50) mg/dL. In primary care, 26.0% of patients were at S1 and 74.0% were at S2. After referral to the endocrinologist, 9.8% of patients moved onto S1, 42.8% onto S2, and 47.4% onto S3. Oral antidiabetic drugs most commonly prescribed in primary care were metformin (90.2%), DPP-4 inhibitors (34.4%), and sulfonylureas (30.5%), while drugs most commonly used in the specialized endocrinology setting were metformin (86%), insulin (56.8%), and DPP-4 inhibitors (49.8%). The most commonly followed guidelines were those of the American Diabetes Association and the consensus guidelines of the Spanish Society of Diabetes, in 77% and 45% of cases respectively. Approximately half the patients treated with oral antidiabetic drugs in primary care are prescribed insulin after referral to an endocrinology specialist. The most commonly followed guidelines in specialized care are the American Diabetes Association guidelines. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  4. Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites

    PubMed Central

    Novick, Gina; Womack, Julie A.; Lewis, Jessica; Stasko, Emily C.; Rising, Sharon S.; Sadler, Lois S.; Cunningham, Shayna C.; Tobin, Jonathan N.; Ickovics, Jeannette R.

    2016-01-01

    Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining Centering Pregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the model’s demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the model’s challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation. PMID:26340483

  5. Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites.

    PubMed

    Novick, Gina; Womack, Julie A; Lewis, Jessica; Stasko, Emily C; Rising, Sharon S; Sadler, Lois S; Cunningham, Shayna C; Tobin, Jonathan N; Ickovics, Jeannette R

    2015-12-01

    Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining CenteringPregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the model's demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the model's challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation.

  6. Microevolution in lower Central America: genetic characterization of the Chibcha-speaking groups of Costa Rica and Panama, and a consensus taxonomy based on genetic and linguistic affinity.

    PubMed Central

    Barrantes, R; Smouse, P E; Mohrenweiser, H W; Gershowitz, H; Azofeifa, J; Arias, T D; Neel, J V

    1990-01-01

    There is evidence that Amerindians have continuously occupied the lower Central American Isthmus for as long as 10,000 years. There remains some doubt about the relationships of these original colonizers to the resident peoples of this zone at the time of European contact (approximately A.D. 1500). We present new genetic data for up to 48 genetic loci for 570 members of six Chibcha-speaking tribes of lower Central America--the Boruca, Bribri, Cabecar, and Guatuso of Costa Rica and the Kuna and Teribe of Panama--and delineate the genetic affinities among the various groups (these six tribes and the Guaymi and Bokota) of lower Central America. We convert standard genetic distance metrics into a form that is linear with the effective time since divergence, and we compare the genetic distances with linguistic distances for the same groups (r = .74, P less than .001). Geographic affinity accounts for some of the genetic divergence among groups (r = .49, P less than .084) and for some of the linguistic divergence (r = .53, P less than .037), but the correspondence between geographic position and taxonomic affinity is not high. We combine all of the genetic and linguistic data to construct a synthetic overview taxonomy of the lower Central American Chibcha. Both the genetic and linguistic data exhibit hierarchical organization of tribal groups, showing a general east-to-west pattern of grouping, with greater affinities between close neighbors. The presence of private genetic variants of some antiquity within the region and their absence outside the zone, coupled with the essential absence of the DI*A polymorphism of mongoloid origin that is widespread outside the zone, argue for a relatively isolated development of the Central American Chibcha. Our results do not support the old view of lower Central America as a frontier between more advanced cultures to the north and south. Any such explanation would require recent waves of migration from outside the region, migration

  7. Virtual care policy recommendations for patient-centred primary care: findings of a consensus policy dialogue using a nominal group technique.

    PubMed

    Shaw, James; Jamieson, Trevor; Agarwal, Payal; Griffin, Bailey; Wong, Ivy; Bhatia, R Sacha

    2017-01-01

    Background The development of new virtual care technologies (including telehealth and telemedicine) is growing rapidly, leading to a number of challenges related to health policy and planning for health systems around the world. Methods We brought together a diverse group of health system stakeholders, including patient representatives, to engage in policy dialogue to set health system priorities for the application of virtual care in the primary care sector in the Province of Ontario, Canada. We applied a nominal group technique (NGT) process to determine key priorities, and synthesized these priorities with group discussion to develop recommendations for virtual care policy. Methods included a structured priority ranking process, open-ended note-taking, and thematic analysis to identify priorities. Results Recommendations were summarized under the following themes: (a) identify clear health system leadership to embed virtual care strategies into all aspects of primary and community care; (b) make patients the focal point of health system decision-making; (c) leverage incentives to achieve meaningful health system improvements; and (d) building virtual care into streamlined workflows. Two key implications of our policy dialogue are especially relevant for an international audience. First, shifting the dialogue away from technology toward more meaningful patient engagement will enable policy planning for applications of technology that better meet patients' needs. Second, a strong conceptual framework on guiding the meaningful use of technology in health care settings is essential for intelligent planning of virtual care policy. Conclusions Policy planning for virtual care needs to shift toward a stronger focus on patient engagement to understand patients' needs.

  8. Consensus opinion from the antibody working group on the diagnosis, reporting, and risk assessment for antibody-mediated rejection and desensitization protocols.

    PubMed

    Montgomery, Robert A; Hardy, Mark A; Jordan, Stanley C; Racusen, Lorraine C; Ratner, Lloyd E; Tyan, Dolly B; Zachary, Andrea A

    2004-07-27

    During the past few decades, much of the experimental and clinical effort in solid-organ transplantation has been directed toward ameliorating or abrogating T-cell-mediated responses. As a result, universally understood and accepted nomenclature and diagnostic criteria have evolved. Humoral immunity in transplantation has yet to undergo a similar renaissance. Readers of transplant journals regularly find it difficult and often impossible to interpret data on the diagnosis and management of antibody-mediated rejection. The Antibody Working Group was assembled in an attempt to provide guidelines for the standardization of nomenclature, diagnostic criteria, reporting, antibody profiling, and risk assessment.

  9. Congenital and acquired neutropenia consensus guidelines on diagnosis from the Neutropenia Committee of the Marrow Failure Syndrome Group of the AIEOP (Associazione Italiana Emato-Oncologia Pediatrica).

    PubMed

    Fioredda, Francesca; Calvillo, Michaela; Bonanomi, Sonia; Coliva, Tiziana; Tucci, Fabio; Farruggia, Piero; Pillon, Marta; Martire, Baldassarre; Ghilardi, Roberta; Ramenghi, Ugo; Renga, Daniela; Menna, Giuseppe; Barone, Angelica; Lanciotti, Marina; Dufour, Carlo

    2011-07-15

    Congenital and acquired neutropenia are rare disorders whose frequency in pediatric age may be underestimated due to remarkable differences in definition or misdiagnosed because of the lack of common practice guidelines. Neutropenia Committee of the Marrow Failure Syndrome Group (MFSG) of the AIEOP (Associazione Italiana Emato-Oncologia Pediatrica) elaborated this document following design and methodology formerly approved by the AIEOP board. The panel of experts reviewed the literature on the topic and participated in a conference producing a document which includes a classification of neutropenia and a comprehensive guideline on diagnosis of neutropenia. Copyright © 2011 Wiley-Liss, Inc.

  10. Comparison of Immunogenicity in Rhesus Macaques of Transmitted-Founder, HIV-1 Group M Consensus, and Trivalent Mosaic Envelope Vaccines Formulated as a DNA Prime, NYVAC, and Envelope Protein Boost

    PubMed Central

    Hulot, Sandrine L.; Korber, Bette; Giorgi, Elena E.; Vandergrift, Nathan; Saunders, Kevin O.; Balachandran, Harikrishnan; Mach, Linh V.; Lifton, Michelle A.; Pantaleo, Giuseppe; Tartaglia, Jim; Phogat, Sanjay; Jacobs, Bertram; Kibler, Karen; Perdiguero, Beatriz; Gomez, Carmen E.; Esteban, Mariano; Rosati, Margherita; Felber, Barbara K.; Pavlakis, George N.; Parks, Robert; Lloyd, Krissey; Sutherland, Laura; Scearce, Richard; Letvin, Norman L.; Seaman, Michael S.; Alam, S. Munir; Montefiori, David; Liao, Hua-Xin; Haynes, Barton F.

    2015-01-01

    ABSTRACT An effective human immunodeficiency virus type 1 (HIV-1) vaccine must induce protective antibody responses, as well as CD4+ and CD8+ T cell responses, that can be effective despite extraordinary diversity of HIV-1. The consensus and mosaic immunogens are complete but artificial proteins, computationally designed to elicit immune responses with improved cross-reactive breadth, to attempt to overcome the challenge of global HIV diversity. In this study, we have compared the immunogenicity of a transmitted-founder (T/F) B clade Env (B.1059), a global group M consensus Env (Con-S), and a global trivalent mosaic Env protein in rhesus macaques. These antigens were delivered using a DNA prime-recombinant NYVAC (rNYVAC) vector and Env protein boost vaccination strategy. While Con-S Env was a single sequence, mosaic immunogens were a set of three Envs optimized to include the most common forms of potential T cell epitopes. Both Con-S and mosaic sequences retained common amino acids encompassed by both antibody and T cell epitopes and were central to globally circulating strains. Mosaics and Con-S Envs expressed as full-length proteins bound well to a number of neutralizing antibodies with discontinuous epitopes. Also, both consensus and mosaic immunogens induced significantly higher gamma interferon (IFN-γ) enzyme-linked immunosorbent spot assay (ELISpot) responses than B.1059 immunogen. Immunization with these proteins, particularly Con-S, also induced significantly higher neutralizing antibodies to viruses than B.1059 Env, primarily to tier 1 viruses. Both Con-S and mosaics stimulated more potent CD8-T cell responses against heterologous Envs than did B.1059. Both antibody and cellular data from this study strengthen the concept of using in silico-designed centralized immunogens for global HIV-1 vaccine development strategies. IMPORTANCE There is an increasing appreciation for the importance of vaccine-induced anti-Env antibody responses for preventing HIV-1

  11. Comparison of Immunogenicity in Rhesus Macaques of Transmitted-Founder, HIV-1 Group M Consensus, and Trivalent Mosaic Envelope Vaccines Formulated as a DNA Prime, NYVAC, and Envelope Protein Boost.

    PubMed

    Hulot, Sandrine L; Korber, Bette; Giorgi, Elena E; Vandergrift, Nathan; Saunders, Kevin O; Balachandran, Harikrishnan; Mach, Linh V; Lifton, Michelle A; Pantaleo, Giuseppe; Tartaglia, Jim; Phogat, Sanjay; Jacobs, Bertram; Kibler, Karen; Perdiguero, Beatriz; Gomez, Carmen E; Esteban, Mariano; Rosati, Margherita; Felber, Barbara K; Pavlakis, George N; Parks, Robert; Lloyd, Krissey; Sutherland, Laura; Scearce, Richard; Letvin, Norman L; Seaman, Michael S; Alam, S Munir; Montefiori, David; Liao, Hua-Xin; Haynes, Barton F; Santra, Sampa

    2015-06-01

    An effective human immunodeficiency virus type 1 (HIV-1) vaccine must induce protective antibody responses, as well as CD4(+) and CD8(+) T cell responses, that can be effective despite extraordinary diversity of HIV-1. The consensus and mosaic immunogens are complete but artificial proteins, computationally designed to elicit immune responses with improved cross-reactive breadth, to attempt to overcome the challenge of global HIV diversity. In this study, we have compared the immunogenicity of a transmitted-founder (T/F) B clade Env (B.1059), a global group M consensus Env (Con-S), and a global trivalent mosaic Env protein in rhesus macaques. These antigens were delivered using a DNA prime-recombinant NYVAC (rNYVAC) vector and Env protein boost vaccination strategy. While Con-S Env was a single sequence, mosaic immunogens were a set of three Envs optimized to include the most common forms of potential T cell epitopes. Both Con-S and mosaic sequences retained common amino acids encompassed by both antibody and T cell epitopes and were central to globally circulating strains. Mosaics and Con-S Envs expressed as full-length proteins bound well to a number of neutralizing antibodies with discontinuous epitopes. Also, both consensus and mosaic immunogens induced significantly higher gamma interferon (IFN-γ) enzyme-linked immunosorbent spot assay (ELISpot) responses than B.1059 immunogen. Immunization with these proteins, particularly Con-S, also induced significantly higher neutralizing antibodies to viruses than B.1059 Env, primarily to tier 1 viruses. Both Con-S and mosaics stimulated more potent CD8-T cell responses against heterologous Envs than did B.1059. Both antibody and cellular data from this study strengthen the concept of using in silico-designed centralized immunogens for global HIV-1 vaccine development strategies. There is an increasing appreciation for the importance of vaccine-induced anti-Env antibody responses for preventing HIV-1 acquisition. This

  12. Implementation of National Consensus Appliance Agreements Act

    THOMAS, 111th Congress

    Sen. Bingaman, Jeff [D-NM

    2010-09-29

    09/29/2010 Read twice and referred to the Committee on Energy and Natural Resources. (text of measure as introduced: CR S7814-7832) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  13. Pediatric cyanide poisoning by fire smoke inhalation: a European expert consensus. Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies.

    PubMed

    Mintegi, Santiago; Clerigue, Nuria; Tipo, Vincenzo; Ponticiello, Eduardo; Lonati, Davide; Burillo-Putze, Guillermo; Delvau, Nicolas; Anseeuw, Kurt

    2013-11-01

    Most fire-related deaths are attributable to smoke inhalation rather than burns. The inhalation of fire smoke, which contains not only carbon monoxide but also a complex mixture of gases, seems to be the major cause of morbidity and mortality in fire victims, mainly in enclosed spaces. Cyanide gas exposure is quite common during smoke inhalation, and cyanide is present in the blood of fire victims in most cases and may play an important role in death by smoke inhalation. Cyanide poisoning may, however, be difficult to diagnose and treat. In these children, hydrogen cyanide seems to be a major source of concern, and the rapid administration of the antidote, hydroxocobalamin, may be critical for these children.European experts recently met to formulate an algorithm for prehospital and hospital management of adult patients with acute cyanide poisoning. Subsequently, a group of European pediatric experts met to evaluate and adopt that algorithm for use in the pediatric population.

  14. Part Two: Infantile Spasms--The New Consensus

    ERIC Educational Resources Information Center

    Pellock, John M.; O'Hara, Kathryn

    2011-01-01

    This article presents the conclusion made by the consensus group regarding infantile spasms. The consensus group concluded that "infantile spasms are a major form of severe epileptic encephalopathy of early childhood that results in neurodevelopmental regression and imposes a significant health burden." The entire group agrees that the best…

  15. Part Two: Infantile Spasms--The New Consensus

    ERIC Educational Resources Information Center

    Pellock, John M.; O'Hara, Kathryn

    2011-01-01

    This article presents the conclusion made by the consensus group regarding infantile spasms. The consensus group concluded that "infantile spasms are a major form of severe epileptic encephalopathy of early childhood that results in neurodevelopmental regression and imposes a significant health burden." The entire group agrees that the best…

  16. Voting in Group Support Systems: Theory, Implementation, and Results from an Exploratory Study

    ERIC Educational Resources Information Center

    Cheng, Kung-E

    2009-01-01

    Group decision making is essential in organizations. Group Support Systems (GSS) can aide groups in making decisions by providing tools and process support. GSS is especially useful for geographically or temporally distributed groups. Researchers of GSS have pointed out that convergence processes are hard to accomplish in GSS. Voting tools in GSS…

  17. Voting in Group Support Systems: Theory, Implementation, and Results from an Exploratory Study

    ERIC Educational Resources Information Center

    Cheng, Kung-E

    2009-01-01

    Group decision making is essential in organizations. Group Support Systems (GSS) can aide groups in making decisions by providing tools and process support. GSS is especially useful for geographically or temporally distributed groups. Researchers of GSS have pointed out that convergence processes are hard to accomplish in GSS. Voting tools in GSS…

  18. Democracy-based consensus in medicine.

    PubMed

    Greco, Massimiliano; Zangrillo, Alberto; Mucchetti, Marta; Nobile, Leda; Landoni, Paolo; Bellomo, Rinaldo; Landoni, Giovanni

    2015-04-01

    High-quality evidence and derived guidelines, as typically published in major academic journals, are a major process that shapes physician decision-making worldwide. However, for many aspects of medical practice, there is a lack of High-quality evidence or an overload of somewhat contradictory low-quality information, which makes decision-making a difficult, uncertain, and unpredictable process. When the issues in question are important and evidence limited or controversial, the medical community seeks to establish common ground for "best practice" through consensus conferences and consensus statements or guidelines. Such consensus statements are seen as a useful tool to establish expert agreement, define the boundaries of acceptable practice, provide priorities for the research agenda, and obtain opinions from different countries and healthcare systems. This standard approach, however, can be criticized for being elitist, noninclusive, and poorly representative of the community of clinicians who will have to make decisions about the implementation of such recommendations. Accordingly, the authors propose a new model based on a combination of a local core meeting (detailed review and expert input) followed by a worldwide web-based network assessment (democracy-based consensus). The authors already have applied this approach to develop consensus on all nonsurgical interventions that increase or reduce perioperative mortality in critically ill patients and in those with acute kidney injury. The methodology was based on 5 sequential local and web-based steps. Both a panel of experts and a large number of professionals from all over the world were involved, giving birth to a new type of "democracy-based consensus." This new type of "democracy-based consensus" has the potential to increase grass-root clinician involvement, expand the reach to less-developed countries, provide a more global perspective on proposed interventions, and perhaps more importantly, increase

  19. Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy.

    PubMed

    Levy Hara, Gabriel; Kanj, Souha S; Pagani, Leonardo; Abbo, Lilian; Endimiani, Andrea; Wertheim, Heiman F L; Amábile-Cuevas, Carlos; Tattevin, Pierre; Mehtar, Shaheen; Lopes Cardoso, Fernando; Unal, Serhat; Gould, Ian

    2016-09-01

    The Antibiotic Stewardship and Resistance Working Groups of the International Society for Chemotherapy propose ten key points for the appropriate use of antibiotics in hospital settings. (i) Get appropriate microbiological samples before antibiotic administration and carefully interpret the results: in the absence of clinical signs of infection, colonisation rarely requires antimicrobial treatment. (ii) Avoid the use of antibiotics to 'treat' fever: use them to treat infections, and investigate the root cause of fever prior to starting treatment. (iii) Start empirical antibiotic treatment after taking cultures, tailoring it to the site of infection, risk factors for multidrug-resistant bacteria, and the local microbiology and susceptibility patterns. (iv) Prescribe drugs at their optimal dosing and for an appropriate duration, adapted to each clinical situation and patient characteristics. (v) Use antibiotic combinations only where the current evidence suggests some benefit. (vi) When possible, avoid antibiotics with a higher likelihood of promoting drug resistance or hospital-acquired infections, or use them only as a last resort. (vii) Drain the infected foci quickly and remove all potentially or proven infected devices: control the infection source. (viii) Always try to de-escalate/streamline antibiotic treatment according to the clinical situation and the microbiological results. (ix) Stop unnecessarily prescribed antibiotics once the absence of infection is likely. And (x) Do not work alone: set up local teams with an infectious diseases specialist, clinical microbiologist, hospital pharmacist, infection control practitioner or hospital epidemiologist, and comply with hospital antibiotic policies and guidelines. Copyright © 2016. Published by Elsevier B.V.

  20. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-Versus-Host Disease: III. The 2014 Biomarker Working Group Report

    PubMed Central

    Paczesny, Sophie; Hakim, Frances T.; Pidala, Joseph; Cooke, Kenneth; Lathrop, Julia; Griffith, Linda M.; Hansen, John; Jagasia, Madan; Miklos, David; Pavletic, Steven; Parkman, Robertson; Russek-Cohen, Estelle; Flowers, Mary E.D.; Lee, Stephanie; Martin, Paul; Vogelsang, Georgia; Walton, Marc; Schultz, Kirk R.

    2015-01-01

    Biology-based markers to confirm or aid in the diagnosis or prognosis of chronic GVHD after allogeneic hematopoietic cell transplantation (HCT) or monitor its progression are critically needed to facilitate evaluation of new therapies. Biomarkers have been defined as any characteristic that is objectively measured and evaluated as an indicator of a normal biological or pathogenic process, a pharmacologic response to a therapeutic intervention. Applications of biomarkers in chronic GVHD clinical trials or patient management include: a) diagnosis and assessment of chronic GVHD disease activity, including distinguishing irreversible damage from continued disease activity, b) prognostic risk to develop chronic GVHD, and c) prediction of response to therapy. Sample collection for chronic GVHD biomarkers studies should be well-documented following established quality control guidelines for sample acquisition, processing, preservation and testing, at intervals that are both calendar- and event-driven. The consistent therapeutic treatment of subjects and standardized documentation needed to support biomarker studies are most likely to be provided in prospective clinical trials. To date, no chronic GVHD biomarkers have been qualified for utilization in clinical applications. Since our previous chronic GVHD Biomarkers Working Group report in 2005, an increasing number of chronic GVHD candidate biomarkers are available for further investigation. This paper provides a four-part framework for biomarker investigations: identification, verification, qualification, and application with terminology based on Food and Drug Administration and European Medicines Agency guidelines. PMID:25644957

  1. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: III. The 2014 Biomarker Working Group Report.

    PubMed

    Paczesny, Sophie; Hakim, Frances T; Pidala, Joseph; Cooke, Kenneth R; Lathrop, Julia; Griffith, Linda M; Hansen, John; Jagasia, Madan; Miklos, David; Pavletic, Steven; Parkman, Robertson; Russek-Cohen, Estelle; Flowers, Mary E D; Lee, Stephanie; Martin, Paul; Vogelsang, Georgia; Walton, Marc; Schultz, Kirk R

    2015-05-01

    Biology-based markers to confirm or aid in the diagnosis or prognosis of chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation or monitor its progression are critically needed to facilitate evaluation of new therapies. Biomarkers have been defined as any characteristic that is objectively measured and evaluated as an indicator of a normal biological or pathogenic process, or of a pharmacologic response to a therapeutic intervention. Applications of biomarkers in chronic GVHD clinical trials or patient management include the following: (1) diagnosis and assessment of chronic GVHD disease activity, including distinguishing irreversible damage from continued disease activity; (2) prognostic risk to develop chronic GVHD; and (3) prediction of response to therapy. Sample collection for chronic GVHD biomarkers studies should be well documented following established quality control guidelines for sample acquisition, processing, preservation, and testing, at intervals that are both calendar and event driven. The consistent therapeutic treatment of subjects and standardized documentation needed to support biomarker studies are most likely to be provided in prospective clinical trials. To date, no chronic GVHD biomarkers have been qualified for use in clinical applications. Since our previous chronic GVHD Biomarkers Working Group report in 2005, an increasing number of chronic GVHD candidate biomarkers are available for further investigation. This paper provides a 4-part framework for biomarker investigations: identification, verification, qualification, and application with terminology based on Food and Drug Administration and European Medicines Agency guidelines. Copyright © 2015 American Society for Blood and Marrow Transplantation. All rights reserved.

  2. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings

    PubMed Central

    Modesti, Pietro A.; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P.; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O’Brien, Eoin; Kilama, Michael O.; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M.; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

    2014-01-01

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on ‘Hypertension and Cardiovascular risk in low resource settings’, which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs. PMID:24577410

  3. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings.

    PubMed

    Modesti, Pietro A; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O'Brien, Eoin; Kilama, Michael O; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

    2014-05-01

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

  4. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group.

    PubMed

    Vasquez, Michael A; Rabe, Eberhard; McLafferty, Robert B; Shortell, Cynthia K; Marston, William A; Gillespie, David; Meissner, Mark H; Rutherford, Robert B

    2010-11-01

    In response to the need for a disease severity measurement, the American Venous Forum committee on outcomes assessment developed the Venous Severity Scoring system in 2000. There are three components of this scoring system, the Venous Disability Score, the Venous Segmental Disease Score, and the Venous Clinical Severity Score (VCSS). The VCSS was developed from elements of the CEAP classification (clinical grade, etiology, anatomy, pathophysiology), which is the worldwide standard for describing the clinical features of chronic venous disease. However, as a descriptive instrument, the CEAP classification responds poorly to change. The VCSS was subsequently developed as an evaluative instrument that would be responsive to changes in disease severity over time and in response to treatment. Based on initial experiences with the VCSS, an international ad hoc working group of the American Venous Forum was charged with updating the instrument. This revision of the VCSS is focused on clarifying ambiguities, updating terminology, and simplifying application. The specific language of proven quality-of-life instruments was used to better address the issues of patients at the lower end of the venous disease spectrum. Periodic review and revision are necessary for generating more universal applicability and for comparing treatment outcomes in a meaningful way.

  5. Energy strategy: Roadmap to consensus

    SciTech Connect

    Not Available

    1990-11-01

    The United States lacks a comprehensive approach to policy-making in the energy realm. Today, as in the past, individual constituency groups tend to focus on their particular aspect of the energy challenge. Many employ a ``decide-announce-defend`` approach to policy-making, setting out to secure a unilateral advantage for themselves. By so doing, they inevitably pit interest against interest. The result is a polarization of constituencies, and shortsighted policies designed to address the issue of the moment. The American Energy Assurance Council (AEAC) is a non-profit organization founded in 1987 for the sole purpose of facilitating progress toward a fair efficient wise, stable, and consensus-based national energy strategy. AEAC does not have a substantive policy agencies. Rather, we are committed to supporting a process whereby the many stakeholders and policy makers concerned with energy-related issues can come together in productive discourse, thereby overcoming ignorance of each other`s positions. The Council seeks to act as a facilitative body, providing a ``safe`` context for inventive and creative thinking. We attempt to build a store of common knowledge, and to build on that store according to mutually agreed-upon groundrules, and employing sophisticated approaches to facilitation and mediation. This report, the National Energy Consensus Experiment (NECE), was an ambitious experiment in consensus-building. We learned a great deal from it, both in terms of substance and process, and we are convinced that it holds important lessons for others who may seek to build consensus in the public policy realm.

  6. Energy strategy: Roadmap to consensus

    SciTech Connect

    Not Available

    1990-11-01

    The United States lacks a comprehensive approach to policy-making in the energy realm. Today, as in the past, individual constituency groups tend to focus on their particular aspect of the energy challenge. Many employ a decide-announce-defend'' approach to policy-making, setting out to secure a unilateral advantage for themselves. By so doing, they inevitably pit interest against interest. The result is a polarization of constituencies, and shortsighted policies designed to address the issue of the moment. The American Energy Assurance Council (AEAC) is a non-profit organization founded in 1987 for the sole purpose of facilitating progress toward a fair efficient wise, stable, and consensus-based national energy strategy. AEAC does not have a substantive policy agencies. Rather, we are committed to supporting a process whereby the many stakeholders and policy makers concerned with energy-related issues can come together in productive discourse, thereby overcoming ignorance of each other's positions. The Council seeks to act as a facilitative body, providing a safe'' context for inventive and creative thinking. We attempt to build a store of common knowledge, and to build on that store according to mutually agreed-upon groundrules, and employing sophisticated approaches to facilitation and mediation. This report, the National Energy Consensus Experiment (NECE), was an ambitious experiment in consensus-building. We learned a great deal from it, both in terms of substance and process, and we are convinced that it holds important lessons for others who may seek to build consensus in the public policy realm.

  7. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

    PubMed Central

    Munns, Craig F.; Shaw, Nick; Kiely, Mairead; Specker, Bonny L.; Thacher, Tom D.; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M. Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A.; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M.; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary

    2016-01-01

    Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. PMID:26745253

  8. Expert consensus document: A consensus on the medical treatment of acromegaly.

    PubMed

    Giustina, Andrea; Chanson, Philippe; Kleinberg, David; Bronstein, Marcello D; Clemmons, David R; Klibanski, Anne; van der Lely, Aart J; Strasburger, Christian J; Lamberts, Steven W; Ho, Ken K Y; Casanueva, Felipe F; Melmed, Shlomo

    2014-04-01

    In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.

  9. Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review

    PubMed Central

    2011-01-01

    Background Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users. Methods Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users. Results Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack

  10. Igniting interest in prevention: using firefighter focus groups to inform implementation and enhancement of an urban canvassing program.

    PubMed

    Frattaroli, Shannon; McDonald, Eileen M; Tran, Nhan T; Trump, Alison R; OʼBrocki, Raymond C; Gielen, Andrea C

    2012-01-01

    Smoke alarm canvassing is recognized as an empirically based, effective intervention for increasing access to and the presence of smoke alarms in homes. We sought to inform the implementation of an intervention designed to enhance an existing fire department smoke alarm canvassing program through an empirically grounded, participatory process. We conducted a series of focus groups with fire union leaders and firefighters involved with the canvassing program in 1 US city, shared the results with the participants, and presented the resulting recommendations to fire department leadership. This research occurred in Baltimore, Maryland. Focus group participants included firefighters who participate in the Fire Department's smoke alarm canvassing program and representatives from the local firefighters' union. The focus groups sought to capture firefighters' experiences with and opinions about the canvassing program and how to improve it as well as challenges to canvassing work. We conducted 10 focus groups with 65 participants. Firefighters' perspectives on the canvassing program and their recommendations for improving it were expressed through 3 categories of themes concerning program management, canvassing challenges, and attitudes about the program and the community. We also discuss the process of presenting these findings and recommendations to the participants and the fire department leadership, and describe how implementation of some of the recommendations has progressed. Both the process and outcomes of this formative work inform how to develop and implement community-based public health interventions in real-world settings through academic-community partnerships. The findings also have implications for how canvassing programs are being implemented.

  11. The Challenges of Implementing Group Work in Primary School Classrooms and Including Pupils with Special Educational Needs

    ERIC Educational Resources Information Center

    Baines, Ed; Blatchford, Peter; Webster, Rob

    2015-01-01

    Findings from two studies are discussed in relation to the experiences and challenges faced by teachers trying to implement effective group work in schools and classrooms and to reflect on the lessons learnt about how to involve pupils with special educational needs (SEN). The first study reports on UK primary school teachers' experiences of…

  12. The Challenges of Implementing Group Work in Primary School Classrooms and Including Pupils with Special Educational Needs

    ERIC Educational Resources Information Center

    Baines, Ed; Blatchford, Peter; Webster, Rob

    2015-01-01

    Findings from two studies are discussed in relation to the experiences and challenges faced by teachers trying to implement effective group work in schools and classrooms and to reflect on the lessons learnt about how to involve pupils with special educational needs (SEN). The first study reports on UK primary school teachers' experiences of…

  13. Writer's Workshop: Implementing Units of Study, Findings from a Teacher Study Group, and Student Success in Writing

    ERIC Educational Resources Information Center

    Chaney, Sandra Lynne

    2011-01-01

    Background: An elementary teacher study group supports each other in a year-long journey as they learn how to work through writer's workshop curriculum in order to implement Units of Study by Lucy Calkins at a K-6 school. Time spent in writing instruction has been largely neglected, and a teacher-researcher wants to document the support found from…

  14. National Cancer Centre Singapore Consensus Guidelines for Hepatocellular Carcinoma

    PubMed Central

    Chow, Pierce K. H.; Choo, Su Pin; Ng, David C. E.; Lo, Richard H. G.; Wang, Michael L. C.; Toh, Han Chong; Tai, David W. M.; Goh, Brian K. P.; Wong, Jen San; Tay, Kiang Hiong; Goh, Anthony S. W.; Yan, Sean X.; Loke, Kelvin S. H.; Thang, Sue Ping; Gogna, Apoorva; Too, Chow Wei; Irani, Farah Gillian; Leong, Sum; Lim, Kiat Hon; Thng, Choon Hua

    2016-01-01

    Hepatocellular carcinoma (HCC) is the 6th most common cancer in the world, but the second most common cause of cancer death. There is no universally accepted consensus practice guidelines for HCC owing to rapid developments in new treatment modalities, the heterogeneous epidemiology and clinical presentation of HCC worldwide. However, a number of regional and national guidelines currently exist which reflect practice relevant to the epidemiology and collective experience of the consensus group. In 2014, clinicians at the multidisciplinary Comprehensive Liver Cancer Clinic (CLCC) at the National Cancer Centre Singapore (NCCS) reviewed the latest published scientific data and existing international and regional practice guidelines, such as those of the National Comprehensive Cancer Network, American Association for the Study of Liver Diseases and the Asian Pacific Association for the Study of the Liver, and modified them to reflect local practice. These would serve as a template by which treatment outcomes can be collated and benchmarked against international data. The NCCS Consensus Guidelines for HCC have been successfully implemented in the CLCC since their publication online on 26th September 2014, and the guidelines allow outcomes of treatment to be compared to international data. These guidelines will be reviewed periodically to incorporate new data. PMID:27386428

  15. Implementation and Process Issues in Using Group Triple P with Chinese Parents: Preliminary Findings.

    ERIC Educational Resources Information Center

    Crisante, Lea; Ng, Sally

    2003-01-01

    Implements and evaluates a positive parenting program intervention with Chinese parents. Results reveal significant improvements on the Prosocial Behavior Score. Given the unwillingness of some parents to complete questionnaires, the difficulties encountered in conducting evaluation in cross-cultural contexts are discussed, along with…

  16. Implementation of Primary Social and Emotional Aspects of Learning Small Group Work: A Qualitative Study

    ERIC Educational Resources Information Center

    Humphrey, Neil; Lendrum, Ann; Wigelsworth, Michael; Kalambouka, Afroditi

    2009-01-01

    The aim of this study was to build an implementation process model for social-emotional interventions. Case studies were conducted at five primary schools in England nominated as "lead practise" by their local authorities. Data collection comprised interviews with school staff, children and parents, observations of intervention sessions and other…

  17. 40 CFR 52.823 - PM10 State Implementation Plan Development in Group II Areas.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) State Implementation Plan (SIP) development purposes. This includes portions of the cities of Des Moines, Mason City, and Cedar Rapids. The specific boundaries of these areas were identified in a letter of... extension of the attainment date as provided in Section 110(e) of the Clean Air Act, if and when the State...

  18. FOCUS School-Based Skill-Building Groups: Training and Implementation

    ERIC Educational Resources Information Center

    Garcia, Ediza; De Pedro, Kris Tunac; Astor, Ron Avi; Lester, Patricia; Benbenishty, Rami

    2015-01-01

    Military children encounter unique stressors that can affect their social and emotional well-being. These challenges can serve as a risk to the military child's successful academic performance. This study fills a much-needed research gap by examining the training and implementation of a public school-based intervention, Families OverComing Under…

  19. Applying Large-Group Interaction Methods in the Planning and Implementation of Major Change Efforts.

    ERIC Educational Resources Information Center

    Bryson, John M.; Anderson, Sharon R.

    2000-01-01

    Compares the assumptions, strengths, and weaknesses of seven approaches frequently used in the public sector to involve large numbers of people in planning and implementing change. The approaches are real-time strategic change, search conferences, future searches, strategic options development and analysis, strategic choice, technology of…

  20. Implementation and Evaluation of Digital E-Lecture Annotation in Learning Groups to Foster Active Learning

    ERIC Educational Resources Information Center

    Grunewald, Franka; Meinel, Christoph

    2015-01-01

    The use of video lectures in distance learning involves the two major problems of searchability and active user participation. In this paper, we promote the implementation and usage of a collaborative educational video annotation functionality to overcome these two challenges. Different use cases and requirements, as well as details of the…

  1. Applying Large-Group Interaction Methods in the Planning and Implementation of Major Change Efforts.

    ERIC Educational Resources Information Center

    Bryson, John M.; Anderson, Sharon R.

    2000-01-01

    Compares the assumptions, strengths, and weaknesses of seven approaches frequently used in the public sector to involve large numbers of people in planning and implementing change. The approaches are real-time strategic change, search conferences, future searches, strategic options development and analysis, strategic choice, technology of…

  2. FOCUS School-Based Skill-Building Groups: Training and Implementation

    ERIC Educational Resources Information Center

    Garcia, Ediza; De Pedro, Kris Tunac; Astor, Ron Avi; Lester, Patricia; Benbenishty, Rami

    2015-01-01

    Military children encounter unique stressors that can affect their social and emotional well-being. These challenges can serve as a risk to the military child's successful academic performance. This study fills a much-needed research gap by examining the training and implementation of a public school-based intervention, Families OverComing Under…

  3. A Group of Educators' Stance on the Implementation of South Africa's Further Education and Training Curriculum

    ERIC Educational Resources Information Center

    Treu, P.; Olivier, M. A. J.; Bean, P.; Van der Walt, J. L.

    2010-01-01

    In their dealings with educators in the Southern Cape region of South Africa, the researchers observed among them a degree of negativity and pessimism about the implementation of the Further Education and Training (FET) policy and curriculum during 2006. Exploratory discussions supported the surmise that a gap existed between policy formulation…

  4. Current opinion and consensus statement regarding the diagnosis, prognosis, and treatment of patients with essential thrombocythemia: a survey of the Spanish Group of Ph-negative Myeloproliferative Neoplasms (GEMFIN) using the Delphi method.

    PubMed

    Besses, C; Hernández-Boluda, J C; Pérez Encinas, M; Raya, J M; Hernández-Rivas, J M; Jiménez Velasco, A; Martínez Lopez, J; Vicente, V; Burgaleta, C

    2016-04-01

    The current consensus on the diagnosis, prognosis, and treatment of essential thrombocythemia (ET) is based on experts' recommendations. However, several aspects of the diagnosis of, prognosis of, and therapy for ET are still controversial. The Delphi method was employed with an expert panel of members of the Spanish Group of Ph-negative Myeloproliferative Neoplasms in order to identify the degree of agreement on the diagnosis, prognosis, and treatment of ET. Nine leading experts selected a total of 41 clinical hematologists with well-known expertise in ET. An electronic questionnaire was used to collect the questions rated in a four-step scale. The questions were grouped into four blocks: diagnosis, risk stratification, goals of therapy, and treatment strategy. After the first round consisting of 80 questions, a second round including 14 additional questions focused on the recommendations advocated by experts of the European LeukemiaNet in 2011 was analyzed. The median and mean values for the first and second rounds were calculated. A summary of the conclusions considered as the most representative of each block of questions is presented. The Delphi method is a powerful instrument to address the current approaches and controversies surrounding ET.

  5. Measuring therapeutic response in chronic graft-versus-host disease. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: IV. The 2014 Response Criteria Working Group report.

    PubMed

    Lee, Stephanie J; Wolff, Daniel; Kitko, Carrie; Koreth, John; Inamoto, Yoshihiro; Jagasia, Madan; Pidala, Joseph; Olivieri, Attilio; Martin, Paul J; Przepiorka, Donna; Pusic, Iskra; Dignan, Fiona; Mitchell, Sandra A; Lawitschka, Anita; Jacobsohn, David; Hall, Anne M; Flowers, Mary E D; Schultz, Kirk R; Vogelsang, Georgia; Pavletic, Steven

    2015-06-01

    In 2005, the National Institutes of Health (NIH) Chronic Graft-versus-Host Disease (GVHD) Consensus Response Criteria Working Group recommended several measures to document serial evaluations of chronic GVHD organ involvement. Provisional definitions of complete response, partial response, and progression were proposed for each organ and for overall outcome. Based on publications over the last 9 years, the 2014 Working Group has updated its recommendations for measures and interpretation of organ and overall responses. Major changes include elimination of several clinical parameters from the determination of response, updates to or addition of new organ scales to assess response, and the recognition that progression excludes minimal, clinically insignificant worsening that does not usually warrant a change in therapy. The response definitions have been revised to reflect these changes and are expected to enhance reliability and practical utility of these measures in clinical trials. Clarification is provided about response assessment after the addition of topical or organ-targeted treatment. Ancillary measures are strongly encouraged in clinical trials. Areas suggested for additional research include criteria to identify irreversible organ damage and validation of the modified response criteria, including in the pediatric population.

  6. Global Aesthetics Consensus: Botulinum Toxin Type A—Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications

    PubMed Central

    Signorini, Massimo; Liew, Steven; Trindade de Almeida, Ada R.; Wu, Yan; Vieira Braz, André; Fagien, Steven; Goodman, Greg J.; Monheit, Gary; Raspaldo, Hervé

    2016-01-01

    Background: Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction. Methods: A multinational, multidisciplinary group of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated consensus recommendations with a worldwide perspective for botulinum toxin and hyaluronic acid fillers. This publication on botulinum toxin type A considers advances in facial analysis, injection techniques, and avoidance and management of complications. Results: Use of botulinum toxin has evolved from the upper face to also encompass the lower face, neck, and midface. The Global Aesthetics Consensus Group emphasizes an integrative, diagnostic approach. Injection dosage and placement are based on analysis of target muscles in the context of adjacent ones and associated soft and hard tissues. The indication for selection of botulinum toxin as a primary intervention is that excessive muscular contraction is the primary etiology of the facial disharmony to be addressed. Global Aesthetics Consensus Group recommendations demonstrate a paradigm shift toward neuromodulation rather than paralysis, including lower dosing of the upper face, more frequent combination treatment with hyaluronic acid fillers, and intracutaneous injection where indicated to limit depth and degree of action. Conclusions: The accumulation of clinical evidence and experience with botulinum toxin has led to refinements in treatment planning and implementation. The Global Aesthetics Consensus Group advocates an etiology-driven, patient-tailored approach, to enable achievement of optimal efficacy and safety in patient populations that are rapidly diversifying with respect to ethnicity, gender, and age. CLINCAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V. PMID:26910696

  7. Design of a consensus-derived synoptic operative report for lung cancer surgery.

    PubMed

    Schneider, Laura; Shargall, Yaron; Schieman, Colin; Seely, Andrew J; Srinathan, Sadeesh; Malthaner, Richard A; Pierre, Andrew F; Safieddine, Najib; Vaillancourt, Rosaire; Plourde, Madelaine; Bond, James; Johnson, Scott; Smith, Shona E; Finley, Christian J

    2014-04-01

    For lung cancer surgery, a narrative operative report is the standard reporting procedure, whereas a synoptic-style report is increasingly utilized by healthcare professionals in various specialties with great success. A synoptic operative report more succinctly and accurately captures vital information and is rapidly generated with good intraobserver reliability. The objective of this study was to systematically develop a synoptic operative report for lung cancer surgery following a modified Delphi consensus model with the support of the Canadian thoracic surgery community. Using online survey software, thoracic surgeons and related physicians were asked to suggest and rate data elements for a synoptic report following the modified Delphi consensus model. The consensus exercise-derived template was forwarded to a small working group, who further refined the definition and priority designation of elements until the working group had reached a satisfactory consensus. In all, 139 physicians were invited to participate in the consensus exercise, with 36.7%, 44.6%, and 19.5% response rates, respectively, in the three rounds. Eighty-nine elements were agreed upon at the conclusion of the exercise, but 141 elements were forwarded to the working group. The working group agreed upon a final data set of 180 independently defined data elements, with 72 mandatory and 108 optional elements for implementation in the final report. This study demonstrates the process involved in developing a multidisciplinary, consensus-based synoptic lung cancer operative report. This novel report style is a quality improvement initiative to improve the capture, dissemination, readability, and potential utility of critical surgical information. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. NIH Consensus Conference. Acupuncture.

    PubMed

    1998-11-04

    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 within a few weeks of the conference. The statement is available at http://consensus.nih.gov. Acupuncture as a therapeutic intervention is widely practiced in the United States. Although there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

  9. A hybrid effectiveness-implementation cluster randomized trial of group CBT for anxiety in urban schools: rationale, design, and methods.

    PubMed

    Eiraldi, Ricardo; Khanna, Muniya S; Jawad, Abbas F; Fishman, Jessica; Glick, Henry A; Schwartz, Billie S; Cacia, Jaclyn; Wandersman, Abraham; Beidas, Rinad

    2016-07-12

    Schools present a context with great potential for the implementation of psychosocial evidence-based practices. Cognitive behavioral therapy (CBT) is an evidence-based practice that has been found to be very effective in treating anxiety in various community settings, including schools. Friends for Life (FRIENDS) is an efficacious group CBT protocol for anxiety. Unfortunately, evidence-based practices for anxiety are seldom employed in under-resourced urban schools, because many treatment protocols are not a good fit for the urban school context or the population, existing behavioral health staff do not receive adequate training or support to allow them to implement the treatment with fidelity, or school districts do not have the resources to contract with external consultants. In our prior work, we adapted FRIENDS to create a more culturally sensitive, focused, and feasible CBT protocol for anxiety disorders (CBT for Anxiety Treatment in Schools (CATS)). The aim of this 5-year study is to evaluate both the effectiveness of CATS for urban public schools compared to the original FRIENDS as well as compare the implementation strategies (train-the-trainer vs. train-the-trainer + ongoing consultation) by conducting a three-arm, parallel group, type 2 hybrid effectiveness-implementation trial in 18 K-8 urban public schools. We will also assess the cost-effectiveness and the mediators and moderators of fidelity. Ninety therapists, 18 agency supervisors, and 360 children will participate. The interactive systems framework for dissemination and implementation guides the training and support procedures for therapists and supervisors. This study has the potential to demonstrate that agency therapists and supervisors who have had little to no prior exposure to evidence-based practices (EBPs) can implement an anxiety disorder EBP with fidelity. Comparisons of the implementation strategies would provide large urban mental health systems with data to make decisions about the

  10. Research and implementation of group animation based on normal cloud model

    NASA Astrophysics Data System (ADS)

    Li, Min; Wei, Bin; Peng, Bao

    2011-12-01

    Group Animation is a difficult technology problem which always has not been solved in computer Animation technology, All current methods have their limitations. This paper put forward a method: the Motion Coordinate and Motion Speed of true fish group was collected as sample data, reverse cloud generator was designed and run, expectation, entropy and super entropy are gotten. Which are quantitative value of qualitative concept. These parameters are used as basis, forward cloud generator was designed and run, Motion Coordinate and Motion Speed of two-dimensional fish group animation are produced, And two spirit state variable about fish group : the feeling of hunger, the feeling of fear are designed. Experiment is used to simulated the motion state of fish Group Animation which is affected by internal cause and external cause above, The experiment shows that the Group Animation which is designed by this method has strong Realistic.

  11. Multi-Attribute Consensus Building Tool

    ERIC Educational Resources Information Center

    Shyyan, Vitaliy; Christensen, Laurene; Thurlow, Martha; Lazarus, Sheryl

    2013-01-01

    The Multi-Attribute Consensus Building (MACB) method is a quantitative approach for determining a group's opinion about the importance of each item (strategy, decision, recommendation, policy, priority, etc.) on a list (Vanderwood, & Erickson, 1994). This process enables a small or large group of participants to generate and discuss a set…

  12. Working Group 1: Software System Design and Implementation for Environmental Modeling

    EPA Science Inventory

    ISCMEM Working Group One Presentation, presentation with the purpose of fostering the exchange of information about environmental modeling tools, modeling frameworks, and environmental monitoring databases.

  13. Implementing structure and control over unofficial inventories in a multispecialty group practice.

    PubMed

    Gall, M

    1994-02-01

    Materiel managers have been in control of most aspects of the supply chain except for the inventories of the end users, which account for 70 percent of the inventory supply dollars. When the Materials Manager at Lexington Clinic in Lexington, Kentucky, was approached by the Clinic's Chief Executive Officer to implement cost containment measures, the Materials Manager seized the opportunity to implement a six-step program aimed at controlling those supply dollars. Through requisition training, enforcing approval levels, limiting the number of requisitioners, and establishing par levels on floor inventories, the clinic's "unofficial" inventory supply dollars were reduced by 7 percent in the first 12 departments where the par levels were established. The program was hailed as a tremendous success and a positive experience for everyone, from nurses to warehouse clerks.

  14. Consequences of anorectal cancer atlas implementation in the cooperative group setting: Radiobiologic analysis of a prospective randomized in silico target delineation study

    PubMed Central

    Mavroidis, Panayiotis; Giantsoudis, Drosoula; Awan, Musaddiq J.; Nijkamp, Jasper; Rasch, Coen R. N.; Duppen, Joop C.; Thomas, Charles R.; Okunieff, Paul; Jones, William E.; Kachnicc, Lisa A.; Papanikolaou, Niko; Fuller, Clifton D.

    2014-01-01

    Purpose The aim of this study is to ascertain the subsequent radiobiological impact of using a consensus guideline target volume delineation atlas. Materials and methods Using a representative case and target volume delineation instructions derived from a proposed IMRT rectal cancer clinical trial, gross tumor volume (GTV) and clinical/planning target volumes (CTV/PTV) were contoured by 13 physician observers (Phase 1). The observers were then randomly assigned to follow (atlas) or not-follow (control) a consensus guideline/atlas for anorectal cancers, and instructed to re-contour the same case (Phase 2). Results The atlas group was found to have increased tumor control probability (TCP) after the atlas intervention for both the CTV (p < 0.0001) and PTV1 (p = 0.0011) with decreasing normal tissue complication probability (NTCP) for small intestine, while the control group did not. Additionally, the atlas group had reduced variance in TCP for all target volumes and reduced variance in NTCP for the bowel. In Phase 2, the atlas group had increased TCP relative to the control for CTV (p = 0.03). Conclusions Visual atlas and consensus treatment guidelines usage in the development of rectal cancer IMRT treatment plans reduced the inter-observer radiobiological variation, with clinically relevant TCP alteration for CTV and PTV volumes. PMID:24996454

  15. Extending Inferential Group Analysis in Type 2 Diabetic Patients with Multivariate GLM Implemented in SPM8

    PubMed Central

    Ferreira, Fábio S.; Pereira, João M.S.; Duarte, João V.; Castelo-Branco, Miguel

    2017-01-01

    Background: Although voxel based morphometry studies are still the standard for analyzing brain structure, their dependence on massive univariate inferential methods is a limiting factor. A better understanding of brain pathologies can be achieved by applying inferential multivariate methods, which allow the study of multiple dependent variables, e.g. different imaging modalities of the same subject. Objective: Given the widespread use of SPM software in the brain imaging community, the main aim of this work is the implementation of massive multivariate inferential analysis as a toolbox in this software package. applied to the use of T1 and T2 structural data from diabetic patients and controls. This implementation was compared with the traditional ANCOVA in SPM and a similar multivariate GLM toolbox (MRM). Method: We implemented the new toolbox and tested it by investigating brain alterations on a cohort of twenty-eight type 2 diabetes patients and twenty-six matched healthy controls, using information from both T1 and T2 weighted structural MRI scans, both separately – using standard univariate VBM - and simultaneously, with multivariate analyses. Results: Univariate VBM replicated predominantly bilateral changes in basal ganglia and insular regions in type 2 diabetes patients. On the other hand, multivariate analyses replicated key findings of univariate results, while also revealing the thalami as additional foci of pathology. Conclusion: While the presented algorithm must be further optimized, the proposed toolbox is the first implementation of multivariate statistics in SPM8 as a user-friendly toolbox, which shows great potential and is ready to be validated in other clinical cohorts and modalities. PMID:28761571

  16. Extending Inferential Group Analysis in Type 2 Diabetic Patients with Multivariate GLM Implemented in SPM8.

    PubMed

    Ferreira, Fábio S; Pereira, João M S; Duarte, João V; Castelo-Branco, Miguel

    2017-01-01

    Although voxel based morphometry studies are still the standard for analyzing brain structure, their dependence on massive univariate inferential methods is a limiting factor. A better understanding of brain pathologies can be achieved by applying inferential multivariate methods, which allow the study of multiple dependent variables, e.g. different imaging modalities of the same subject. Given the widespread use of SPM software in the brain imaging community, the main aim of this work is the implementation of massive multivariate inferential analysis as a toolbox in this software package. applied to the use of T1 and T2 structural data from diabetic patients and controls. This implementation was compared with the traditional ANCOVA in SPM and a similar multivariate GLM toolbox (MRM). We implemented the new toolbox and tested it by investigating brain alterations on a cohort of twenty-eight type 2 diabetes patients and twenty-six matched healthy controls, using information from both T1 and T2 weighted structural MRI scans, both separately - using standard univariate VBM - and simultaneously, with multivariate analyses. Univariate VBM replicated predominantly bilateral changes in basal ganglia and insular regions in type 2 diabetes patients. On the other hand, multivariate analyses replicated key findings of univariate results, while also revealing the thalami as additional foci of pathology. While the presented algorithm must be further optimized, the proposed toolbox is the first implementation of multivariate statistics in SPM8 as a user-friendly toolbox, which shows great potential and is ready to be validated in other clinical cohorts and modalities.

  17. A feasibility study of expert patient and community mental health team led bipolar psychoeducation groups: implementing an evidence based practice.

    PubMed

    Coulthard, Katharine; Patel, Dipty; Brizzolara, Clare; Morriss, Richard; Watson, Stuart

    2013-11-11

    Group psychoeducation is a cost effective intervention which reduces relapse and improves functioning in bipolar disorder but is rarely implemented. The aim of this study was to identify the acceptability and feasibility of a group psychoeducation programme delivered by community mental health teams (CMHTs) and peer specialist (PS) facilitators. Organisational learning was used to identify and address systematically barriers and enablers, at organisational, health professional and patient levels, to its implementation into a routine service. A systematic examination of barriers and enablers to a three day training process informed the delivery of a first treatment group and a similar process informed the delivery of the second treatment group. Triangulation of research methods improved its internal validity: direct observation of training, self-rated surveys of participant experiences, group discussion, and thematically analysed individual participant and facilitator interviews were employed. Barriers and enablers were identified at organisational, educational, treatment content, facilitator and patient levels. All barriers under the control of the research team were addressed with subsequent improvements in patient knowledge about the condition and about local service. In addition, self-management, agency and altruism were enhanced. Barriers that could not be addressed required senior clinical and education leadership outside the research team's control. PS and professional facilitators were successfully trained and worked together to deliver groups which were generally reported as being beneficial. Psychoeducation groups involving CMHT and PS facilitators is acceptable and feasible but their sustainment requires senior leadership within and outside the organisation that control finance and education services.

  18. Implementing Cooperative Writing Response Groups and Self-Evaluation in South America: Struggle and Survival.

    ERIC Educational Resources Information Center

    Porto, Melina

    2002-01-01

    Focuses on the impact of cooperative writing response groups and self-evaluation on the learners, other faculty, and the institution (a university in Argentina). Argues that cooperative writing response groups and self-evaluation are worth pursuing in constrained educational environments because of how beneficial the approach was perceived to be…

  19. Advancing Social Justice in Urban Schools through the Implementation of Transformative Groups for Youth of Color

    ERIC Educational Resources Information Center

    Shin, Richard Q.; Rogers, Jennifer; Stanciu, Amalia; Silas, Melany; Brown-Smythe, Claudette; Austin, Brenda

    2010-01-01

    The unique challenges faced by some youth of color living in high poverty contexts necessitate the creation of innovative, culturally relevant, group interventions. Framing the work of group counselors from a social justice perspective provides a structure for emphasizing the complex intersection of economic, political, and socio-historical issues…

  20. Implementation of Learning Groups in an Audio-Tutorial Biology Program.

    ERIC Educational Resources Information Center

    Self, Mary Anne Nally

    A study was conducted at Bunker Hill Community College to assess the impact of the use of learning groups on student absenteeism and academic performance. The study involved four sections of a Biology 1 class. Two sections were designated as the control group and were taught using the traditional course format, which involved a 2-hour session in…

  1. The Character and Effectiveness of Citizen Monitoring Groups in Implementing Civil Rights in Public Schools.

    ERIC Educational Resources Information Center

    Hochschild, Jennifer L.; Hadrick, Valerie

    The character and impact of citizen monitoring groups are examined in this report, which evaluates groups monitoring three civil rights issues related to public education: race desegregation, sex equity, and services for the handicapped. The authors conducted site visits to study monitoring of race desegregation in 15 school systems, sex equity in…

  2. Implementing Self-Management within a Group Counseling Context: Effects on Academic Enabling Behaviors

    ERIC Educational Resources Information Center

    Briesch DuBois, Jacquelyn M.; Briesch, Amy M.; Hoffman, Jessica A.; Struzziero, Joan; Toback, Robin

    2017-01-01

    Self-management interventions have been adapted to serve as targeted interventions to increase academic enabling behaviors in groups of students. However, a trade-off exists between adapting these interventions to feasibly fit group contexts and maintaining theoretical intervention components. This study examines the use of self-management within…

  3. Implementing Effective Group Work for Mathematical Achievement in Primary School Classrooms in Hong Kong

    ERIC Educational Resources Information Center

    Kutnick, Peter; Fung, Dennis C. L.; Mok, Ida. A. C.; Leung, Frederick K. S.; Li, Johnson C. H.; Lee, Betty P.-Y.; Lai, Veronica K. W.

    2017-01-01

    The Hong Kong Education Bureau recommends that primary school pupils' mathematical achievement be enhanced via collaborative discussions engendered by group work. This pedagogic change may be hindered by Confucian heritage classroom practices and Western-dominated group work approaches that predominate in Hong Kong. To overcome these obstacles, we…

  4. Critique, Contextualism and Consensus

    ERIC Educational Resources Information Center

    Green, Jane

    2004-01-01

    In an epistemology of contextualism, how robust does consensus need to be for critique to be practically effective? In 'Relativism and the Critical Potential of Philosophy of Education,' Frieda Heyting proposes a form of contextualism, but her argument raises a number of problems. The kinds of criteria that her version of contextualism will…

  5. Critique, Contextualism and Consensus

    ERIC Educational Resources Information Center

    Green, Jane

    2004-01-01

    In an epistemology of contextualism, how robust does consensus need to be for critique to be practically effective? In 'Relativism and the Critical Potential of Philosophy of Education,' Frieda Heyting proposes a form of contextualism, but her argument raises a number of problems. The kinds of criteria that her version of contextualism will…

  6. Information without Implementation: A Practical Example for Developing a Best Practice Education Control Group.

    PubMed

    Balderson, Benjamin H; McCurry, Susan M; Vitiello, Michael V; Shortreed, Susan M; Rybarczyk, Bruce D; Keefe, Francis J; Korff, Michael Von

    2016-01-01

    This article considers methodology for developing an education-only control group and proposes a simple approach to designing rigorous and well-accepted control groups. This approach is demonstrated in a large randomized trial. The Lifestyles trial (n = 367) compared three group interventions: (a) cognitive-behavioral treatment (CBT) for osteoarthritis pain, (b) CBT for osteoarthritis pain and insomnia, and (c) education-only control (EOC). EOC emulated the interventions excluding hypothesized treatment components and controlling for nonspecific treatment effects. Results showed this approach resulted in a control group that was highly credible and acceptable to patients. This approach can be an effective and practical guide for developing high-quality control groups in trials of behavioral interventions.

  7. Differences in the Implementation of Diagnosis-Related Groups across Clinical Departments: A German Hospital Case Study

    PubMed Central

    Ridder, Hans-Gerd; Doege, Vanessa; Martini, Susanne

    2007-01-01

    Objective This article aims to examine the implementation process of diagnosis-related groups (DRGs) in the clinical departments of a German hospital group and to explain why some gain competitive advantage while others do not. Study Setting To investigate this research question, we conducted a qualitative study based on primary data obtained in six clinical departments in a German hospital group between 2003 and 2005. Study Design We chose the case study method in order to gain deep insights into the process dynamics of the implementation of DRGs in the six clinical departments. The dynamic capability approach is used as a theoretical foundation. Employing theory-driven categories we focused on idiosyncratic and common patterns of “successful coders” and “unsuccessful coders.” Data Collection To observe the implementation process of DRGs, we conducted 43 semistructured interviews with key persons, carried out direct observations of the monthly meetings of the DRG project group, and sampled written materials. Principal Findings “Successful coders” invest into change resources, demonstrate a high level of acceptance of innovations, and organize effective processes of coordination and learning. Conclusions All clinical departments only put an emphasis on the coding aspects of the DRGs. There is a lack of vision regarding the optimization of patient treatment processes and specialization. Physicians are the most important key actors, rather than the main barriers. PMID:17995556

  8. The Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time.

    PubMed

    Bangsbo, Jens; Krustrup, Peter; Duda, Joan; Hillman, Charles; Andersen, Lars Bo; Weiss, Maureen; Williams, Craig A; Lintunen, Taru; Green, Ken; Hansen, Peter Riis; Naylor, Patti-Jean; Ericsson, Ingegerd; Nielsen, Glen; Froberg, Karsten; Bugge, Anna; Lundbye-Jensen, Jesper; Schipperijn, Jasper; Dagkas, Symeon; Agergaard, Sine; von Seelen, Jesper; Østergaard, Charlotte; Skovgaard, Thomas; Busch, Henrik; Elbe, Anne-Marie

    2016-10-01

    From 4 to 7 April 2016, 24 researchers from 8 countries and from a variety of academic disciplines gathered in Snekkersten, Denmark, to reach evidence-based consensus about physical activity in children and youth, that is, individuals between 6 and 18 years. Physical activity is an overarching term that consists of many structured and unstructured forms within school and out-of-school-time contexts, including organised sport, physical education, outdoor recreation, motor skill development programmes, recess, and active transportation such as biking and walking. This consensus statement presents the accord on the effects of physical activity on children's and youth's fitness, health, cognitive functioning, engagement, motivation, psychological well-being and social inclusion, as well as presenting educational and physical activity implementation strategies. The consensus was obtained through an iterative process that began with presentation of the state-of-the art in each domain followed by plenary and group discussions. Ultimately, Consensus Conference participants reached agreement on the 21-item consensus statement.

  9. A Delphi consensus panel on nutritional therapy in chronic kidney disease.

    PubMed

    Bellizzi, Vincenzo; Bianchi, Stefano; Bolasco, Piergiorgio; Brunori, Giuliano; Cupisti, Adamasco; Gambaro, Giovanni; Gesualdo, Loreto; Polito, Pasquale; Santoro, Domenico; Santoro, Antonio

    2016-10-01

    The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD. Also when and how to start dietary manipulation of different nutrients in CKD is not well defined. A group of Italian nephrologists participated, under the auspices of the Italian Society of Nephrology, in a Delphi exercise to explore the consensus on some open questions regarding the nutritional treatment in CKD in Italy, generating a consensus opinion for 23 statements on: (1) general principles of NT; (2) indications for and initiation of NT; (3) role of protein-free products; (4) NT safety; (5) integrated management of NT. This Delphi exercise shows that there is broad consensus regarding NT in CKD across a wide range of management areas. These clinician-led consensus statements provide a framework for appropriate guidance on NT in patients with CKD, and are intended as a guide in decision-making whenever possible.

  10. The Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time

    PubMed Central

    Bangsbo, Jens; Duda, Joan; Hillman, Charles; Andersen, Lars Bo; Weiss, Maureen; Williams, Craig A; Lintunen, Taru; Green, Ken; Hansen, Peter Riis; Naylor, Patti-Jean; Ericsson, Ingegerd; Nielsen, Glen; Froberg, Karsten; Bugge, Anna; Lundbye-Jensen, Jesper; Dagkas, Symeon; Agergaard, Sine; von Seelen, Jesper; Østergaard, Charlotte; Skovgaard, Thomas; Busch, Henrik; Elbe, Anne-Marie

    2016-01-01

    From 4 to 7 April 2016, 24 researchers from 8 countries and from a variety of academic disciplines gathered in Snekkersten, Denmark, to reach evidence-based consensus about physical activity in children and youth, that is, individuals between 6 and 18 years. Physical activity is an overarching term that consists of many structured and unstructured forms within school and out-of-school-time contexts, including organised sport, physical education, outdoor recreation, motor skill development programmes, recess, and active transportation such as biking and walking. This consensus statement presents the accord on the effects of physical activity on children's and youth's fitness, health, cognitive functioning, engagement, motivation, psychological well-being and social inclusion, as well as presenting educational and physical activity implementation strategies. The consensus was obtained through an iterative process that began with presentation of the state-of-the art in each domain followed by plenary and group discussions. Ultimately, Consensus Conference participants reached agreement on the 21-item consensus statement. PMID:27354718

  11. Establishment, Implementation, and Consolidation of Clinical Pharmacy Services in Community Pharmacies: Perceptions of a Group of Pharmacists.

    PubMed

    Dosea, Aline S; Brito, Giselle C; Santos, Lincoln M C; Marques, Tatiane C; Balisa-Rocha, Blície; Pimentel, Deborah; Bueno, Denise; Lyra, Divaldo P

    2015-12-10

    When pharmacists incorporate clinical practice into their routine, barriers and facilitators influence the implementation of patient care services. Three focus groups were conducted with 11 pharmacists who were working for the Farmácia Popular do Brasil program on the establishment, implementation, and consolidation of clinical pharmacy services. The perception of the pharmacists in Brazil about the program was that it facilitated access to health care and medication. The distance between neighboring cities made it difficult for patients to return for services. Lack of staff training created a lack of communication skills and knowledge. The pharmacists wanted to have increased technical support, skill development opportunities, and monitoring of researchers who assessed progress of the service. Pharmacists overcame many of their insecurities and felt more proactive and committed to quality service. Positive experiences in service implementations have shown that it is possible to develop a model of clinical services in community pharmacies.

  12. An integral-factorized implementation of the driven similarity renormalization group second-order multireference perturbation theory.

    PubMed

    Hannon, Kevin P; Li, Chenyang; Evangelista, Francesco A

    2016-05-28

    We report an efficient implementation of a second-order multireference perturbation theory based on the driven similarity renormalization group (DSRG-MRPT2) [C. Li and F. A. Evangelista, J. Chem. Theory Comput. 11, 2097 (2015)]. Our implementation employs factorized two-electron integrals to avoid storage of large four-index intermediates. It also exploits the block structure of the reference density matrices to reduce the computational cost to that of second-order Møller-Plesset perturbation theory. Our new DSRG-MRPT2 implementation is benchmarked on ten naphthyne isomers using basis sets up to quintuple-ζ quality. We find that the singlet-triplet splittings (ΔST) of the naphthyne isomers strongly depend on the equilibrium structures. For a consistent set of geometries, the ΔST values predicted by the DSRG-MRPT2 are in good agreements with those computed by the reduced multireference coupled cluster theory with singles, doubles, and perturbative triples.

  13. Group-complementary code sets for implementing pulse compression with desirable range resolution properties

    NASA Astrophysics Data System (ADS)

    Weathers, G.; Holliday, E. M.

    This paper describes the structure and properties of a waveform design technique intended to provide desirable range resolution properties in radar sensor systems. The waveform design, called group-complementary coding, consists of groups of binary sequences which can be used for bi-phase coding of a radar carrier pulsed waveform. When pulse compression processing is extended to include the composite of a number of pulses through coherent integration, then group-complementary coding provides the often desirable property of complete range sidelobe cancellation (for zero Doppler shift).

  14. Developing a model osteoarthritis consultation: a Delphi consensus exercise

    PubMed Central

    2013-01-01

    Background Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems. Methods A postal Delphi consensus exercise was undertaken with two expert groups: i) general practitioners (GPs) with expertise in OA management and ii) patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%. Results The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i) assessment of chronic joint pain, ii) patient’s ideas and concerns, iii) exclusion of red flags, iv) examination, v) provision of the diagnosis and written information, vi) promotion of exercise and weight loss, vii) initial pain management and viii) arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence. Conclusions This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care. PMID:23320630

  15. Developing a model osteoarthritis consultation: a Delphi consensus exercise.

    PubMed

    Porcheret, Mark; Grime, Janet; Main, Chris; Dziedzic, Krysia

    2013-01-16

    Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems. A postal Delphi consensus exercise was undertaken with two expert groups: i) general practitioners (GPs) with expertise in OA management and ii) patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%. The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i) assessment of chronic joint pain, ii) patient's ideas and concerns, iii) exclusion of red flags, iv) examination, v) provision of the diagnosis and written information, vi) promotion of exercise and weight loss, vii) initial pain management and viii) arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence. This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.

  16. [Adalimumab for the treatment of adult Crohn's disease--update of a consensus report by the Working Group Inflammatory Bowel Disease of the Austrian Society of Gastroenterology and Hepatology].

    PubMed

    Novacek, G; Haas, T; Knoflach, P; Petritsch, W; Tilg, H; Vogelsang, H; Reinisch, W

    2013-09-01

    TNF alpha antibodies have clearly improved the outcome of moderate to severe Crohn's disease. Adalimumab is the first fully human, monoclonal TNF alpha antibody, which can be self-administered subcutaneously. Since August 2012 adalimumab is approved for the treatment of moderately to severely active Crohn's disease, in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and/or an immunosuppressant or who are intolerant to or have medical contraindications for such therapies. Compared to placebo adalimumab can induce significantly more often steroid-free remission and mucosal healing in patients with moderate to severe Crohn's disease, reduce the rate of Crohn's disease-related hospitalisations and surgery and improve health-related quality of life. Adalimumab is clinically efficacious both in patients with Crohn's disease naïve to previous exposure to TNF-alpha antibodies and in those previously exposed with a rapid onset of action within days and confirmed maintenance performance over 3 years. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Due to its low immunogenicity allergic reactions are rare. The update of a consensus report by the Working Group Inflammatory Bowel Disease of the Austrian Society of Gastroenterology and Hepatology presents the existing evidence on adalimumab for the treatment of Crohn's disease and is aimed to assist as a code of practice in its applications. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Consensus statement on definition, diagnosis, and management of high-risk prostate cancer patients on behalf of the Spanish Groups of Uro-Oncology Societies URONCOR, GUO, and SOGUG.

    PubMed

    Henríquez, I; Rodríguez-Antolín, A; Cassinello, J; Gonzalez San Segundo, C; Unda, M; Gallardo, E; López-Torrecilla, J; Juarez, A; Arranz, J

    2017-08-07

    Prostate cancer (PCa) is the most prevalent malignancy in men and the second cause of mortality in industrialized countries. Based on Spanish Register of PCa, the incidence of high-risk PCa is 29%, approximately. In spite of the evidence-based beneficial effect of radiotherapy and androgen deprivation therapy in high-risk PCa, these patients (pts) are still a therapeutic challenge for all specialists involved, in part due to the absence of comparative studies to establish which of the present disposable treatments offer better results. Nowadays, high-risk PCa definition is not well consensual through the published oncology guides. Clinical stage, tumour grade, and number of risk factors are relevant to be considered on PCa prognosis. However, these factors are susceptible to change depending on when surgical or radiation therapy is considered to be the treatment of choice. Other factors, such as reference pathologist, different diagnosis biopsy schedules, surgical or radiotherapy techniques, adjuvant treatments, biochemical failures, and follow-up, make it difficult to compare the results between different therapeutic options. This article reviews important issues concerning high-risk PCa. URONCOR, GUO, and SOGUG on behalf of the Spanish Groups of Uro-Oncology Societies have reached a consensus addressing a practical recommendation on definition, diagnosis, and management of high-risk PCa.

  18. Task Group on a Culture of Savings: Implementing Behavior Change in DoD

    DTIC Science & Technology

    2011-01-01

    Robert Hale Task Group Chairman – Navy Future Personnel and Pay Solution (FPPS) - Business Case November 30, 2009 – Case for Shared Services in the...Public Sector - Accenture Shared Services in Government - AT Kearney – 2009 Global Shared Services Survey Results - Deloitte – Shared Services - a...Benchmark Study - The Johnson Group – Economics of Business Process Outsourcing - Technology Association of Georgia – State of Shared Services and Business

  19. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group.

    PubMed

    Garcia-Borreguero, Diego; Kohnen, Ralf; Silber, Michael H; Winkelman, John W; Earley, Christopher J; Högl, Birgit; Manconi, Mauro; Montplaisir, Jacques; Inoue, Yuichi; Allen, Richard P

    2013-07-01

    A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6 months or longer presented at meetings over the past 2 years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?" The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1 year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6 months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5 years: gabapentin enacarbil, pramipexole, and ropinirole (1 year); levodopa (2 years); and rotigotine (5 years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED. The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of

  20. Implementation of joint health indicators in Europe - Joint Action for ECHIM. Arpo Aromaa on behalf of the ECHIM core group

    PubMed Central

    2012-01-01

    The story of the implementation of the joint EU health indicators (ECHI indicators) began in the 1990s after the Amsterdam Treaty. The first concrete step in establishing a health monitoring capacity for EU was the Commission working group set up in 1997. Several consecutive and parallel projects, notably the health indicator projects ECHI-1 and ECHI-2 between the years 2000 and 2005 led to a preparedness to implement the jointly agreed health indicators (ECHI shortlist) in all European countries. ECHIM (2005 – 2008) and the Joint Action for ECHIM (2009 - ) laid the foundation for the implementation of health indicators, and initiated Europe wide implementation proper. After the European recession of 2008 the circumstances in different countries were not optimal. Also the collaboration with the Commission could have been better. Nevertheless, the implementation process of the ECHI indicators is now well underway in most countries. By June 2012 half of the Member States had incorporated the ECHI indicators into their national health information system, and, if work can continue, by 2014 most countries are likely to have done so. Unfortunately, a gap may occur between the current programme and the next public health programme. The current momentum must not be lost. Therefore, all those responsible need to urge that the Commission (DG SANCO) together with the Member States helps to bridge the gap from June 2012 to January 2014. The new Public Health Programme provides the necessary financial instruments for setting up a permanent EU health information and reporting system. PMID:23043717

  1. Short-Term Impact of a Teen Pregnancy-Prevention Intervention Implemented in Group Homes.

    PubMed

    Oman, Roy F; Vesely, Sara K; Green, Jennifer; Fluhr, Janene; Williams, Jean

    2016-11-01

    Youth living in group home settings are at significantly greater risk for sexual risk behaviors; however, there are no sexual health programs designed specifically for these youth. The study's purpose was to assess the effectiveness of a teen pregnancy-prevention program for youth living in group home foster care settings and other out-of-home placements. The study design was a cluster randomized controlled trial involving youth (N = 1,037) recruited from 44 residential group homes located in California, Maryland, and Oklahoma. Within each state, youth (mean age = 16.2 years; 82% male; 37% Hispanic, 20% African-American, 20% white, and 17% multiracial) in half the group homes were randomly assigned to the intervention group (n = 40 clusters) and the other half were randomly assigned to a control group that offered "usual care" (n = 40 clusters). The intervention (i.e., Power Through Choices [PTC]) was a 10-session, age-appropriate, and medically accurate sexual health education program. Compared to the control group, youth in the PTC intervention showed significantly greater improvements (p < .05) from preintervention to postintervention in all three knowledge areas, one of two attitude areas, all three self-efficacy areas, and two of three behavioral intention areas. This is the first published randomized controlled trial of a teen pregnancy-prevention program designed for youth living in foster care settings and other out-of-home placements. The numerous significant improvements in short-term outcomes are encouraging and provide preliminary evidence that the PTC program is an effective pregnancy-prevention program. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  2. Some Aspects of the Implementation of Double Group Symmetry and Electron Correlation in Molecular 4-Component Calculations

    NASA Technical Reports Server (NTRS)

    Dyall, Kenneth G.; Arnold, James O. (Technical Monitor)

    1994-01-01

    The efficient implementation of method for electron correlation in molecular 4-component calculations demands that symmetry be exploited where possible. Algorithms for the construction of matrices and the transformation of integrals over symmetry-adapted basis functions, where the point group is restricted to D(sub 2h) and subgroups, will be presented. The merits of keeping the primitive integrals in the scalar basis will be compared with those of transforming them to the 2-spinor basis.

  3. Family Group Decision Making (FGDM) with Lakota families in two tribal communities: tools to facilitate FGDM implementation and evaluation.