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Results: 1 to 9 of 9

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A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).
Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A, Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW, Zammit C, Chesnut RM
(2019) Intensive Care Med 45: 1783-1794
MeSH Terms: Adult, Aged, Aged, 80 and over, Algorithms, Brain Injuries, Traumatic, Consensus Development Conferences as Topic, Female, Humans, Intracranial Hypertension, Male, Middle Aged, Monitoring, Physiologic, Practice Guidelines as Topic
Show Abstract · Added October 30, 2019
BACKGROUND - Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based.
METHODS - We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists' decision tendencies were the focus of recommendations.
RESULTS - We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination.
CONCLUSIONS - Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.
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13 MeSH Terms
Quality indicators for the management of Barrett's esophagus, dysplasia, and esophageal adenocarcinoma: international consensus recommendations from the American Gastroenterological Association Symposium.
Sharma P, Katzka DA, Gupta N, Ajani J, Buttar N, Chak A, Corley D, El-Serag H, Falk GW, Fitzgerald R, Goldblum J, Gress F, Ilson DH, Inadomi JM, Kuipers EJ, Lynch JP, McKeon F, Metz D, Pasricha PJ, Pech O, Peek R, Peters JH, Repici A, Seewald S, Shaheen NJ, Souza RF, Spechler SJ, Vennalaganti P, Wang K
(2015) Gastroenterology 149: 1599-606
MeSH Terms: Adenocarcinoma, Barrett Esophagus, Consensus, Consensus Development Conferences as Topic, Disease Management, Disease Progression, Esophageal Neoplasms, Esophagoscopy, Esophagus, Gastroenterology, Humans, United States
Show Abstract · Added February 5, 2016
The development of and adherence to quality indicators in gastroenterology, as in all of medicine, is increasing in importance to ensure that patients receive consistent high-quality care. In addition, government-based and private insurers will be expecting documentation of the parameters by which we measure quality, which will likely affect reimbursements. Barrett's esophagus remains a particularly important disease entity for which we should maintain up-to-date guidelines, given its commonality, potentially lethal outcomes, and controversies regarding screening and surveillance. To achieve this goal, a relatively large group of international experts was assembled and, using the modified Delphi method, evaluated the validity of multiple candidate quality indicators for the diagnosis and management of Barrett's esophagus. Several candidate quality indicators achieved >80% agreement. These statements are intended to serve as a consensus on candidate quality indicators for those who treat patients with Barrett's esophagus.
Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
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12 MeSH Terms
The 12th consensus conference of the Acute Dialysis Quality Initiative (ADQI XII).
Kellum JA, Mythen MG, Shaw AD
(2014) Br J Anaesth 113: 729-31
MeSH Terms: Consensus Development Conferences as Topic, Dialysis, Fluid Therapy, History, 19th Century, Humans
Added October 20, 2015
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5 MeSH Terms
Systemic cytotoxic and biological therapies of colorectal liver metastases: expert consensus statement.
Schwarz RE, Berlin JD, Lenz HJ, Nordlinger B, Rubbia-Brandt L, Choti MA
(2013) HPB (Oxford) 15: 106-15
MeSH Terms: Antineoplastic Combined Chemotherapy Protocols, Chemotherapy, Adjuvant, Clinical Trials, Phase III as Topic, Colorectal Neoplasms, Consensus Development Conferences as Topic, Hepatectomy, Humans, Liver Neoplasms, Neoplasm Metastasis, Patient Selection, Practice Guidelines as Topic, Radiotherapy, Adjuvant, Survival Analysis, Treatment Outcome
Show Abstract · Added March 20, 2014
Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15 years. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liver-only CRLM are at risk of disease recurrence and cancer-related death, combining resection with systemic therapy appears sensible. However, trial-based evidence is sparse to support this concept. Peri-operative FOLFOX has demonstrated a progression-free survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapy-associated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, pre-operative chemotherapy should not extend beyond 3 months. For patients with unresectable liver-only CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatin- or irinotecan-containing combinations represent the standard options, although single-agent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without K-ras mutations, anti-epidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.
© 2012 International Hepato-Pancreato-Biliary Association.
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14 MeSH Terms
The International Serious Adverse Events Consortium (iSAEC) phenotype standardization project for drug-induced torsades de pointes.
Behr ER, January C, Schulze-Bahr E, Grace AA, Kääb S, Fiszman M, Gathers S, Buckman S, Youssef A, Pirmohamed M, Roden D
(2013) Eur Heart J 34: 1958-63
MeSH Terms: Adverse Drug Reaction Reporting Systems, Anti-Arrhythmia Agents, Anti-Infective Agents, Antipsychotic Agents, Consensus, Consensus Development Conferences as Topic, Drug-Related Side Effects and Adverse Reactions, Genetic Markers, Genetic Testing, Histamine Antagonists, Humans, Interprofessional Relations, Phenotype, Risk Factors, Sex Factors, Torsades de Pointes
Added June 26, 2014
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16 MeSH Terms
The phenotype standardization project: improving pharmacogenetic studies of serious adverse drug reactions.
Pirmohamed M, Aithal GP, Behr E, Daly A, Roden D
(2011) Clin Pharmacol Ther 89: 784-5
MeSH Terms: Chemical and Drug Induced Liver Injury, Consensus Development Conferences as Topic, Drug-Related Side Effects and Adverse Reactions, Humans, Pharmaceutical Preparations, Pharmacogenetics, Phenotype, Skin Diseases, Torsades de Pointes
Show Abstract · Added June 26, 2014
The ability to predict the risk for serious drug-induced adverse reactions first requires a large patient database for characterization and validation of genetic markers. The Phenotype Standardization Project (PSP) was initiated to standardize phenotypic definitions, thereby facilitating much-needed recruitment without sacrificing the reliability of patient classification. Three phenotypes have been considered in this initial phase: drug-induced liver injury, drug-induced skin injury, and drug-induced torsade de pointes.
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9 MeSH Terms
Pathology reporting of neuroendocrine tumors: application of the Delphic consensus process to the development of a minimum pathology data set.
Klimstra DS, Modlin IR, Adsay NV, Chetty R, Deshpande V, Gönen M, Jensen RT, Kidd M, Kulke MH, Lloyd RV, Moran C, Moss SF, Oberg K, O'Toole D, Rindi G, Robert ME, Suster S, Tang LH, Tzen CY, Washington MK, Wiedenmann B, Yao J
(2010) Am J Surg Pathol 34: 300-13
MeSH Terms: Biomarkers, Tumor, Cell Differentiation, Cell Proliferation, Checklist, Consensus Development Conferences as Topic, Delphi Technique, Genetic Techniques, Humans, Immunohistochemistry, Neoplasm Staging, Neuroendocrine Tumors, Practice Guidelines as Topic, Predictive Value of Tests, Prognosis, Reproducibility of Results, Terminology as Topic
Show Abstract · Added April 12, 2016
Epithelial neuroendocrine tumors (NETs) have been the subject of much debate regarding their optimal classification. Although multiple systems of nomenclature, grading, and staging have been proposed, none has achieved universal acceptance. To help define the underlying common features of these classification systems and to identify the minimal pathology data that should be reported to ensure consistent clinical management and reproducibility of data from therapeutic trials, a multidisciplinary team of physicians interested in NETs was assembled. At a group meeting, the participants discussed a series of "yes" or "no" questions related to the pathology of NETs and the minimal data to be included in the reports. After discussion, anonymous votes were taken, using the Delphic principle that 80% agreement on a vote of either yes or no would define a consensus. Questions that failed to achieve a consensus were rephrased once or twice and discussed, and additional votes were taken. Of 108 questions, 91 were answerable either yes or no by more than 80% of the participants. There was agreement about the importance of proliferation rate for tumor grading, the landmarks to use for staging, the prognostic factors assessable by routine histology that should be reported, the potential for tumors to progress biologically with metastasis, and the current status of advanced immunohistochemical and molecular testing for treatment-related biomarkers. The lack of utility of a variety of immunohistochemical stains and pathologic findings was also agreed upon. A consensus could not be reached for the remaining 17 questions, which included both minor points related to extent of disease assessment and some major areas such as terminology, routine immunohistochemical staining for general neuroendocrine markers, use of Ki67 staining to assess proliferation, and the relationship of tumor grade to degree of differentiation. On the basis of the results of the Delphic voting, a minimum pathology data set was developed. Although there remains disagreement among experts about the specific classification system that should be used, there is agreement about the fundamental pathology data that should be reported. Examination of the areas of disagreement reveals significant opportunities for collaborative study to resolve unanswered questions.
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16 MeSH Terms
Finally, a consensus statement on sickle cell disease manifestations: a critical step in improving the medical care and research agenda for individuals with sickle cell disease.
DeBaun MR
(2010) Am J Hematol 85: 1-3
MeSH Terms: Anemia, Sickle Cell, Consensus Development Conferences as Topic, Humans, International Classification of Diseases
Added November 27, 2013
1 Communities
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4 MeSH Terms
Proposed new diagnostic criteria for complex regional pain syndrome.
Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR
(2007) Pain Med 8: 326-31
MeSH Terms: Complex Regional Pain Syndromes, Consensus Development Conferences as Topic, Factor Analysis, Statistical, Humans, Reproducibility of Results, Terminology as Topic
Show Abstract · Added March 5, 2014
This topical update reports recent progress in the international effort to develop a more accurate and valid diagnostic criteria for complex regional pain syndrome (CRPS). The diagnostic entity of CRPS (published in the International Association for the Study of Pain's Taxonomy monograph in 1994; International Association for the Study of Pain [IASP]) was intended to be descriptive, general, and not imply etiopathology, and had the potential to lead to improved clinical communication and greater generalizability across research samples. Unfortunately, realization of this potential has been limited by the fact that these criteria were based solely on consensus and utilization of the criteria in the literature has been sporadic at best. As a consequence, the full potential benefits of the IASP criteria have not been realized. Consensus-derived criteria that are not subsequently validated may lead to over- or underdiagnosis, and will reduce the ability to provide timely and optimal treatment. Results of validation studies to date suggest that the IASP/CRPS diagnostic criteria are adequately sensitive; however, both internal and external validation research suggests that utilization of these criteria causes problems of overdiagnosis due to poor specificity. This update summarizes the latest international consensus group's action in Budapest, Hungary to approve and codify empirically validated, statistically derived revisions of the IASP criteria for CRPS.
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6 MeSH Terms