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

{"title":"NIH consensus development statement on hydroxyurea treatment for sickle cell disease.","authors":"Otis W Brawley,&nbsp;Llewellyn J Cornelius,&nbsp;Linda R Edwards,&nbsp;Vanessa Northington Gamble,&nbsp;Bettye L Green,&nbsp;Charles E Inturrisi,&nbsp;Andra H James,&nbsp;Danielle Laraque,&nbsp;Magda H Mendez,&nbsp;Carolyn J Montoya,&nbsp;Brad H Pollock,&nbsp;Lawrence Robinson,&nbsp;Aaron P Scholnik,&nbsp;Melissa Schori","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>National Institutes of Health consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of (1) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality (AHRQ), (2) presentations by investigators working in areas relevant to the conference questions during a 2-day public session, (3) questions and statements from conference attendees during open discussion periods that are part of the public session, and (4) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the NIH or the U.S. Government.The statement reflects the panel's assessment of medical knowledge available at the time the statement was written. Thus, it provides a \"snapshot in time\" of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research.</p>","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"25 1","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2008-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27294422","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 on prevention of fecal and urinary incontinence in adults.","authors":"","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 fecal and urinary incontinence in adults.</p><p><strong>Participants: </strong>A non-DHHS, nonadvocate 15-member panel representing the fields of geriatrics, nursing, gastroenterology, obstetrics and gynecology, internal medicine, urology, general surgery, oncology, neurosurgery, epidemiology, biostatistics, psychiatry, rehabilitation medicine, environmental health sciences, and healthcare financing. 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 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>(1) Fecal incontinence and urinary incontinence will affect more than one fourth of all U.S. adults during their lives. The natural history of fecal incontinence is unknown, and the natural history of urinary incontinence over several years is not well described. (2) Fecal incontinence and urinary incontinence often have serious effects on the lives of the many individuals who suffer physical discomfort, embarrassment, stigma, and social isolation, and on family members, caregivers, and society. Financial costs are substantial and may be underestimated because of underreporting. (3) Routine episiotomy is the most easily preventable risk factor for fecal incontinence. Risk factors for both fecal and urinary incontinence include female sex, older age, and neurologic disease (including stroke). Increased body mass, decreased physical activity, depression, and diabetes may also increase risk. (4) Pelvic floor muscle training and biofeedback are effective in preventing and reversing fecal and urinary incontinence in women for the first year after giving birth, and these approaches may also prevent or reduce urinary incontinence in older women and in men undergoing prostate surgery. Fecal and urinary incontinence may be prevented by lifestyle changes, such as weight loss and exercise. (5) Efforts to raise public awareness of incontinence and the benefits of prevention and management should aim to eliminate stigma, promote disclosure and care-seeking, and reduce suffering. Organized approaches to improv","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"24 1","pages":"1-37"},"PeriodicalIF":0.0,"publicationDate":"2007-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27213292","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 on Tobacco Use: Prevention, Cessation, and Control.","authors":"","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 tobacco use: prevention, cessation and control.</p><p><strong>Participants: </strong>A non-DHHS, non-advocate 14-member panel included experts in the fields of medicine, general and pediatric psychiatry, addiction medicine, nursing, social work, population science, cancer prevention, minority health and health disparities, clinical study methodology, clinical epidemiology, and a public representative. A listing of the panel members and their institutional affiliations is included in the draft conference statement. In addition, 15 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>Tobacco use remains a very serious public health problem. Coordinated national strategies for tobacco prevention, cessation, and control are essential if the United States is to achieve the Healthy People 2010 goals. Most adult smokers want to quit, and effective interventions exist. However, only a small proportion of tobacco users try treatment. This gap represents a major national quality-of-care problem. Many cities and states have implemented effective policies to reduce tobacco use; public health and government leaders should learn from these experiences. Because smokeless tobacco use may increase in the United States, it will be increasingly important to understand net population harms related to use of smokeless tobacco. Prevention, especially among youth, and cessation are the cornerstones of strategies to reduce tobacco use. Tobacco use is a critical and chronic problem that requires close attention from health care providers, health care organizations, and research support organizations.</p>","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"23 3","pages":"1-26"},"PeriodicalIF":0.0,"publicationDate":"2006-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26580017","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 on Multivitamin/Mineral Supplements and Chronic Disease Prevention.","authors":"","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 Multivitamin/Mineral Supplements and Chronic Disease Prevention.</p><p><strong>Participants: </strong>A non-DHHS, non-advocate 13-member panel included experts in the fields of food science and human nutrition, biostatistics, biochemistry, toxicology, geriatric medicine, family medicine, pediatrics and pediatric endocrinology, cancer prevention, epidemiology, disease prevention and health promotion, and consumer protection. In addition, 19 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 an independent report of the panel and is not a policy statement of the NIH or the Federal Government.</p><p><strong>Conclusions: </strong>Use of multivitamins/minerals (MVMs) has grown rapidly over the past several decades, and dietary supplements are now used by more than half of the adult population in the United States. In general, MVMs are used by individuals who practice healthier lifestyles, thus making observational studies of the overall relationship between MVM use and general health outcomes difficult to interpret. Despite the widespread use of MVMs, we still have insufficient knowledge about the actual amount of total nutrients that Americans consume from diet and supplements. This is at least in part due to the fortification of foods with these nutrients, which adds to the effects of MVMs or single-vitamin or single-mineral supplements. Historically, fortification of foods has led to the remediation of vitamin and mineral deficits, but the cumulative effects of supplementation and fortification have also raised safety concerns about exceeding upper levels. Thus, there is a national need to improve the methods of obtaining accurate and current data on the public's total intake of these nutrients in foods and dietary supplements. In systematically evaluating the effectiveness and safety of MVMs in relation to chronic disease prevention, we found few rigorous studies on which to base clear conclusions and recommendations. Most of the studies we examined do not provide strong evidence for beneficial health-related effects of supplements taken singly, in pairs, or in combinations of three or more. Wi","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"23 2","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2006-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26580014","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 on cesarean delivery on maternal request.","authors":"","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 cesarean delivery on maternal request.</p><p><strong>Participants: </strong>A non-DHHS, nonadvocate 18-member panel representing the fields of obstetrics and gynecology, preventive medicine, biometrics, family planning and reproductive physiology, nurse midwifery, anesthesiology, patient safety, epidemiology, pediatrics, perinatal medicine, urology, urogynecology, general nursing, inner city public health sciences, law, psychiatry, and health services research. 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 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 incidence of cesarean delivery without medical or obstetric indications is increasing in the United States, and a component of this increase is cesarean delivery on maternal request. Given the tools available, the magnitude of this component is difficult to quantify. There is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request as compared to planned vaginal delivery, and more research is needed. Until quality evidence becomes available, any decision to perform a cesarean delivery on maternal request should be carefully individualized and consistent with ethical principles. Given that the risks of placenta previa and accreta rise with each cesarean delivery, cesarean delivery on maternal request is not recommended for women desiring several children. Cesarean delivery on maternal request should not be performed prior to 39 weeks of gestation or without verification of lung maturity, because of the significant danger of neonatal respiratory complications. Maternal request for cesarean delivery should not be motivated by unavailability of effective pain management. Efforts must be made to assure availability of pain management services for all women. NIH or another appropriate Federal agency should establish and maintain a Web site to provide up-to-date information on the benefits and risks of all modes of delivery.</p>","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"23 1","pages":"1-29"},"PeriodicalIF":0.0,"publicationDate":"2006-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26616171","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 on manifestations and management of chronic insomnia in adults.","authors":"","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 manifestations and management of chronic insomnia in adults.</p><p><strong>Participants: </strong>A non-DHHS, non-advocate 12-member panel representing the fields of psychology, psychiatry, neuroscience, anesthesiology, sleep disorders, geriatric medicine, epidemiology, health services research, nursing, and community medicine. In addition, 19 experts from fields related to the subject matter of the conference presented data to the panel and to the conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the medical literature prepared by the University of Alberta Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience.</p><p><strong>Conference process: </strong>Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://www.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. This statement and all past statements from the NIH Consensus Development Program are available at the same web address of http://www.consensus.nih.gov.</p><p><strong>Conclusions: </strong>Chronic insomnia is a major public health problem affecting millions of individuals, along with their families and communities. Little is known about the mechanisms, causes, clinical course, comorbidities, and consequences of chronic insomnia. Evidence supports the efficacy of cognitive-behavioral therapy and benzodiazepine receptor agonists in the treatment of this disorder, at least in the short term. Very little evidence supports the efficacy of other treatments, despite their widespread use. Moreover, even for those treatments that have been systematically evaluated, the panel is concerned about the mismatch between the potential lifelong nature of this illness and the longest clinical trials, which have lasted 1 year or less. A substantial public and private research effort is warranted, including developing research tools and conducting longitudinal studies of randomized clinical trials. Finally, there is a major need for educational programs directed at physicians, health care providers, and the public.</p>","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"22 2","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2005-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26616163","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 on management of menopause-related symptoms.","authors":"","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 menopause-related symptoms.</p><p><strong>Participants: </strong>A non-DHHS, nonadvocate 12-member panel representing the fields of obstetrics and gynecology, general internal medicine, endocrinology, rheumatology, family and health psychology, geriatric medicine, health services research, demography, biochemistry, epidemiology, clinical research, and biostatistics. In addition, 26 experts in fields related to the conference topic presented data to the panel and to the conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the medical literature prepared by the Oregon Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience.</p><p><strong>Conference process: </strong>Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and 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. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://consensus.nih.gov.</p><p><strong>Conclusions: </strong>Menopause is the permanent cessation of menstrual periods that occurs naturally in women, usually in their early 50s. Many women have few or no symptoms; these women are not in need of medical treatment. Premenopausal or perimenopausal women who have menopause induced by surgery, chemotherapy, or radiation are more likely to experience bothersome and even disabling symptoms. These women need safe and effective treatment. It is difficult to differentiate those symptoms that are truly associated with menopause from those due to aging. Hot flashes, night sweats, and vaginal dryness are clearly tied to the menopausal transition, and there is some positive evidence of a menopausal link for sleep disturbance. Vasomotor symptoms are reported with high frequency during the menopausal transition. Estrogen, either by itself or with progestins, is the most consistently effective therapy for these symptoms. However, the Women's Health Initiative (WHI) has identified important risk factors associated with use of these therapies. Decision making for women regarding treatment for menopausal symptoms requires personal knowledge and balancing of these risks. There are many potential alternatives to est","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"22 1","pages":"1-38"},"PeriodicalIF":0.0,"publicationDate":"2005-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26616164","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 on manifestations and management of chronic insomnia in adults.","authors":"","doi":"10.1176/foc.7.4.foc538","DOIUrl":"https://doi.org/10.1176/foc.7.4.foc538","url":null,"abstract":"OBJECTIVE To provide health care providers, patients, and the general public with a responsible assessment of currently available data on manifestations and management of chronic insomnia in adults. PARTICIPANTS A non-DHHS, non-advocate 12-member panel representing the fields of psychology, psychiatry, neuroscience, anesthesiology, sleep disorders, geriatric medicine, epidemiology, health services research, nursing, and community medicine. In addition, 19 experts from fields related to the subject matter of the conference presented data to the panel and to the conference audience. EVIDENCE Presentations by experts and a systematic review of the medical literature prepared by the University of Alberta Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience. CONFERENCE PROCESS Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://www.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. This statement and all past statements from the NIH Consensus Development Program are available at the same web address of http://www.consensus.nih.gov. CONCLUSIONS Chronic insomnia is a major public health problem affecting millions of individuals, along with their families and communities. Little is known about the mechanisms, causes, clinical course, comorbidities, and consequences of chronic insomnia. Evidence supports the efficacy of cognitive-behavioral therapy and benzodiazepine receptor agonists in the treatment of this disorder, at least in the short term. Very little evidence supports the efficacy of other treatments, despite their widespread use. Moreover, even for those treatments that have been systematically evaluated, the panel is concerned about the mismatch between the potential lifelong nature of this illness and the longest clinical trials, which have lasted 1 year or less. A substantial public and private research effort is warranted, including developing research tools and conducting longitudinal studies of randomized clinical trials. Finally, there is a major need for educational programs directed at physicians, health care providers, and the public.","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"17 1","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87689688","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 on improving end-of-life care.","authors":"","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 improving end-of-life care.</p><p><strong>Participants: </strong>A non-DHHS, non-advocate ten-member panel representing the fields of geriatrics, psychiatry, economics, health policy, nursing, philosophy, epidemiology, and oncology. In addition, 19 experts from fields related to the subject matter of the conference presented data to the panel and to the conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the medical literature prepared by the Southern California Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience.</p><p><strong>Conference process: </strong>Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://www.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. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://www.consensus.nih.gov.</p><p><strong>Conclusions: </strong>(1) Circumstances surrounding end of life are poorly understood, leaving many Americans to struggle through this life event. (2) The dramatic increase in the number of older adults facing the need for end-of-life care warrants development of a research infrastructure and resources to enhance that care for patients and their families. (3) Ambiguity surrounding the definition of end-of-life hinders the development of science, delivery of care, and communications between patients and providers. (4) Current end-of-life care includes some untested interventions that need to be validated. (5) Subgroups of race, ethnicity, culture, gender, age, and disease states experience end-of-life care differently, and these differences remain poorly understood. (6) Valid measures exist for some aspects of end of life; however, measures have not been used consistently or validated in diverse settings or with diverse groups. (7) End-of-life care is often fragmented among providers and provider settings, leading to a lack of continuity of care and impeding the ability to provide high-quality, interdisciplinary care. (8) Enhanced communication among patients, families, and providers is crucial to high-quality end-of-life care. (9) The design of the current Medicare hospice benefit limits the availability of the full ran","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"21 3","pages":"1-26"},"PeriodicalIF":0.0,"publicationDate":"2004-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26616162","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 on preventing violence and related health-risking social behaviors in adolescents.","authors":"","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 preventing violence and related health-risking social behaviors in adolescents.</p><p><strong>Participants: </strong>A non-DHHS, non-advocate 13-member panel representing the fields of community and family medicine, pediatrics, nursing, psychiatry, behavioral health, economics, juvenile justice, outcomes research, and a public representative. In addition, 21 experts in fields pertaining to the conference topic presented data to the panel and to the conference audience.</p><p><strong>Evidence: </strong>Presentations by experts and a systematic review of the scientific literature related to youth violence prevention provided by the Southern California Evidence-Based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience.</p><p><strong>Conference process: </strong>Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and 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. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://consensus.nih.gov.</p><p><strong>Conclusions: </strong>The panel highlights the following findings and recommendations: (1) Violence affects all of us at some level and represents an issue of vital national and international importance; (2) Some interventions have been shown by rigorous research to reduce violence precursors, violence, and arrest. However, many interventions aimed at reducing violence have not been sufficiently evaluated or proven effective, and a few widely implemented programs have been shown to be ineffective and perhaps harmful; (3) Programs that seek to prevent violence through fear and tough treatment appear ineffective. Intensive programs that aim at developing skills and competencies can work; (4) Interventions to reduce violence may be context dependent. Research must proceed in varying contexts and take account of local culture; (5) Attention to diversity among investigators involved in violence prevention research is important. Universities and funding agencies should make improving the situation a priority; (6) We encourage funding sufficient to promote the dissemination of violence prevention programs that have been shown to be effective through rigorous RCT research. Funding must include support","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"21 2","pages":"1-34"},"PeriodicalIF":0.0,"publicationDate":"2004-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26616167","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}