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

{"title":"NIH Consensus Development Conference on Celiac Disease.","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 regarding celiac disease.</p><p><strong>Participants: </strong>A non-DHHS, non-advocate 13-member panel representing the fields of internal medicine, gastroenterology, medical genetics, pathology, endocrinology, nutrition, and a consumer representative. In addition, 19 experts in related fields presented data to the panel and to the conference audience.</p><p><strong>Evidence: </strong>Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of celiac disease research papers, prepared by the National Library of Medicine. 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.</p><p><strong>Conclusions: </strong>Celiac disease is an immune-mediated intestinal disorder with protean manifestations. Celiac disease is common, affecting 0.5 to 1.0 percent of the general population of the United States, but is greatly underdiagnosed. There are now specific and sensitive serologic tests available to aid in diagnosis that need to be more widely applied. The treatment of celiac disease remains a lifelong gluten-free diet, which results in remission for most individuals. The classic presentation of diarrhea and malabsorption is less common, and atypical and silent presentations are increasing. Most individuals are being seen by primary care providers and a broad range of specialists. Therefore, heightened awareness of this disease is imperative. Education of physicians, registered dietitians, and other health providers is needed. The panel recommends the following: (1) Education of physicians, dietitians, nurses, and the public about celiac disease by a trans-National Institutes of Health (NIH) initiative, to be led by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), in association with the Centers for Disease Control and Prevention; (2) Standardization of serologic tests and pathologic criteria for the diagnosis of celiac disease; (3) Adoption of a standard definition of a gluten-free diet based on objective evidence such as that being developed by the American Dietetic Association; (4) Development of an adequate testing procedure for gluten in foods and def","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"21 1","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"2004-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26616169","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 Statement on total knee replacement.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding total knee replacement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A non-DHHS, non-advocate 11-member panel representing the fields of orthopaedics, rheumatology, internal medicine, nursing, physical therapy, rehabilitation, biostatistics, epidemiology, and health services research, as well as a TKR patient. In addition, 21 experts in related fields presented data to the panel and to the conference audience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence: &lt;/strong&gt;Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of total knee replacement research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conference process: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The success of primary TKR in most patients is strongly supported by more than 20 years of followup data. There appears to be rapid and substantial improvement in the patient's pain, functional status, and overall health-related quality of life in about 90 percent of patients; about 85 percent of patients are satisfied with the results of surgery. Short-term outcomes, as documented by functional outcome scales, are generally substantially improved after TKR. Functional outcome is improved after TKR for people across the spectrum of disability status. Technical factors in performing surgery may influence both the short- and long-term success rate. There is consensus regarding the following perioperative interventions that improve TKR outcomes: systemic antibiotic prophylaxis, aggressive postoperative pain management, perioperative risk assessment and management of medical conditions, and preoperative education. Revision TKR is done to alleviate pain and improve function. Contraindications for revision TKR include persistent infection, poor bone quality, highly limited quadriceps or extensor function, poor skin coverage, and poor vascular status. Results are not as good as with primary TKR; outcomes are better for aseptic loosening than for infections. Failed revisions require a salvage procedure (resection of arthroplasty, arthrodesis, or amputation), with inferior results compared with revision TKR. Fac","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"20 1","pages":"1-34"},"PeriodicalIF":0.0,"publicationDate":"2003-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26616165","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 Statement on symptom management in cancer: pain, depression, and fatigue.","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 regarding management of cancer symptoms such as pain, depression, and fatigue.</p><p><strong>Participants: </strong>A non-Federal, non-advocate, 13-member panel representing the fields of psychiatry, nursing, social work, medical oncology, pediatric oncology, epidemiology, pharmacology, radiation oncology, and the public. In addition, experts in these same fields presented data to the panel and to a conference audience of approximately 300.</p><p><strong>Evidence: </strong>Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of cancer symptom management research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience.</p><p><strong>Conference process: </strong>Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the 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 at the end of the conference. The statement was made available on the World Wide Web at http://consensus.nih.gov immediately after the conference. 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>Too many cancer patients with pain, depression, and fatigue receive inadequate treatment for their symptoms. Clinicians should use brief assessment tools routinely to ask patients about pain, depression, and fatigue and to initiate evidence-based treatments. Current evidence to support the concept of cancer symptom clusters is insufficient, and additional theoretically driven research is warranted. Research is needed on the definition, occurrence, assessment, and treatment of pain, depression, and fatigue alone and together through adequately funded prospective studies. Fear of cancer and its consequences must be ameliorated. All patients with cancer should have optimal symptom control from diagnosis throughout the course of illness, irrespective of personal and cultural characteristics. The state of the science in cancer symptom management should be reassessed periodically.</p>","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"19 4","pages":"1-29"},"PeriodicalIF":0.0,"publicationDate":"2002-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24411847","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 Statement on Management of Hepatitis C: 2002.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding the management and treatment of hepatitis C.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A non-Federal, nonadvocate, 12-member panel representing the fields of infectious diseases, gastroenterology, medical oncology, molecular genetics, geriatrics, internal medicine, and the public. In addition, experts in these same fields presented data to the panel and to a conference audience of approximately 300.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence: &lt;/strong&gt;Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of hepatitis C research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conference process: &lt;/strong&gt;Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the experts and the audience for comment. The panel then met in executive session to consider these comments and released a revised statement at the end of the conference. The statement was made available on the World Wide Web at http://consensus.nih.gov immediately after the conference. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The incidence of newly acquired hepatitis C infection has diminished in the United States. This decline is largely due to a decrease in cases among IDUs for reasons that are unclear and, to a lesser extent, to testing of blood donors for HCV. The virus is transmitted by blood and such transmission now occurs primarily through injection drug use, sex with an infected partner or multiple partners, and occupational exposure. The majority of infections become chronic, and therefore the prevalence of HCV infections is high, with about 3 million Americans now estimated to be chronically infected. HCV is a leading cause of cirrhosis, a common cause of HCC and the leading cause of liver transplantation in the United States. The disease spectrum associated with HCV infection varies greatly. Various studies have suggested that 3 to 20 percent of chronically infected patients will develop cirrhosis over a 20-year period, and these patients are at risk for HCC. Persons who are older at the time of infection, patients with continuous exposure to alcohol, and those co-infected with HIV or HBV demonstrate accelerated progression to more advanced liver disease. Conversely, individuals infected at a younger age have little or no disease progression over several decades. The diagnosis of chronic hepatitis C infection is often suggested by abnorm","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"19 3","pages":"1-46"},"PeriodicalIF":0.0,"publicationDate":"2002-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24208861","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 statement on management of the clinically inapparent adrenal mass (\"incidentaloma\").","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding the management of clinically inapparent adrenal masses (\"incidentalomas\").&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A non-Federal, nonadvocate, 12-member panel representing the fields of medicine, surgery, endocrinology, pathology, biostatistics, epidemiology, radiology, oncology, and the public. In addition, experts in these same fields presented data to the panel and to a conference audience of approximately 300.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence: &lt;/strong&gt;Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of incidentaloma research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conference process: &lt;/strong&gt;Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the experts and the audience for comment. The panel then met in executive session to consider these comments and released a revised statement at the end of the conference. The statement was made available on the World Wide Web at http://consensus.nih.gov immediately after the conference. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The management of clinically inapparent adrenal masses is complicated by limited studies of incidence, prevalence, and natural history, including the psychologic impact on the patient who is informed of the diagnosis. Improvements in the resolution of abdominal imaging techniques combined with increased use of abdominal imaging suggest that the prevalence of clinically inapparent adrenal masses will continue to escalate. The low prevalence of adrenal cortical carcinomas and the relatively low incidence of progression to hyperfunction call into question the advisability of the current practice of intense, long-term clinical followup of this common condition. All patients with an incidentaloma should have a 1-mg dexamethasone suppression test and a measurement of plasma-free metanephrines. Patients with hypertension should also undergo measurement of serum potassium and plasma aldosterone concentration/plasma renin activity ratio. A homogeneous mass with a low attenuation value (less than 10 HU) on CT scan is likely a benign adenoma. Surgery should be considered in all patients with functional adrenal cortical tumors that are clinically apparent. All patients with biochemical evidence of pheochromocytoma should undergo surgery. Data are insufficient to indicate the superiority of a surgical or nonsurgical appro","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"19 2","pages":"1-25"},"PeriodicalIF":0.0,"publicationDate":"2002-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24200699","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 statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding the use of endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A non-Federal, non-advocate, 13-member panel representing the fields of gastroenterology, hepatology, clinical epidemiology, oncology, biostatistics, surgery, health services research, radiology, internal medicine, and the public. In addition, experts in these same fields presented data to the panel and to a conference audience of approximately 300.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence: &lt;/strong&gt;Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of ERCP research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conference process: &lt;/strong&gt;Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the experts and the audience for comment. The panel then met in executive session to consider these comments and released a revised statement at the end of the conference. The statement was made available on the World Wide Web at http://consensus.nih.gov immediately after the conference. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In the diagnosis of choledocholithiasis, magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and ERCP have comparable sensitivity and specificity. Patients undergoing cholecystectomy do not require ERCP preoperatively if there is low probability of having choledocholithiasis. Laparoscopic common bile duct exploration and postoperative ERCP are both safe and reliable in clearing common bile duct stones. ERCP with endoscopic sphincterotomy (ES) and stone removal is a valuable therapeutic modality in choledocholithiasis with jaundice, dilated common bile duct, acute pancreatitis, or cholangitis. In patients with pancreatic or biliary cancer, the principal advantage of ERCP is palliation of biliary obstruction when surgery is not elected. In patients who have pancreatic or biliary cancer and who are surgical candidates, there is no established role for preoperative biliary drainage by ERCP. Tissue sampling for patients with pancreatic or biliary cancer not undergoing surgery may be achieved by ERCP, but this is not always diagnostic. ERCP is the best means to diagnose ampullary cancers. ERCP has no role in the diagnosis of acute pancreatitis except when biliary pancreatitis is suspected. In patients with severe biliary pancreati","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"19 1","pages":"1-26"},"PeriodicalIF":0.0,"publicationDate":"2002-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24200701","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 Statement on symptom management in cancer: pain, depression, and fatigue.","authors":"Marcia Zorn, J. Rowland, C. Varricchio","doi":"10.1037/e584932011-001","DOIUrl":"https://doi.org/10.1037/e584932011-001","url":null,"abstract":"OBJECTIVE To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding management of cancer symptoms such as pain, depression, and fatigue. PARTICIPANTS A non-Federal, non-advocate, 13-member panel representing the fields of psychiatry, nursing, social work, medical oncology, pediatric oncology, epidemiology, pharmacology, radiation oncology, and the public. In addition, experts in these same fields presented data to the panel and to a conference audience of approximately 300. EVIDENCE Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of cancer symptom management research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience. CONFERENCE PROCESS Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the 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 at the end of the conference. The statement was made available on the World Wide Web at http://consensus.nih.gov immediately after the conference. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. CONCLUSIONS Too many cancer patients with pain, depression, and fatigue receive inadequate treatment for their symptoms. Clinicians should use brief assessment tools routinely to ask patients about pain, depression, and fatigue and to initiate evidence-based treatments. Current evidence to support the concept of cancer symptom clusters is insufficient, and additional theoretically driven research is warranted. Research is needed on the definition, occurrence, assessment, and treatment of pain, depression, and fatigue alone and together through adequately funded prospective studies. Fear of cancer and its consequences must be ameliorated. All patients with cancer should have optimal symptom control from diagnosis throughout the course of illness, irrespective of personal and cultural characteristics. The state of the science in cancer symptom management should be reassessed periodically.","PeriodicalId":86986,"journal":{"name":"NIH consensus and state-of-the-science statements","volume":"16 1","pages":"1-29"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78865115","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}