NIH consensus and state-of-the-science statements最新文献

{"title":"NIH consensus development conference: diagnosing gestational diabetes mellitus.","authors":"James P Vandorsten,&nbsp;William C Dodson,&nbsp;Mark A Espeland,&nbsp;William A Grobman,&nbsp;Jeanne Marie Guise,&nbsp;Brian M Mercer,&nbsp;Howard L Minkoff,&nbsp;Brenda Poindexter,&nbsp;Lisa A Prosser,&nbsp;George F Sawaya,&nbsp;James R Scott,&nbsp;Robert M Silver,&nbsp;Lisa Smith,&nbsp;Alyce Thomas,&nbsp;Alan T N Tita","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide healthcare providers, patients, and the general public with a responsible assessment of currently available data on diagnosing gestational diabetes mellitus (GDM).</p><p><strong>Participants: </strong>A non-U.S. Department of Health and Human Services, nonadvocate 15-member panel representing the fields of obstetrics and gynecology, maternal-fetal medicine, pediatrics, diabetic research, biostatistics, women's health issues, health services research, decision analysis, health management and policy, health economics, epidemiology, and community engagement. In addition, 16 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the University of Alberta Evidence-based Practice Centre, through the Agency for Healthcare Research and Quality (AHRQ). Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was posted at http://prevention.nih.gov/ for public comment and the panel released a final statement approximately 10 weeks later. The final statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>At present, GDM is commonly diagnosed in the United States using a 1-hour screening test with a 50-gram glucose load followed by a 3-hour 100-gram glucose tolerance test (a two-step approach) for those found to be abnormal on the screen. This approach identifies approximately 5% to 6% of the population as having GDM. In contrast, newly proposed diagnostic strategies rely on the administration of a 2-hour glucose tolerance test (a one-step approach) with a fasting component and a 75-gram glucose load. These strategies differ on whether a 1-hour sample is included, whether two abnormal values are required, and the diagnostic cutoffs that are used. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has proposed diagnostic thresholds based on demonstrated associations between glycemic levels and an increased risk of obstetric and perinatal morbidities. The panel considered whether a one-step approach to the diagnosis of GDM should be adopted in place of the two-step approach. The one-step approach offers certain operational advantages. The current two-step approach is used only during pregnancy and is largely restricted to the United States. There would be value in a consistent, international diagnostic standard across one's lifespan. This unification would allow better standardization of best practices in patient care and comparability of research outcomes. The one-step approach also holds potential advantages for women and their health care providers, as it would al","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"29 1","pages":"1-31"},"PeriodicalIF":0.0,"publicationDate":"2013-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31492333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH State-of-the-Science Conference Statement: Role of active surveillance in the management of men with localized prostate cancer.","authors":"Patricia A Ganz,&nbsp;John M Barry,&nbsp;Wylie Burke,&nbsp;Nananda F Col,&nbsp;Phaedra S Corso,&nbsp;Everett Dodson,&nbsp;M Elizabeth Hammond,&nbsp;Barry A Kogan,&nbsp;Charles F Lynch,&nbsp;Lee Newcomer,&nbsp;Eric J Seifter,&nbsp;Janet A Tooze,&nbsp;Kasisomayajula Vish Viswanath,&nbsp;Hunter Wessells","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide healthcare providers, patients, and the general public with a responsible assessment of currently available data on the use of active surveillance and other observational management strategies for low-grade, localized prostate cancer.</p><p><strong>Participants: </strong>A non-U.S. Department of Health and Human Services, nonadvocate 14-member panel representing the fields of cancer prevention and control, urology, pathology, epidemiology, genetics, transplantation, bioethics, economics, health services research, shared decisionmaking, health communication, and community engagement. In addition, 22 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the Tufts Evidence-based Practice Center, through the Agency for Healthcare Research and Quality (AHRQ). Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>Prostate cancer screening with prostate-specific antigen (PSA) testing has identified many men with low-risk disease. Because of the very favorable prognosis of low-risk prostate cancer, strong consideration should be given to modifying the anxiety-provoking term \"cancer\" for this condition. Treatment of low-risk prostate cancer patients with radical prostatectomy or radiation therapy leads to side effects such as impotence and incontinence in a substantial number. Active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer. More than 100,000 men a year diagnosed with prostate cancer in the United States are candidates for this approach. However, there are many unanswered questions about active surveillance strategies and prostate cancer that require further research and clarification. These include: • Improvements in the accuracy and consistency of pathologic diagnosis of prostate cancer • Consensus on which men are the most appropriate candidates for active surveillance • The optimal protocol for active surveillance and the potential for individualizing the approach based on clinical and patient factors • Optimal ways to communicate the option of active surveillance to patients • Methods to assist patient decisionmaking • Reasons for acceptance or rejection of active surveillance as a treatment strategy • Short- and long-term outcomes of active surveillance. Well-designed studies to","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"28 1","pages":"1-27"},"PeriodicalIF":0.0,"publicationDate":"2011-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31223449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH consensus development conference: Inhaled nitric oxide therapy for premature infants.","authors":"F Sessions Cole,&nbsp;Claudia Alleyne,&nbsp;John D E Barks,&nbsp;Robert J Boyle,&nbsp;John L Carroll,&nbsp;Deborah Dokken,&nbsp;William H Edwards,&nbsp;Michael Georgieff,&nbsp;Katherine Gregory,&nbsp;Michael V Johnston,&nbsp;Michael Kramer,&nbsp;Christine Mitchell,&nbsp;Josef Neu,&nbsp;DeWayne M Pursley,&nbsp;Walter Robinson,&nbsp;David H Rowitch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide healthcare providers, patients, and the general public with a responsible assessment of currently available data on the use of inhaled nitric oxide in early routine, early rescue, or later rescue regimens in the care of premature infants <34 weeks gestation who require respiratory support.</p><p><strong>Participants: </strong>A non-Department of Health and Human Services, nonadvocate 16-member panel representing the fields of biostatistics, child psychology, clinical trials, ethics, family-centered care, neonatology, neurodevelopmental follow-up, nursing, pediatric epidemiology, neurobehavior, neurological surgery, neurology, and pulmonology, perinatology, and research methodology. In addition, 18 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the Johns Hopkins University Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is a report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>(1) Taken as a whole, the available evidence does not support use of inhaled nitric oxide in early routine, early rescue, or later rescue regimens in the care of premature infants <34 weeks gestation who require respiratory support. (2) There are rare clinical situations, including pulmonary hypertension or hypoplasia, that have been inadequately studied in which inhaled nitric oxide may have benefit in infants <34 weeks gestation. In such situations, clinicians should communicate with families regarding the current evidence on its risks and benefits as well as remaining uncertainties. (3) Basic research and animal studies have contributed to important understandings of inhaled nitric oxide benefits on lung development and function in infants at high risk of bronchopulmonary dysplasia. These promising results have only partly been realized in clinical trials of inhaled nitric oxide treatment in premature infants. Future research should seek to understand this gap. (4) Predefined subgroup and post hoc analyses of previous trials showing potential benefit of inhaled nitric oxide have generated hypotheses for future research for clinical trials. Prior strategies shown to be ineffective are discouraged unless new evidence emerges. The positive results of one multicenter trial, which was characterized by later timing, higher dose, and longer dura","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"27 5","pages":"1-34"},"PeriodicalIF":0.0,"publicationDate":"2010-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29439366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH state-of-the-science conference statement: Preventing Alzheimer's disease and cognitive decline.","authors":"Martha L Daviglus,&nbsp;Carl C Bell,&nbsp;Wade Berrettini,&nbsp;Phyllis E Bowen,&nbsp;E Sander Connolly,&nbsp;Nancy Jean Cox,&nbsp;Jacqueline M Dunbar-Jacob,&nbsp;Evelyn C Granieri,&nbsp;Gail Hunt,&nbsp;Kathleen McGarry,&nbsp;Dinesh Patel,&nbsp;Arnold L Potosky,&nbsp;Elaine Sanders-Bush,&nbsp;Donald Silberberg,&nbsp;Maurizio Trevisan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide health care providers, patients, and the general public with a responsible assessment of currently available data on prevention of Alzheimer's disease and cognitive decline.</p><p><strong>Participants: </strong>A non-Department of Health and Human Services, nonadvocate 15-member panel representing the fields of preventive medicine, geriatrics, internal medicine, neurology, neurological surgery, psychiatry, mental health, human nutrition, pharmacology, genetic medicine, nursing, health economics, health services research, family caregiving, and a public representative. In addition, 20 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the Duke University Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>Cognitive decline and Alzheimer’s disease are major causes of morbidity and mortality worldwide and are substantially burdensome to the affected persons, their caregivers, and society in general. Extensive research over the past 20 years has provided important insights on the nature of Alzheimer’s disease and cognitive decline and the magnitude of the problem. Nevertheless, there remain important and formidable challenges in conducting research on these diseases, particularly in the area of prevention. Currently, firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline or Alzheimer’s disease. Highly reliable consensus-based diagnostic criteria for cognitive decline, mild cognitive impairment, and Alzheimer’s disease are lacking, and available criteria have not been uniformly applied. Evidence is insufficient to support the use of pharmaceutical agents or dietary supplements to prevent cognitive decline or Alzheimer’s disease. We recognize that a large amount of promising research is under way; these efforts need to be increased and added to by new understandings and innovations (as noted in our recommendations for future research). For example, ongoing studies including (but not limited to) studies on antihypertensive medications, omega-3 fatty acids, physical activity, and cognitive engagement may provide new insights into the prevention or delay of cognitive decline or Alzheimer’s disease. This impo","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"27 4","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2010-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28968755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH consensus development conference draft statement on vaginal birth after cesarean: new insights.","authors":"F Gary Cunningham,&nbsp;Shrikant I Bangdiwala,&nbsp;Sarah S Brown,&nbsp;Thomas Michael Dean,&nbsp;Marilynn Frederiksen,&nbsp;Carol J Rowland Hogue,&nbsp;Tekoa King,&nbsp;Emily Spencer Lukacz,&nbsp;Laurence B McCullough,&nbsp;Wanda Nicholson,&nbsp;Nancy Frances Petit,&nbsp;Jeffrey Lynn Probstfield,&nbsp;Adele C Viguera,&nbsp;Cynthia A Wong,&nbsp;Sheila Cohen Zimmet","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide health care providers, patients, and the general public with a responsible assessment of currently available data on vaginal birth after cesarean (VBAC).</p><p><strong>Participants: </strong>A non-DHHS, nonadvocate 15-member panel representing the fields of obstetrics and gynecology, urogynecology, maternal and fetal medicine, pediatrics, midwifery, clinical pharmacology, medical ethics, internal medicine, family medicine, perinatal and reproductive psychiatry, anesthesiology, nursing, biostatistics, epidemiology, health care regulation, risk management, and a public representative, and a public representative. In addition, 21 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the Oregon Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>Given the available evidence, trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision. The data reviewed in this report show that both trial of labor and elective repeat cesarean delivery for a pregnant woman with one prior transverse uterine incision have important risks and benefits and that these risks and benefits differ for the woman and her fetus. This poses a profound ethical dilemma for the woman, as well as her caregivers, because benefit for the woman may come at the price of increased risk for the fetus and vice versa. This conundrum is worsened by the general paucity of high-level evidence about both medical and nonmedical factors, which prevents the precise quantification of risks and benefits that might help to make an informed decision about trial of labor compared with elective repeat cesarean delivery. The panel was mindful of these clinical and ethical uncertainties in making the following conclusions and recommendations. One of the panel’s major goals is to support pregnant women with one prior transverse uterine incision to make informed decisions about trial of labor compared with elective repeat cesarean delivery. The panel recommends that clinicians and other maternity care providers use the responses to the six questions, especially questions 3 and 4, to incorporate an evidence-based approach into the decisionmaking process. Information, inc","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"27 3","pages":"1-42"},"PeriodicalIF":0.0,"publicationDate":"2010-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28775471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH consensus development conference statement: Lactose intolerance and health.","authors":"Frederick J Suchy,&nbsp;Patsy M Brannon,&nbsp;Thomas O Carpenter,&nbsp;Jose R Fernandez,&nbsp;Vicente Gilsanz,&nbsp;Jeffrey B Gould,&nbsp;Karen Hall,&nbsp;Siu L Hui,&nbsp;Joanne Lupton,&nbsp;Julie Mennella,&nbsp;Natalie J Miller,&nbsp;Stavroula Kalis Osganian,&nbsp;Deborah E Sellmeyer,&nbsp;Marshall A Wolf","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide health care providers, patients, and the general public with a responsible assessment of currently available data on lactose intolerance and health.</p><p><strong>Participants: </strong>A non-DHHS, nonadvocate 14-member panel representing the fields of internal medicine, pediatrics, pediatric and adult endocrinology, gastroenterology, hepatology, neonatology and perinatology, geriatrics, racial/ethnic disparities, radiology, maternal and fetal nutrition, vitamin and mineral metabolism, nutritional sciences, bone health, preventive medicine, biopsychology, biostatistics, statistical genetics, epidemiology, and a public representative. In addition, 22 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the University of Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>• Lactose intolerance is a real and important clinical syndrome, but its true prevalence is not known. • The majority of people with lactose malabsorption do not have clinical lactose intolerance. Many individuals who think they are lactose intolerant are not lactose malabsorbers. • Many individuals with real or perceived lactose intolerance avoid dairy and ingest inadequate amounts of calcium and vitamin D, which may predispose them to decreased bone accrual, osteoporosis, and other adverse health outcomes. In most cases, individuals do not need to eliminate dairy consumption completely. • Evidence-based dietary approaches with and without dairy foods and supplementation strategies are needed to ensure appropriate consumption of calcium and other nutrients in lactose-intolerant individuals. • Educational programs and behavioral approaches for individuals and their healthcare providers should be developed and validated to improve the nutrition and symptoms of individuals with lactose intolerance and dairy avoidance.</p>","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"27 2","pages":"1-27"},"PeriodicalIF":0.0,"publicationDate":"2010-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28740718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH state-of-the-science conference statement: Enhancing use and quality of colorectal cancer screening.","authors":"Donald Steinwachs,&nbsp;Jennifer Dacey Allen,&nbsp;William Eric Barlow,&nbsp;R Paul Duncan,&nbsp;Leonard E Egede,&nbsp;Lawrence S Friedman,&nbsp;Nancy L Keating,&nbsp;Paula Kim,&nbsp;Judith R Lave,&nbsp;Thomas A LaVeist,&nbsp;Roberta B Ness,&nbsp;Robert J Optican,&nbsp;Beth A Virnig","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide health care providers, patients, and the general public with a responsible assessment of currently available data on enhancing use and quality of colorectal cancer screening.</p><p><strong>Participants: </strong>A non-DHHS, nonadvocate 13-member panel representing the fields of cancer surveillance, health services research, community-based research, informed decision-making, access to care, health care policy, health communication, health economics, health disparities, epidemiology, statistics, thoracic radiology, internal medicine, gastroenterology, public health, end-of-life care, and a public representative. In addition, 20 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the RTI International-University of North Carolina Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>The panel found that despite substantial progress toward higher colorectal cancer screening rates nationally, screening rates fall short of desirable levels. Targeted initiatives to improve screening rates and reduce disparities in underscreened communities and population subgroups could further reduce colorectal cancer morbidity and mortality. This could be achieved by utilizing the full range of screening options and evidence-based interventions for increasing screening rates. With additional investments in quality monitoring, Americans could be assured that all screening achieves high rates of cancer prevention and early detection. To close the gap in screening, this report identifies the following priority areas for implementation and research to enhance the use and quality of colorectal cancer screening: • Eliminate financial barriers to colorectal cancer screening and appropriate follow up. • Widely implement interventions that have proven effective at increasing colorectal cancer screening, including patient reminder systems and one-on-one interactions with providers, educators, or navigators. • Conduct research to assess the effectiveness of tailoring programs to match the characteristics and preferences of target population groups to increase colorectal cancer screening. • Implement systems to ensure appropriate follow-up of positive colorectal cancer screening results","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"27 1","pages":"1-31"},"PeriodicalIF":0.0,"publicationDate":"2010-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28699919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH state-of-the-science conference statement: diagnosis and management of ductal carcinoma in situ (DCIS).","authors":"Carmen J Allegra,&nbsp;Denise R Aberle,&nbsp;Pamela Ganschow,&nbsp;Stephen M Hahn,&nbsp;Clara N Lee,&nbsp;Sandra Millon-Underwood,&nbsp;Malcom C Pike,&nbsp;Susan D Reed,&nbsp;Audrey F Saftlas,&nbsp;Susan A Scarvalone,&nbsp;Arnold M Schwartz,&nbsp;Carol Slomski,&nbsp;Greg Yothers,&nbsp;Robin Zon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the diagnosis and management of ductal carcinoma in situ (DCIS).</p><p><strong>Participants: </strong>An non-DHHS, nonadvocate 14-member panel representing the fields of fields of oncology, radiology, surgery (general and reconstructive), pathology, radiation oncology, internal medicine, epidemiology, biostatistics, nursing, obstetrics and gynecology, preventative medicine and population health, and social work. In addition, 22 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>The diagnosis and management of DCIS is highly complex with many unanswered questions, including the fundamental natural history of untreated disease. Because of the noninvasive nature of DCIS, coupled with its favorable prognosis, strong consideration should be given to remove the anxiety-producing term \"carcinoma\" from the description of DCIS. The outcomes in women treated with available therapies are excellent. Thus, the primary question for future research must focus on the accurate identification of patient subsets diagnosed with DCIS, including those persons who may be managed with less therapeutic intervention without sacrificing the excellent outcomes presently achieved. Essential in this quest will be the development and validation of accurate risk stratification methods based on a comprehensive understanding of the clinical, radiological, pathological, and biological factors associated with DCIS.</p>","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"26 2","pages":"1-27"},"PeriodicalIF":0.0,"publicationDate":"2009-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40038530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Institutes of Health State-of-the-Science Conference Statement: Family History and Improving Health: August 24-26, 2009.","authors":"Alfred O Berg,&nbsp;Macaran A Baird,&nbsp;Jeffrey R Botkin,&nbsp;Deborah A Driscoll,&nbsp;Paul A Fishman,&nbsp;Peter D Guarino,&nbsp;Robert A Hiatt,&nbsp;Gail P Jarvik,&nbsp;Sandra Millon-Underwood,&nbsp;Thomas M Morgan,&nbsp;John J Mulvihill,&nbsp;Toni I Pollin,&nbsp;Selma R Schimmel,&nbsp;Michael Edward Stefanek,&nbsp;William M Vollmer,&nbsp;Janet K Williams","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"26 1","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2009-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28374015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIH consensus development statement on management of hepatitis B.","authors":"E A Belongia,&nbsp;J Costa,&nbsp;I F Gareen,&nbsp;J L Grem,&nbsp;J M Inadomi,&nbsp;E R Kern,&nbsp;J A McHugh,&nbsp;G M Petersen,&nbsp;M F Rein,&nbsp;M F Sorrell,&nbsp;D B Strader,&nbsp;H T Trotter","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the management of hepatitis B.</p><p><strong>Participants: </strong>A non-DHHS, nonadvocate 12-member panel representing the fields of hepatology and liver transplantation, gastroenterology, public health and epidemiology, infectious diseases, pathology, oncology, family practice, internal medicine, and a public representative. In addition, 22 experts from pertinent fields presented data to the panel and conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.</p><p><strong>Conference process: </strong>The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>The most important predictors of cirrhosis or hepatocellular carcinoma in persons who have chronic HBV are persistently elevated HBV DNA and ALT levels in blood. Other risk factors include HBV genotype C infection, male sex, older age, family history of hepatocellular carcinoma, and co-infection with HCV or HIV. The major goals of anti-HBV therapy are to prevent the development of progressive disease, specifically cirrhosis and liver failure, as well as hepatocellular carcinoma development and subsequent death. To date, no RCTs of anti-HBV therapies have demonstrated a beneficial impact on overall mortality, liver-specific mortality, or development of hepatocellular carcinoma. Most published reports of hepatitis therapy use changes in short-term virologic, biochemical, and histologic parameters to infer likelihood of long-term benefit. Approved therapies are associated with improvements in intermediate biomarkers, including HBV DNA, HBeAg loss or seroconversion, decreases in ALT levels, and improvement in liver histology (Table). Although various monitoring practices have been recommended, no clear evidence exists for an optimal approach. The most important research needs include representative prospective cohort studies to define the natural history of the disease and large RCTs of monotherapy and combined therapies, including placebo-controlled trials, that measure the effects on clinical health outcomes. Table. Criteria Useful in Determining for Whom Therapy is Indicated: Patients for whom therapy is indicated: Patients who have acute liver failure, cirrhosis and clinical complic","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"25 2","pages":"1-29"},"PeriodicalIF":0.0,"publicationDate":"2008-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27816687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}